Is child health promotion reaching the most disadvantaged? A qualitative study of the views of health visitors in England
Condon, L. (2011) Is child health promotion reaching the most disadvantaged? A qualitative study of the views of health visitors in England. In: RCN 2011 International Nursing Research Conference , Harrogate UK, 16th-19th May 2011.
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ABSTRACT Background: Child health promotion services are provided throughout the developed world in order to maintain and improve child health. In England child health promotion policy over the last decade has moved towards a core programme for all children, with targeted interventions for those with the highest health and social needs. It is not known how this policy shift has affected health visitors’ preventive work with pre-school children living in disadvantaged areas. Aim: To explore health visitors’ views on the effects of national policy change upon the child health promotion services they offer to pre-school children in disadvantaged urban areas. Methods: An in-depth telephone interview study was conducted between October 2006 and January 2007. All participants (n = 25) were registered health visitors who had previously taken part in a 2005 national child health promotion survey, and who were currently working with pre-school children in urban areas. Data were analysed thematically using a constructivist approach. Results: Despite high levels of need, children who would have benefited from targeted interventions could be offered only the core child health programme. Organisational and resource difficulties led to health visitors being unable to offer an enhanced service even when need was clearly identified. Discussion This study illustrates the importance of exploring the effects of national policy change from the perspective of practitioners, in order to identify unintended outcomes. Where a minimal core child health promotion programme was implemented, health visitors experienced difficulties in monitoring children’s health and delivering appropriate targeted interventions. Conclusion: Local interpretation of national policy is a key factor in determining the level of service provided by health visitors for disadvantaged pre-school children.