Scotland's Baby Box pilot: qualitative research

1 Introduction and methods

Background to Scotland's Baby Box scheme

1.1 Scotland's Baby Box scheme is a Scottish Government initiative to provide a free Baby Box for all babies due in Scotland from 15 August 2017 onwards. The baby can sleep in the box itself - it is made of sturdy cardboard and includes a mattress with protector, a fitted sheet and a cellular blanket. The Box includes a range of products for a baby's first weeks and months, including clothes, baby care items, books and a play mat.

Origins and aims

1.2 Scotland's Baby Box aims to promote a fair and equal start for all children and to aid in achieving the best possible outcomes for children. It is also intended to provide a safe space for babies to sleep near their parents, to promote bonding and early attachment. ^[1] The idea for a universal Baby Box scheme originated in Finland, where similar baby boxes were introduced by the government in 1938, initially for low-income pregnant women and subsequently for all. Uptake of the box in Finland is near universal (around 95%).

1.3 The Scottish Government's brief for this research described expected benefits from introducing the scheme in Scotland including:

• Reducing socio-economic inequalities by ensuring every family with a newborn has access to essential items, and
• Informing parental behaviours that will positively impact on outcomes for the child, including safe sleeping practices, attachment and parent-child interaction.

1.4 Ensuring that 'our children have the best start in life and are ready to succeed' is one of the Scottish Government's key National Outcomes. ^[2] The Baby Box scheme is part of a range of Scottish Government initiatives intended to strengthen support for new parents, babies and children, including the provision of state-funded early learning and childcare and investing in support for new parents (for example, the Family Nurse Partnership programme and the expansion of health visiting services, which includes the Enhanced Health Visitor Pathway).

The Baby Box pilot

1.5 The Scottish Government will roll-out the Baby Box scheme across Scotland from 15 August 2017. In order to inform this roll-out, it carried out a three-month pilot between January and March 2017 in two local authority areas: Clackmannanshire and Orkney. Orkney and Clackmannanshire were selected for the pilot in part because of their different geographic and demographic profiles. Orkney's geography made it a useful test of potential delivery challenges in Scotland's more remote areas, while Clackmannanshire includes a diverse mix of deprived and affluent areas, providing a test of how families in different circumstances react to the Baby Box.

1.6 All pregnant women in those two local authorities with a due date in the three-month period from 1 January to 31 March 2017 were eligible to receive a Baby Box. In total, 160 boxes were despatched to families during the pilot period - 49 to Orkney and 111 to Clackmannanshire.

1.7 Figure 1, below, shows the profile of families who received boxes during the pilot by area deprivation (as measured by the Scottish Index of Multiple Deprivation ( SIMD) ^[3] ). The pattern largely reflects differences in the overall profile of the two areas - Orkney does not include any areas that fall into the most deprived quintile of areas in Scotland, while most of Clackmannanshire's datazones are found in the middle and more deprived quintiles. ^[4,5]

Figure 1.1 Distribution of families receiving a pilot baby box by SIMD

Base: all families who received a pilot box for whom data was provided.
n = 153 (out of 160 who received a box) (Orkney =44; Clackmannanshire = 109).

Data provided by APS Group (Scotland) Ltd.

Research aims and methods

1.8 The Scottish Government commissioned Ipsos MORI Scotland to carry out qualitative research on the Baby Box pilot in order to inform the development and roll-out of the Baby Box scheme in Scotland. The research focused on the process of registering for and receiving the box, parental views and uses for the box and its contents, and providing initial insights into potential benefits.

1.9 The research involved in-depth interviews with:

• 34 families who had received a pilot box (13 in Orkney, 21 in Clackmannanshire). This included 31 individual interviews and one informal small group interview, conducted with pilot parents attending a baby massage class. Where possible the research team asked to speak to both parents together, but in practice most interviews were with mothers (4 interviews in Clackmannanshire were with both parents).
• 8 midwives (5 in Orkney and 3 in Clackmannanshire ^[6] ) involved in registering parents for the scheme in the two pilot areas, and
• 3 health visitors (all in Clackmannanshire) working with families who had received pilot boxes
• 2 members of staff at APS (the Scottish Government's contractors for providing Baby Boxes).

1.10 Fourteen pilot families (including 8 who had been interviewed individually previously and 6 additional families) also contributed to an online forum about the scheme, run using Ipsos MORI's 'qualspace' platform.

1.11 Families were recruited to the research by Ipsos MORI using contact details received either from midwives (for parents with due dates in January) or from APS (where a completed registration card for the scheme indicated they were willing to be contacted for research). In addition to recruiting families from both Orkney and Clackmannanshire, the research team also selected families to ensure the sample included parents from both more and less deprived areas, and both first time parents and parents who already had other children. ^[7]

1.12 Families, midwives and health visitors were interviewed (either face-to-face or by phone) ^[8] by researchers from Ipsos MORI using a flexible topic guide to ensure key issues were covered with each participant (see Appendix A for details). Interviews were audio-recorded and detailed notes were made after each interview, summarising views on key topics. These notes were systematically reviewed to identify the full range of views expressed.

Scope and limitations of the research

1.13 This research provides evidence on: how a sample of parents view and use the pilot boxes; how the logistics and contents could be improved for national roll-out; and what, if any, impacts parents and professionals perceive the box to have.

1.14 Qualitative samples are designed to ensure that a range of different views and experiences are captured. It is not appropriate to draw conclusions from qualitative data about the prevalence of particular views or experiences. As such, quantifying language, such as 'all', 'most' or 'a few' is avoided as far as possible when discussing qualitative findings in this report.

1.15 The short timeframe and relatively small scale of Scotland's Baby Box pilot meant that it was not possible to design a study that could robustly assess the impact of Baby Boxes on outcomes for children and families.

Report structure and conventions

1.16 The remainder of this report is structured as follows:

• Chapter 2 outlines parents' and health professionals' reactions to the overall concept of the Scottish Baby Box
• Chapter 3 summarises findings on parents' and health professionals' views of the implementation of the Baby Box pilot, including the registration process, delivery process, and contents of the pilot boxes
• Chapter 4 outlines views on the potential impacts of the Baby Box scheme on the key health and social outcomes the scheme hopes to influence: safe sleeping; parent-child interactions; and socio-economic inequality.
• Chapter 5 summarises the key conclusions and discusses implications for the roll-out of the scheme.

1.17 Each of Chapters 2 to 4 is prefaced by a boxed summary of key points and ends with a brief summary of implications for policy.

Reporting conventions

1.18 Direct quotations from participants are included in italics, to illustrate and clarify findings as appropriate.