Clery, Amanda;
(2024)
Learning from variation in delivery
of the health visiting service in England:
a mixed methods study.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: The health visiting service in England is universal, provided to all families with children under 5 years old to improve outcomes and reduce health inequalities. Over the past 10 years, the service has seen an array of changes, from transfer of commissioning to local authorities, to reductions in public heath budgets, disproportionately affecting the most disadvantaged children. There is known inconsistency in how health visiting is delivered to families. Therefore, the aim of my thesis was to explore variation in the health visiting service across England, with a focus on disadvantage. Methods: Using a mixed methods design, I firstly conducted a scoping review to explore disadvantage conceptualised in the child health literature. Next, I analysed administrative data from the Community Services Data Set, 2 individual local authorities, and the Family Nurse Partnership to describe variation in health visiting services across England according to child and family characteristics. Finally, I collected qualitative interview data from health visiting professionals and parents in 3 sites across England to understand their experiences of why health visiting services vary. Results: There was wide variation in delivery of mandated health visiting contacts across England, which were least likely to be received by the most disadvantaged children. Conversely, in 2 local authorities, additional contacts were most likely received by the most disadvantaged children, highlighting a different patterning between these 2 aspects of the service. This was not clearly distinguished by professionals in my qualitative interviews, which shed light on how strategies for monitoring performance, commissioning structures, and resource constraints contributed to variation in delivery of health visiting. Conclusions: This mixed methods study provided novel insights into how and why health visiting services vary in different local authorities across England. Identifying targets that create stability in service delivery would be of benefit to both parents and professionals.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Learning from variation in delivery of the health visiting service in England: a mixed methods study |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10186312 |
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