Realist evaluation of an enhanced health visiting programme
Realist evaluation of an enhanced health visiting programme
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DOI：
10.1371/journal.pone.0180569
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发表时间：
2017-07-03
期刊：
影响因子：
3.7
通讯作者：
Hardie, Samantha
中科院分区：
文献类型：
--
作者：
Doi, Lawrence;Jepson, Ruth;Hardie, Samantha
背景在许多国家，健康访视者的角色正在发生变化。在苏格兰，通过实施强化的健康访问方案，包括增加有组织的家访，这一作用发生了重大变化。这项评估是在14个苏格兰卫生委员会之一的NHS Ayrshire和Arran进行的。我们的目的是了解和解释如何，以及为什么，该计划可以有助于改善健康和福祉的结果为children and family.Methods我们使用了现实主义的评估方法，分三个阶段进行。在第一阶段，参与制定和执行方案的八名管理人员提供了数据，这些数据被用来制定初步的方案理论。在第二阶段，该计划的理论进行了测试，使用定性数据从25个健康访客和22个家长。该方案的理论进行了完善，通过分析和解释的数据，在第三阶段。结果家访的方案提供的背景下相互作用的方案的机制，并产生的结果，如早期识别的健康和福祉问题之间的家庭谁需要更多的支持，导致转介和参与的额外帮助的来源。家访促进了父母与保健访问员之间关系的发展，父母将保健访问员视为他们在儿童福利和发展相关问题上的第一个接触点。此外，该方案进一步明确了保健视察员的作用，这反过来又加强了伙伴关系的工作。然而，该方案的某些方面可能需要进一步发展。例如，父母和健康访客都担心一些家访之间的差距很大。结论增强的健康访问计划增加了监测和早期识别健康和福祉问题的机会。它为更有效的伙伴关系建立了结构，并确保儿童和家庭的需要得到支持。这些益处需要在有效性研究中进一步评估。
Background The health visitors' role in many countries is changing. In Scotland, the role has undergone substantial changes through the introduction of an enhanced health visiting programme, which includes increased, structured home visits. This evaluation was conducted within NHS Ayrshire and Arran, one of the 14 Scottish Health Boards. Our aim was to understand and explain how, and why, the programme could contribute to improving health and wellbeing outcomes for children and families.Methods We used a realist evaluation approach, conducted in three phases. In phase one, eight managerial staff involved in developing and implementing the programme provided data, which were used to develop initial programme theories. In phase two, the programme theories were tested using qualitative data from 25 health visitors and 22 parents. The programme theories were refined through analyses and interpretation of data in phase three.Results The home visiting context provided by the programme interacted with the mechanisms of the programme and produced outcomes such as early identification of health and wellbeing issues amongst families who needed more support, leading to referral and engagement with sources of additional help. The home visits facilitated development of parent-health visitor relationships, and parents considered health visitors as their first point of contact on children's wellbeing and developmental-related issues. Moreover, the programme provided more clarity to health visitors' role, which in turn enhanced partnership working. However, there were aspects of the programme that may require further development. For instance, both parents and health visitors were concerned about the wide gaps between some home visits.Conclusions The enhanced health visiting programme increased opportunities for monitoring and early identification of health and wellbeing concerns. It created structures for a more efficient partnership working and ensured that the needs of children and families were supported. These benefits need to be evaluated further in an effectiveness study.