Study protocol: evaluation of the 0-5 public health investment in England - a mixed-methods study integrating analyses of national linked administrative data with in-depth case studies.

INTRODUCTION: Health visiting is a long-established, nationally implemented programme that works with other services at a local level to improve the health and well-being of children and families. To maximise the impact and efficiency of the health visiting programme, policy-makers and commissioners need robust evidence on the costs and benefits of different levels and types of health visiting, for different families, in different local contexts. METHODS AND ANALYSIS: This mixed-methods study will analyse individual-level health visiting data for 2018/2019 and 2019/2020 linked with longitudinal data from children's social care, hospitals and schools to estimate the association of number and type of health visiting contacts with a range of children and maternal outcomes. We will also use aggregate local authority data to estimate the association between local models of health visiting and area-level outcomes. Outcomes will include hospitalisations, breast feeding, vaccination, childhood obesity and maternal mental health. Where possible, outcomes will be valued in monetary terms, and we will compare total costs to total benefits of different health visiting service delivery models. Qualitative case studies and extensive stakeholder input will help explain the quantitative analyses and interpret the results in the context of local policy, practice and circumstance. ETHICS AND DISSEMINATION: The University College London Research Ethics Committee approved this study (ref 20561/002). Results will be submitted for publication in a peer-reviewed journal and findings will be shared and debated with national policy-makers, commissioners and managers of health visiting services, health visitors and parents.

Health visiting in the UK in light of the COVID-19 pandemic experience (RReHOPE): a realist review protocol.

INTRODUCTION: Health visiting services, providing support to under 5s and their families, are organised and delivered in very different ways in different parts of the UK. While there has been attention to the key components of health visiting practice and what works well and how, there is little research on how health visiting services are organised and delivered and how that affects their ability to meet their objectives. The COVID-19 pandemic rapidly disrupted service delivery from March 2020. This realist review aims to synthesise the evidence on changes during the pandemic to identify the potential for improving health visiting services and their delivery. METHODS AND ANALYSIS: This review will follow the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) quality standards and Pawson's five iterative stages to locate existing theories, search for evidence, select literature, extract data, synthesise evidence and draw conclusions. It will be guided by stakeholder engagement with practitioners, commissioners, policymakers, policy advocates and people with lived experience. This approach will consider the emerging strategies and evolving contexts in which the services are delivered, and the varied outcomes for different groups. A realist logic of analysis will be used to make sense of what was happening to health visiting services during and following the pandemic response through the identification and testing of programme theories. Our refined programme theory will then be used to develop recommendations for improving the organisation, delivery and ongoing postpandemic recovery of health visiting services. ETHICS AND DISSEMINATION: General University Ethics Panel approval has been obtained from University of Stirling (reference 7662). Dissemination will build on links to policymakers, commissioners, providers, policy advocates and the public. A range of audiences will be targeted using outputs tailored to each. A final stakeholder event focused on knowledge mobilisation will aid development of recommendations. PROSPERO REGISTRATION NUMBER: CRD42022343117.

First-time Mothers' Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry.

BACKGROUND: Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings. OBJECTIVE: This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges. METHODS: This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges. RESULTS: The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app. CONCLUSIONS: Although this study included a small sample, it elicited rich data and insights into first-time mothers' app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1017/S1463423618000294.

The invisible issue, children, and families in substandard accommodation: how can paediatric interdisciplinary teams help?

AimsIn the UK the number of children living in temporary accommodation has risen by 80% since COVID-19 [1]. One fifth of Australian children aged 0 to 5 years lived in homelessness/housing instability prior to COVID-19 [2,3]. Little is known regarding the impact of homelessness on the health of children living with homeless families. Moreover, the types of services and interprofessional collaborations needed to address children’s needs remains unknown [3,4]. This presentation outlines an innovative model of interdisciplinary collaborative health delivery that addresses these gaps [5]. The model used an embedded Nurse Practitioner ‘health hub’ to assess children and help parents meet their child’s needs.Objectives: This project captured the:1. Health of homeless children presenting to homelessness and community services in South Australia.2. Referral rates and uptake of the children3. Interdisciplinary health needs of the children living with homeless familiesMethodsA mixed methods study design was conducted. Health severity scales, extended health assessments, case note reviews, and interviews with parents and staff, to determine the health impacts of homelessness on children and the children’s interdisciplinary health needs. The conditions identified were coded using a severity scale of 1 to 3;3= severe, the child needing immediate care/intervention, 2= moderate, the child needs a referral but can wait for public hospital/clinic, 1= minor, the child does not need immediate referral). Referrals were made to: Paediatricians, dentists, physiotherapists, immunisation nurses, General Practitioners and other allied health professionals.ResultsOverall interim results show 62% of children presenting had health conditions (e.g. chronic dental caries, craniosynostosis with developmental delay) requiring interventions, while 38% were assessed as having good health requiring no intervention.Table 1 above illustrates the presenting conditions of the children attending the Nurse Practitioner led clinic. A consultation with the NP for an in-depth health assessment and often were the first comprehensive health assessment the children had received since birth.We found 18% children had a developmental delay (6 times the national average), 17% had behavioural and/or mental health issues, 17% required an ENT intervention, 24% had dental issues and 24% had a variety of presenting conditions. The correlational analysis and odds ratio results along with the interdisciplinary model of care and the case note analysis will be presented at the RCPCH conference. The intervention/evaluation reflects the complexity and depth of the unmet need in these children.ConclusionOverall the children are disconnected from health. This research identified that:• A significant number of children required medical interventions.• Children living in housing insecurity are at risk of missing out on care that is essential to their development and health• These children lack access to mainstream services• Health care costs act as a barrier to services• There is a poor referral uptake by children living in housing insecurity• There is a lack of information on the number of homeless children, particularly Aboriginal childrenIt is imperative that the health needs of children living with housing instability are measured and the responses of health professional interventions are tracked.