A realist evaluation of the enhanced health visiting service in NHS Ayrshire and Arran

5 What did parents say?

5.1 This chapter presents the findings of how the programme works in practice from parents' perspective (phase 2), based on the assumptions outlined in the logic model. Overall, five key themes were identified.

Support provided by health visitors

5.2 Parents highly appreciated the support provided by health visitors. They felt that the increased, structured home visiting made it possible for them to receive more support both for themselves and their children.

I think it's definitely improved since I've had my current child. This past year, I've had a lot of support because I went through postnatal depression with her and they (health visitors) were there supporting me as much as they could, type thing. In 2005 when I had my first one, I was just left. I mean, I had no support whatsoever (P16).

5.3 The enhanced, structured home visiting programme ensured that families who required additional support also received them. The few families that have required the service affirmed this.

I'm getting more visits just now for, like, medical reasons… (P21).

5.4 Parents found the option of contacting health visitors by phone in the absence of drop-in clinics quite positive and reassuring.

…they always say, well if you get any other problems, just give us a call. So it's quite nice (P16).

5.5 Thus, if parents needed further support the opportunity to gain access to health visitors by phone seemed important.

Home visiting versus drop-in clinics

5.6 Almost all the parents acknowledged that the home visiting was hugely beneficial. They felt that health visitors gave them more attention, which was important in terms of discussing issues in depth.

They don't just rush in, like, let's get the baby weighed. They don't do that anymore, because they did that when I had my first one. It was, kind of like, in to do what they need to do and then go. Whereas now, it's kind of, how are you doing? (P16).

5.7 This was even evident among parents who had previously experienced the drop-in clinics.

It's quite personal I suppose but if they come into your house you can open up a bit more whereas if you come to the clinic and there's a big queue of people behind you waiting, you always think right I'm just gonna go in and get them weighed and go, but actually you want to discuss other things with them (P12).

5.8 However, a third of the parents who had previously experienced the drop-in clinics also stated that they missed attending them.

He's had the amount of visits like he's meant to have with this new thing, but as I say, I do prefer if I could go down to the clinic (P13).

5.9 Amongst those who said they missed the drop-in clinics, aspects of the drop-in clinics which engendered such sentiments included opportunity of weighing the baby on a more regular basis, and meeting and receiving advice from other parents.

I loved it (drop-in clinics). See when my oldest son - he's 11 - when he was born it was great because you met other mums. I was young when I had him so I didn't really know anybody so it was great to try and get advice off other mums, and then with my youngest, when they were saying they were closing it I was kind of…because it was good to meet other folks when you were there (P4).

Health visitor-parent relationship

5.10 Continuity of care where care is provided by the same person for all or most, planned episodes of care has the potential to build trust between a practitioner and a client. With the enhanced, structured home visiting programme, a health visitor is expected to fulfil the entire timeline with a family. In this study, very few parents mentioned that they had visits from a single health visitor. Yet, they felt that this did not influence their relationships with the health visitors. A common reason given as to why they have had different health visitors was because the substantive health visitor was on annual leave.

5.11 All the parents, with the exception of two, felt that the timeline promotes continuity of care and yields better relationships with health visitors.

I would say the relationship has been probably better for my current child because it's been continuously the same person whereas with first child it was just whoever did the clinic that morning (P14).

5.12 Of the two who had not had a good relationship with health visitors, one had two different health visitors and was unable to establish a rapport with either of them. The other, although, has had the same health visitor, felt that the relationship had been poor after the health visitor failed to consider her views during assessment.

5.13 However, those parents who established trusting relationships with health visitors, also added that the health visitor will be their first point of contact if they were concerned about any developmental or weight related issues as described below.

If it was concerns about development or weight or things, I would phone them first (P14).

Reflections on the universal timeline

5.14 Many parents expressed a greater awareness of the service they now receive from health visitors. They commented that the timeline was a great deal better than the previous service. They were almost universally positive about the increased home visiting. For instance, comments akin to the one below were not unusual.

It's been great! I'd say more so, that they've been more involved with my third baby I've felt than with the last two. I felt that they were more wanting to come out and see you more than just going to the drop-in clinic (P4).

5.15 It also appeared that additional number of visits were offered to parents who required them.

He was two months early, so he was in the hospital for a month basically. When he first got home, we had quite a lot of visits (P22).

5.16 However, a few parents felt that gaps in between visits could be improved. One such case was a first time mother who felt that a six months gap between her previous visit and the coming one was a bit too wide.

Like I said, from six months to 12 months there seems to be a big gap there, because I think that although I've got an appointment with the doctor which is quite good I suppose, but it's not the health visitor service (P2).

5.17 As well as the six to 12 months gap, there is also another wide gap between the 12 to 27-30 months' assessment visits. It appeared that first time mothers were particularly concerned about these gaps.

Assessment and engaging with wider services

5.18 Generally, parents reported that their views were considered as part of their children's assessment. However, only one parent felt that a health visitor disregarded her opinion when assessing her child and this was repeated later when she had her own assessment.

5.19 Almost all the parents felt that the timeline has facilitated the process of engaging early with wider services. They indicated that health visitors were very helpful in terms of assisting them to access services both for themselves and their children.

The way that I've been feeling the past few month, you know, the way I've been feeling down and everything as well. You know, she's helped and got me that appointment at the doctor and everything and I've started feeling a lot better now (P20).