P80 Calling for a second-order practice shift in health visiting: reflecting on the findings of a realist review of service organisation and delivery during the COVID-19 pandemic

Citation

Gadsby E, King E, Bell M, Wong G & Kendall S (2024) P80 Calling for a second-order practice shift in health visiting: reflecting on the findings of a realist review of service organisation and delivery during the COVID-19 pandemic. Society for Social Medicine Annual Scientific Meeting Abstracts. Journal of Epidemiology and Community Health, 78 (Suppl 1). https://doi.org/10.1136/jech-2024-ssmabstracts.174

Abstract
Background: Health visiting teams in the UK deliver a universal service for children aged 0 to 5 and their families, enabling early intervention and support. Their services are organised, delivered and experienced differently across the UK, with little evidence to suggest what works best, for whom, in what contexts. During the COVID-19 pandemic, many health visiting and related services were provided in new and different ways. We set out to identify and synthesise new knowledge emerging from the pandemic experience, regarding how best to organise and deliver health visiting services, being aware of the very different contexts across the UK. Methods: A realist review of the literature published since January 2020 relevant to universal health visiting services in the UK involved key stakeholder representatives, including people with lived experience, at every step. Document searching was broad to find any literature relevant to our initial programme theory. Data were extracted, organised and presented as draft Context, Mechanism, and Outcome Configurations, which were then iteratively refined, and translated into findings and recommendations. Results: 118 documents contributed to the review. Data revealed key concerns of families and practitioners throughout the pandemic and reported practical changes made to service delivery. Evidence gave rich insights into the lived experiences of families and practitioners during the pandemic, and the impacts on babies, families and the workforce. Most documents focused on health visiting in England, as opposed to the devolved nations, despite marked differences in country contexts. Discussions with stakeholders suggested that the situation was changing decisions being made by health visitors in their day-to-day practice. However, our data revealed little of this. Furthermore, there were no data that helped to examine how service managers and local or regional decision-makers responded to the situation. Conclusion: The review underlined the difficulties associated with describing and understanding health visiting work. During a time of considerable turbulence and complexity, there was little discussion of how key service delivery decisions were affected. There was little sense of how health visitors engaged with the changes brought about by the pandemic response; or how health visitors reflected on the decisions they made in this situation; or what opportunities were taken for health visitors to make a ‘second-order practice shift’. Our study highlighted the need to critically examine the theories that underlie health visiting services and guide the day-to-day interactions of health visitors, and to scrutinize them for consistency and relevance within current contexts.

Journal
Journal of Epidemiology and Community Health: Volume 78, Issue Suppl 1