Feasibility and acceptability of using the Alarm Distress BaBy (ADBB) scale within universal health visiting practice in England: a mixed-methods study protocol.

INTRODUCTION: The Alarm Distress BaBy (ADBB) scale developed by Guedeney and Fermanian in 2001, is a validated screening tool designed for use by healthcare practitioners to identify infant social withdrawal. This study will explore the acceptability and feasibility of the use of the full ADBB scale and a modified ADBB (m-ADBB) scale as part of routine health visiting visits in England. METHODS AND ANALYSIS: A mixed methods sequential exploratory design will be used. Five health visitors will be trained in using the ADBB scale and 20 in the m-ADBB scale, from two National Health Service sites in England. Qualitative semi-structured interviews will be carried out with health visitors after they receive the training and again 2 months after using the scales in routine family health visits. Quantitative data will also be collected from the same participants for a range of items during the study period. The theoretical framework of Normalisation Process Theory will underpin the study, to provide in-depth explanations of the implementation process. Qualitative data will be analysed using thematic analysis. Quantitative data will be analysed using descriptive analysis. ETHICS AND DISSEMINATION: Ethical approval was granted by the University of Oxford Departmental Research Ethics Committee. Dissemination of results will be via organisational websites, social media platforms, newsletters, professional networks, conferences and journal articles.

Supporting nursing, midwifery and allied health professional teams through restorative clinical supervision.

The mental health and wellbeing of healthcare staff have been significantly affected by the demands resulting from the recent COVID-19 pandemic. Restorative supervision is a type of clinical supervision that supports reflective practice that can help build practitioners' resilience by focusing on the individual's experience, aiming to sustain their wellbeing and their motivation at work. This model has been shown to reduce stress and burnout and increase compassion satisfaction. This article discusses the implementation of a restorative clinical supervision programme used to support staff wellbeing in nursing, midwifery and allied health professional teams in a large London-based NHS trust.

The iHV Emotional Wellbeing at Work Champions Programme: Building capacity to protect and enhance the emotional wellbeing of the health visiting workforce in the UK.

The Institute of Health Visiting (iHV) Emotional Wellbeing at Work Programme was developed during the COVID-19 pandemic to support the health visiting services to deal with the increased demands placed on them. This paper discusses the development of the iHV Emotional Wellbeing at Work (EWW) Champions Programme, which has built on the original model to enable the creation of EWW Champions. The iHV has a good track record of building leadership and capacity for rolling out training and development on a wider scale using the iHV Champions model of training. The portfolio currently includes a range of Perinatal and Infant Mental Health Champions (Baldwin and Kelly, 2016; Baldwin et al., 2018) [1,2], Research Champions (Mugweni et al., 2019) [3], Delivering Different News Champions, Healthy Weight and Healthy Nutrition Champions, Changing Conversations: Autism Ambassadors, and Neonatal Families Ambassadors. This paper discusses how the EWW programme was further developed to create this Champions' model to enable other experienced and skilled health visitors to become EWW facilitators. Through this model, trained health visitors can support their colleagues in the workplace, protecting and enhancing their emotional wellbeing at work and broadening access to support services and resources.

Translating fathers' support for breastfeeding into practice.

Breastfeeding has numerous health benefits for the mother and child. For breastfeeding to be successful and continue for longer, women need adequate support. Fathers/partners play an important role in providing this support to women, but research suggests that fathers/partners often feel inadequately informed and supported by health professionals. Midwives and health visitors are in ideal positions to offer women and their partner's timely and relevant breastfeeding information and support throughout the perinatal period. This article discusses the benefits of breastfeeding, presents research evidence of the crucial role fathers/partners play in promoting and supporting breastfeeding, and recommends ways in which health professionals can provide breastfeeding information and support to fathers/partners.

A mixed-methods feasibility study of an intervention to improve men's mental health and wellbeing during their transition to fatherhood.

BACKGROUND: Many health visiting services in England use the Promotional Guide system with mothers and fathers, an intervention to support their transition to parenthood, but there is little known about its use and effectiveness, especially with fathers. The aim of this study was to test the feasibility and acceptability of the Promotional Guide system with first-time fathers and pilot potential outcome measures to assess their mental health and wellbeing. METHODS: A mixed methods prospective observational cohort study. Expectant first-time fathers were recruited from four London (UK) local authority boroughs. Data were collected through online pre and post intervention questionnaires, and semi-structured telephone interviews. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using framework analysis. RESULTS: Eighty-six fathers were interested in participating; 7 did not meet inclusion criteria and 79 were invited to complete the baseline questionnaire. Questionnaires completed by 45 men at both timepoints were included in the final analysis. Mean and standard deviations were calculated for all outcomes, showing a slight deterioration in the scores across all measures in the postnatal period compared to the antenatal. Ten of these men were also interviewed. Six major categories were identified: 1) Experience of health visitor contact, 2) Experience of Promotional Guides, 3) Experience of perinatal health services, 4) Experience of fatherhood, 5) Fathers' mental health and wellbeing, and 6) Experience of the research process. While antenatal and postnatal outcomes were collected from 45 first-time fathers, none had received the intervention in its entirety. This study identified major gaps in the implementation of the Promotional Guide system with fathers. CONCLUSION: This study assessed recruitment of first-time fathers, time to complete recruitment, and retention rates and identified outcome measures that could be used in a future definitive study. While it wasn't possible to examine the potential changes following the use of the Promotional Guide system, the study reported on the changes in the fathers' 'states' in the antenatal and postnatal period. It provided a narrative on whether first-time fathers found it acceptable to be asked about their mental health and wellbeing, highlighted their specific needs during their transition to fatherhood, and how they wanted to be supported. It also identified barriers to implementation of the Promotional Guide system by health visitors, which need to be addressed prior to any future research into this intervention. These findings have a number of implications for researchers, health professionals, health service managers, commissioners, policy makers and parents.

Qualitative study of UK health professionals' experiences of working at the point of care during the COVID-19 pandemic.

OBJECTIVES: To develop an understanding of health professionals' experiences of working at the point of care during the COVID-19 pandemic, the impact on their health and well-being and their support needs. DESIGN: A qualitative study using semistructured interviews. Data were analysed using framework analysis. SETTING: One large National Health Service integrated care trust. PARTICIPANTS: A purposive sample of 19 qualified health professionals (doctors, nurses or allied health professionals), working with patients with COVID-19 admitted to the hospitals between March and May 2020 were eligible to take part. RESULTS: Eight major categories were identified: (1) Working in a 'war zone', (2) 'Going into a war zone without a weapon', (3) 'Patients come first', (4) Impact of COVID-19, (5) Leadership and management, (6) Support systems, (7) Health professionals' support needs, and (8) Camaraderie and pride. Health professionals reported increased levels of stress, anxiety and a lack of sleep. They prioritised their patients' needs over their own and felt a professional obligation to be at work. A key finding was the reported camaraderie among the health professionals where they felt that they were 'fighting this war together'. CONCLUSIONS: This study provides a valuable insight into the experiences of some of the frontline health professionals working in a large London-based hospital trust during the first COVID-19 peak. Findings from this study could be used to inform how managers, leaders and organisations can better support their health professional staff during the current pandemic and beyond.

Reflections on setting up a nursing preceptorship programme.

It is now common practice for preceptorship programmes to be offered to newly qualified nurses within the NHS. The Nursing and Midwifery Council expects newly qualified nurses to be given protected time for learning in their first year of qualified practice and to access support from a preceptor. This article discusses a preceptorship programme that has been implemented in a large integrated NHS Trust in north-west London and shares reflections and learning to date, which can benefit others wanting to roll out a similar programme in the UK.

A qualitative exploratory study of UK first-time fathers' experiences, mental health and wellbeing needs during their transition to fatherhood.

OBJECTIVES: To develop an understanding of men's experiences of first-time fatherhood, their mental health and wellbeing needs. DESIGN: A qualitative study using semi-structured interviews. Data were analysed using framework analysis. SETTING: Two large National Health Service integrated care trusts covering four London (UK) local authority boroughs. PARTICIPANTS: First-time fathers with children under 12 months of age were included. Maximum variation sampling was used, with 21 fathers recruited. Ten of these men described their ethnic background as Indian, seven as White British, one as Spanish, one as Black African, one as Black Caribbean and one as Pakistani. Participants' ages ranged from 20 to over 60 years; completion of full-time education ranged from high school certificate to doctorate level; and annual income ranged from £15 000 to over £61 000. Non-English speaking fathers, those experiencing bereavement following neonatal death, stillbirth, pregnancy loss, sudden infant death, and fathers with existing severe mental illnesses were excluded. RESULTS: Nine major categories were identified: 'preparation for fatherhood', 'rollercoaster of feelings', 'new identity', 'challenges and impact', 'changed relationship: we're in a different place', 'coping and support', 'health professionals and services: experience, provision and support', 'barriers to accessing support', and 'men's perceived needs: what fathers want'. Resident (residing with their partner and baby) and non-resident fathers in this study highlighted broadly similar needs, as did fathers for whom English was their first language and those for whom it was not. A key finding of this study relates to men's own perceived needs and how they would like to be supported during the perinatal period, contributing to the current evidence. CONCLUSIONS: This study provides insight into first-time fathers' experiences during their transition to fatherhood, with important implications for healthcare policy makers, service providers and professionals for how perinatal and early years services are planned and provided for both new parents.

Mental health and wellbeing during the transition to fatherhood: a systematic review of first time fathers' experiences.

OBJECTIVE: The aim of this systematic review was to identify and synthesize the best available evidence on first time fathers' experiences and needs in relation to their mental health and wellbeing during their transition to fatherhood. INTRODUCTION: Men's mental health and wellbeing during their transition to fatherhood is an important public health issue that is currently under-researched from a qualitative perspective and poorly understood. INCLUSION CRITERIA: Resident first time fathers (biological and non-biological) of healthy babies born with no identified terminal or long-term conditions were included. The phenomena of interest were their experiences and needs in relation to mental health and wellbeing during their transition to fatherhood, from commencement of pregnancy until one year after birth. Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory, ethnography and action research were included. METHODS: A three-step search strategy was used. The search strategy explored published and unpublished qualitative studies from 1960 to September 2017. All included studies were assessed by two independent reviewers and any disagreements were resolved by consensus or with a third reviewer. The recommended Joanna Briggs Institute (JBI) approach to critical appraisal, study selection, data extraction and data synthesis was used. RESULTS: Twenty-two studies met the eligibility criteria and were included in the review, which were then assessed to be of moderate to high quality (scores 5-10) based on the JBI Critical Appraisal Checklist for Qualitative Research. The studies were published between 1990 and 2017, and all used qualitative methodologies to accomplish the overall aim of investigating the experiences of expectant or new fathers. Nine studies were from the UK, three from Sweden, three from Australia, two from Canada, two from the USA, one from Japan, one from Taiwan and one from Singapore. The total number of first time fathers included in the studies was 351. One hundred and forty-four findings were extracted from the included studies. Of these, 142 supported findings were aggregated into 23 categories and seven synthesized findings: 1) New fatherhood identity, 2) Competing challenges of new fatherhood, 3) Negative feelings and fears, 4) Stress and coping, 5) Lack of support, 6) What new fathers want, and 7) Positive aspects of fatherhood. CONCLUSIONS: Based on the synthesized findings, three main factors that affect first time fathers' mental health and wellbeing during their transition to fatherhood were identified: the formation of the fatherhood identity, competing challenges of the new fatherhood role and negative feelings and fears relating to it. The role restrictions and changes in lifestyle often resulted in feelings of stress, for which fathers used denial or escape activities, such as smoking, working longer hours or listening to music, as coping techniques. Fathers wanted more guidance and support around the preparation for fatherhood, and partner relationship changes. Barriers to accessing support included lack of tailored information resources and acknowledgment from health professionals. Better preparation for fatherhood, and support for couple relationships during the transition to parenthood could facilitate better experiences for new fathers, and contribute to better adjustments and mental wellbeing in new fathers.

First-time fathers' needs and experiences of transition to fatherhood in relation to their mental health and wellbeing: a qualitative systematic review protocol.

REVIEW QUESTION/OBJECTIVE: This qualitative review seeks to identify first-time fathers' needs and experiences in relation to their mental health and wellbeing during their transition to fatherhood. This will include resident first-time fathers who are either the biological or non-biological father.The objectives are to explore first-time fathers' experiences in relation to.

Postnatal Depression: Don't reinvent the wheel.

Poor mental health accounts for 23% of all ill health in the UK, with the cost of treating it expected to double in the next 20 years. In addition, postnatal depression (PND) in both mothers and fathers can have a detrimental long-term impact on a child's cognitive, social and behavioural development. This paper discusses the development process of an innovative evidence-based resource which involved professional expertise and parent involvement. This unique resource helps to recognise PND in both mothers and fathers and will support health visitors in making a real impact in improving outcomes for children and families.

The integrated two-year check: a model of partnership working.

The Healthy Child Programme, the national universal public health programme for all children and families in the UK, requires health visitors to carry out a health review for children between two and 2.5 years. Similarly, the revised Early Years Foundation Stage statutory framework now places a new requirement on early years practitioners to review a child's learning and development through a progress check at two years. While work is being undertaken nationally for the two-year health review to be delivered jointly by health, early years and early intervention services, this paper discusses the development of an innovative, integrated local model that not only ensures better reach of two-year-old children in Harrow but also ensures best use of professional resources and expertise, and a more joined-up service for children and families.

Exploring the experiences of nurses studying professional doctorates.

Recently there has been a rapid increase in the number of professional doctorates being undertaken in the UK. Nursing doctorates in particular are relatively new to the UK and therefore little is known about nurses' experiences of them, especially from a qualitative perspective. The aim of this study was to explore the experiences of nurses studying professional doctorates in health care, and in particular to determine what factors influence nurses in undertaking the programme, and to identity any challenges they encounter. Data were collected through semi-structured interviews and a purposeful sample of five was selected from a total of 24. Data were analysed using a grounded theory method. The desire to enhance professional and personal identity was the core influential factor, while challenges included the balance between family, social, work and academic responsibilities. Nurses created a system through the use of a range of coping mechanisms to overcome these challenges. Findings from this study could be informative for prospective students, academic staff and practitioners involved with doctorate students. This study could also be used as a preliminary analysis to form the basis for theoretical sampling in a larger scale study.

Exploring the professional identity of health visitors.

Health visiting is a complex, diverse and varied role. This article reviews the development of the role and how this has affected health visitors' professional identity.

Do specialist community public health nurses assess risk factors for depression, suicide, and self-harm among South Asian mothers living in London?

Evidence indicates that suicide rates are higher in South Asian women in the United Kingdom compared with other ethnic groups, suggesting increased vulnerability to attempted suicide and mental distress in these women. Specialist Community Public Health Nurses (SCPHNs, including health visitors) are in an ideal position to assess such risk. The objectives are to determine whether SCPHNs assess known risk factors for depression, self-harm, and suicide during initial contact with South Asian mothers in London; the extent to which these risk factors are documented in the nursing records; and whether their assessments of South Asian women differ from those of other ethnic groups. Structured content analysis of semistructured interviews with 8 SCPHNs and analysis of 60 matched pairs of SCPHN records were carried out in an inner London community. The results revealed that SCPHNs assessed general risk factors for postnatal depression and some culture-specific factors when assessing South Asian mothers. Documentation of risk factors was under-represented in the SCPHN records and there was a significant difference between the documented risk factors for South Asian women and women from other ethnic groups. While SCPHNs understood some aspects of South Asian culture, service improvements must be made to ensure better care provision.

Changing practice: a review of the first contact service.

The provision of the first contact service by health visitors to mothers and babies is a key element of the commissioning and delivery of the health visiting services within the United Kingdom. Its history dates back to the first National Health Service Act, and there have been many interpretations about its purpose and perceived benefits. A project group within an inner London primary care trust sought to review the evidence base surrounding the first contact visit in order to develop a standard for practice, which would guide and promote consistent practice throughout the health visiting department. This article illustrates the way in which a group of practitioners can work together to review service design and delivery.