Scotland's Baby Box pilot: qualitative research

5 Conclusions

5.1 This report has presented findings from qualitative research with parents and professionals on their experience and views of Scotland's Baby Box pilot. In this final chapter, we return to the aims of the research - to inform the development and roll-out of the Baby Box scheme across Scotland and to provide initial insights into its benefits - and draw out key conclusions and implications for the further development of the scheme.

Improving the scheme for national roll-out

5.2 The Scottish Government will roll out the Baby Box scheme across Scotland from 15 August 2017. A key aim of this research was to identify potential improvements to the process and contents prior to roll-out. Indeed, the Scottish Government has already decided on some changes to the contents of the box and delivery processes, informed in part by early feedback from this research.

Contents

5.3 The Scottish Baby Box pilot boxes were generally received extremely positively in terms of parents' responses to the range and quality of items. While parents commented on items they considered more or less useful and on a couple of items where the quality might be improved, overall the contents of the box appeared to exceed their expectations.

5.4 The main area where there was disagreement among both parents and health professionals related to what, if any, health promotion-related information should accompany the box. There is arguably no easy answer as to the 'right' amount of information to include - too much information may be overwhelming or ignored, while too little could be viewed as a missed opportunity to communicate key health messages via a universal scheme. However, the degree of debate this issue attracted suggests that it may require some further consideration in advance of roll-out and should be kept under review as the scheme progresses. In considering how to strike a balance in this respect, the suggestion made by a health visitor interviewed for this research may be helpful: that the key is making clear the purpose of the box and concentrating any information or health messaging on that.

Logistics

5.5 As the implementation of the Baby Box pilot differed in a number of respects from plans for the full roll-out of the scheme, it will be particularly important to monitor any implementation issues in the early months of roll-out, including any issues related to:

• how timings for registration and delivery are working in practice (given that these will both be earlier than in the pilot)
• the effectiveness of the registration process (including whether midwives are returning the cards, as intended, or giving them to parents to

complete and return as sometimes happened during the pilot, and whether any changes to the registration card are resulting in more accurate completion)

• automated processes for keeping parents informed about delivery plans
• processes for ensuring that parents that are harder to reach are being registered for baby boxes.

5.6 Given the relatively small scale of the pilot, there are also a number of logistical issues that were not tested and which it will again be important to review in the early months of roll-out, including:

• any additional delivery issues that might arise in large urban centres - for example, issues around delivering to tenements with narrow stairs
• how data is collated and quality assured once far larger numbers of parents are registering for the boxes, to ensure accuracy and usability for verification, delivery and future monitoring and evaluation purposes.

Communication

5.7 Both parents and health professionals interviewed for the pilot expressed a desire for more information about the Baby Box scheme. The fact that the universal roll-out of the scheme divided opinion among both parents and health professionals reinforces the need to effectively communicate the rationale for the scheme, in addition to disseminating more general information about the contents, timing and logistics of registering for and receiving a box.

5.8 Given the pivotal role of midwives in registering parents for the scheme, it will be important to ensure midwives feel confident in introducing the scheme as it is rolled-out, and to better understand what information they need to feel confident. While health visitors did not express a desire to have a more formal role in the Baby Box scheme, providing them, and other professionals involved with families, with information about the scheme could enable them to encourage families to get the most out of their Baby Boxes.

Maximising the benefits of Baby Boxes

5.9 The Scottish Government intends the Baby Box scheme to have a positive impact on reducing socio-economic inequalities and informing parental behaviours known to have a positive impact on child outcomes, including safe sleeping and positive parent-child interactions. As discussed elsewhere in this report, the timeframe and scale of the pilot meant that this research could not robustly assess whether or not the scheme has had these impacts - doing so requires longer-term, larger-scale evaluation. However, based on the experiences and perceptions of pilot parents, it is nonetheless possible to identify both areas where the scheme has the potential to have an impact, and possible barriers to it doing so. Where possible, taking steps to increase the former and address the latter should help maximise the possible benefits of the scheme.

5.10 In particular, the findings suggest a need to consider how to maximise the scope for the scheme to impact on safe sleeping. To do so requires improvements in clear communication about which elements of the box and its contents could contribute to safe sleeping and what key safe sleeping practices should be applied, regardless of whether parents are using the box or an alternate sleep space. While the pilot box itself did include some such guidance (on the inside lid of the box) and parents received a leaflet directing them to the Ready Steady Baby Application, the findings of this research suggest there may be a need to review whether this could be enhanced or communicated more effectively to parents.

5.11 Parents also identified cultural barriers to, and some practical concerns about, use of the box as a sleep space, which will need to be overcome if the box itself is to have a widespread impact on sleeping practice. While cultural barriers may erode over time, as more families receive the boxes and try using it for sleeping, this is not inevitable and there may still be some merit in considering how the benefits of using the box for sleeping are communicated.

5.12 The impact of the box's contents on parent-child interaction and socio-economic inequalities raise wider questions around whether universalism or targeting resources is the most effective way of achieving these outcomes. This research suggests that, for some parents, receiving baby boxes may have a positive impact on both their finances and aspects of their behaviour, for example by encouraging them to read with their baby earlier. However, other parents viewed the impact as much more limited, indicating that the box largely duplicated their existing material resources and has not had much, if any, impact on their knowledge of child health or parenting issues.

5.13 In terms of maximising the potential impact of the Baby Box scheme on socio-economic inequalities, the research suggests a need to:

• Ensure earlier communication of the contents of the box (as is planned when it is rolled out), and
• Ensure that parents who may be more vulnerable are definitely registering to receive it (something that should be monitored as the box is rolled out).

Conclusion

5.14 This research has identified a range of potential benefits from Scotland's Baby Box, as well as areas for improvement to improve the chances of those benefits being achieved. As the scheme is rolled-out nationally, maximising the potential benefits of the scheme will require a combination of careful monitoring (to ensure known challenges are successfully overcome and that any new challenges are identified and addressed) and longer-term evaluation to more robustly assess impact.