Realist evaluation of an enhanced health visiting programme

Doi, Lawrence; Jepson, Ruth; Hardie, Samantha

doi:10.1371/journal.pone.0180569

Cited by 16 publications

(12 citation statements)

References 22 publications

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“…The Australian healthcare system provides universal health services to promote child health and development and to support parents with young children. This is parallel to universal provision in New Zealand (Fraser, Grant, & Mannix, ), Britain (Cowley et al, ; Doi, Jepson, & Hardie, ), the Netherlands (Turley, Vanek, Johnston, & Archibald, ), and Sweden (Edvardsson et al, ; Fägerskiöld & Ek, ). Similarly, the Australian system aims to assist all preschool aged children to achieve optimal outcomes, while ensuring that children and families with more specific needs receive additional support (Fraser et al, ; Schmied, Fowler, Rossiter, Homer, & Kruske, ).…”

Section: Introductionmentioning

confidence: 91%

Australian parents’ use of universal child and family health services: A consumer survey

Rossiter

Fowler

Hesson

et al. 2018

Health Soc Care Community

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This study aimed to explore Australian parents’ use of universally available well‐child health services. It used an online survey of 719 parents of children aged from birth to 5 years in all states and territories to examine patterns of service use and consumer preferences. In Australia, several health professional groups provide advice to pregnant women, infants, children, and parents, offering health promotion, developmental screening, parenting support, and referral to specialist health services if required. The survey examined parents’ use of different child and family health providers, and their preferences for support with several common parenting issues. The study indicated that families with young children obtain primary healthcare from a range of service providers, often more than one, depending on children's ages and needs. Parents frequently visit general practitioners for immunisation and medical concerns. They attend dedicated child and family health nurses for parenting advice and well‐child checks and prefer them as an information source for many health issues. However, a substantial proportion of parents (44.1%) do not currently visit a child and family health nurse, often because they not only do not perceive a need but also sometimes because these services are unknown, inaccessible, or considered unsuitable. They may seek advice from less qualified sources. There is potential for increased collaboration between child and family health providers to ensure effective resource use and consistency of parenting information and advice. Nursing services may need to address accessibility and appropriateness of care.

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Section: Introductionmentioning

confidence: 91%

Australian parents’ use of universal child and family health services: A consumer survey

Rossiter

Fowler

Hesson

et al. 2018

Health Soc Care Community

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“… 7 Realist evaluations are well suited to addressing the complexity of healthcare systems and are able to produce useful findings for decision makers keen to improve healthcare programmes. 8 The strength of realist evaluation is that it can draw valuable lessons about how particular conditions make particular outcomes more likely. 9 Its goal is to explain and generate knowledge of how to improve a programme.…”

Section: Methods and Analysismentioning

confidence: 99%

Study protocol: a mixed-methods realist evaluation of the Universal Health Visiting Pathway in Scotland

et al. 2020

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IntroductionThe growing political emphasis on the early years reflects the importance of these formative years of life. Health visitors in the UK are uniquely positioned to improve health outcomes for children and families and to reduce health inequalities. Recently, there has been a policy change in Scotland in an attempt to enhance the delivery of the universal health visiting service. This study aims to examine the extent to which the enhanced Universal Health Visiting Pathway is implemented and delivered across Scotland and to assess any associated impacts.Methods and analysisA mixed-methods study incorporating four methodological components and uses realist evaluation as the overall conceptual framework. It comprises three phases (1) initial programme theory development; (2) programme theory validation and (3) programme theory refinement. The programme theory validation will use interview and focus group data of parents and health visitors, and conduct a case note review at five study sites. It also involves a national survey of parents and health visitors and routine data analysis of existing secondary data. The analyses of the ensuing qualitative and quantitative data will be carried out using a convergent mixed-methods approach to ensure continuous triangulation of multiple data. The findings of the evaluation will provide contextually relevant understanding of how the Universal Health Visiting Pathway works and evidence the impact of increased investments in health visiting in Scotland.Ethics and disseminationThis protocol has been approved by the School of Health in Social Science Research Ethics Committee, University of Edinburgh. Additional approvals have been granted/will be sought from the Public Benefit and Privacy Panel for health and social care in Scotland for the case note review,survey and routine data analysis elements of the evaluation. The findings will be prepared as reports to the funders and presented at conferences. It will be submitted for publication in peer-reviewed journals.

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“…To capture the complex and dynamic nature of the disparity-reduction effort, we drew on a wide range of data sources, methods, and materials [ 28 , 29 ], including in-depth semi structured interviews with all stakeholders at all managerial levels, social network analysis (SNA) of data on the relationships between all actors participating in the program, the clinic teams' perceptions of their ability to implement the program (TE), data on clinic characteristics such as size and patient population served, and QUIDS scores at baseline and 3-year follow-up. The data sources are presented in Fig 1 and outlined below.…”

Section: Methodsmentioning

confidence: 99%

Evaluating an organization-wide disparity reduction program: Understanding what works for whom and why

et al. 2018

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BackgroundDisparity-reduction programs have been shown to vary in the degree to which they achieve their goal; yet the causes of these variations is rarely studied. We investigated a broad-scale program in Israel’s largest health plan, aimed at reducing disparities in socially disadvantaged groups using a composite measure of seven health and health care indicators.MethodsA realistic evaluation was conducted to evaluate the program in 26 clinics and their associated managerial levels. First, we performed interviews with key stakeholders and an ethnographic observation of a regional meeting to derive the underlying program theory. Next, semi-structured interviews with 109 clinic teams, subregional headquarters, and regional headquarters personnel were conducted. Social network analysis was performed to derive measures of team interrelations. Perceived team effectiveness (TE) and clinic characteristics were assessed to elicit contextual characteristics. Interventions implemented by clinics were identified from interviews and coded according to the mechanisms each clinic employed. Assessment of each clinic’s performance on the seven-indicator composite measure was conducted at baseline and after 3 years. Finally, we reviewed different context-mechanism-outcome (CMO) configurations to understand what works to reduce disparity, and under what circumstances.ResultsClinics’ inner contextual characteristics varied in both network density and perceived TE. Successful CMO configurations included 1) highly dense clinic teams having high perceived TE, only a small gap to minimize, and employing a wide range of interventions; (2) clinics with a large gap to minimize with high clinic density and high perceived TE, focusing efforts on tailoring services to their enrollees; and (3) clinics having medium to low density and perceived TE, and strong middle-management support.ConclusionsClinics that achieved disparity reduction had high clinic density, close ties with middle management, and tailored interventions to the unique needs of the populations they serve.

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Realist evaluation of an enhanced health visiting programme

Cited by 16 publications

References 22 publications

Australian parents’ use of universal child and family health services: A consumer survey

Australian parents’ use of universal child and family health services: A consumer survey

Study protocol: a mixed-methods realist evaluation of the Universal Health Visiting Pathway in Scotland

Evaluating an organization-wide disparity reduction program: Understanding what works for whom and why

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