Health visiting in the UK in light of the COVID-19 pandemic experience (RReHOPE): study synopsis.

内容摘要

The COVID-19 pandemic interrupted and, in some cases, transformed the way health visiting teams work, the way they interact with families and children and with the wider community and other service providers. Health visiting services are organised, delivered and experienced differently in different places, with little evidence to suggest what works best, for whom and in what contexts. To synthesise the evidence on changes during the pandemic to identify the potential for improving health visiting services and their delivery in the United Kingdom. This realist review engaged professional stakeholders (N = 28) and those caring for babies during the pandemic (N = 6) throughout the process. We searched five electronic databases for publications on health visiting during the COVID-19 pandemic from October 2022 to April 2023. This was followed by citation searching and review of organisational websites. Programme theory was iteratively refined through discussions with the team, professional stakeholders and people with lived experience and was translated into key findings and recommendations. One hundred and eighteen documents informed this review; most focused on health visiting in England (56%) or the United Kingdom (34%), with relatively few from Wales (6%), Scotland (3%) and Northern Ireland (1%). Documents highlighted the widespread, uneven and lasting impact of the COVID-19 pandemic on babies and families. Findings revealed significant concerns expressed by both families and practitioners and corresponding actions taken by health visiting services. These concerns and responses emphasised the flexibility and resourcefulness of health visitors, the vital role of trusting relationships between health visitors and families and the importance of holistic assessments for early intervention. Changes in service delivery were varied and were not always evaluated or sustainable. While the data illuminated some of the hidden complexities of health visiting practice, limited evidence was found on decision-making at organisational and managerial levels during the pandemic response. Included papers were predominantly from an advocacy or practitioner perspective, and few focused on health visiting in Scotland, Wales and Northern Ireland. Our focus on the universal health visiting pathways meant that documents pertaining to additional support received by the most vulnerable families might have been excluded. Experiences of Black, Asian and minority ethnic families and staff were illustrated in several papers. The COVID-19 pandemic highlighted the essential role of health visitors in safeguarding child and family well-being in the United Kingdom. While digital adaptations provide necessary continuity, face-to-face interactions remain essential for effective health visiting. The crisis exposed pre-existing workforce pressures and inconsistencies in service provision, emphasising the need for adequate support and funding. Policy-makers must recognise the complexity of health visiting and ensure sustained investment in universal home visiting services. Future resilience requires a realistic understanding of health visitors' work, integration into broader child health policies and enhanced interagency collaboration to address inequalities and improve long-term public health outcomes. Our implications for policy-makers will be translated into reflexive questions to prompt critical thinking about health visiting services in local areas. The small number of documents from countries outside England highlights this as a key area for future research. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR134986. Health visiting services provide checks and support for every child in the United Kingdom up to 5-year-olds. These services are organised and delivered differently across the United Kingdom, and there were further changes during the COVID-19 pandemic. We wanted to learn what happened and how health visiting services might be improved in the future. We carried out a review of published research and information from organisations about what has happened in health visiting services since March 2020. We also involved 28 professional stakeholders in our study, and 6 people with lived experience of caring for babies during the pandemic. They helped us make sense of the findings. Of the 118 documents in our review, most came from charities, professional organisations or health visitors. Most documents focused on England rather than other parts of the United Kingdom. Findings showed concerns from parents and health visitors about how the pandemic affected children’s health and development. Health visitors worked hard to adapt with new ways to support families. But, not all these changes were evaluated or were sustainable in the long run. Trusting relationships between families and health visitors were key, and early checks on a child’s well-being remained essential. However, there was little information on how big decisions were made at a management or policy level during the pandemic. The pandemic underlined the vital role of health visitors in protecting young children and their families. While video calls and online services helped maintain some level of support, they could not replace face-to-face visits, which are crucial for identifying concerns early. The pandemic also revealed existing problems, such as staff shortages and uneven service delivery across the United Kingdom. To ensure families get the support they need, health visiting services need adequate funding, integration into broader child health policies and strengthened collaboration between different services.