Supporting the case for “progressive universalism” in health visiting: Scottish mothers and health visitors’ perspectives on targeting and rationing health visiting services, with a focus on the Lothian Child Concern Model.

Aims. To explore parents and professionals’ experience of family assessment in health visiting (public health nursing), with a focus on the Lothian Child Concern Model (LCCM). Background. Health visitors (HVs) currently assess families as requiring core, additional or intensive support, and offer support at a corresponding level. The majority of families are assessed as core and receive no pro-active support beyond the early days. Previous assessment tools, consisting of checklists, have been criticised as being ineffective in identifying a range of health needs and unacceptable to parents and HVs. The LCCM model was developed and introduced in the study area to promote a partnership approach with parents and assess strengths as well as difficulties in parents’ capacity to care for their child. Methods. Qualitative methods were used. Ten mothers and twelve HVs took part in individual semi-structured interviews. Results. Most mothers were aware of the assessment process but some felt that they were not involved in the decision making process. Explaining the assessment process to parents is problematic and not all HVs do so. The assessment process was stressful for some mothers. HVs find the model useful for structuring and documenting the assessment process. Many believe that most families benefit from some support, using public health approaches. Families are often assessed as core because there are insufficient resources to support all those who meet the criteria of the additional category, and managers assess caseloads in terms of families with child protection concerns. Conclusions. The study findings support the concept of “progressive universalism” which provides a continuum of intensity of support to families, depending on need. Mothers would like better partnership working with HVs. Relevance to clinical practice. The study endorses proposed policy changes to re-establish the public health role of HVs and to lower the threshold for families to qualify for support.

What influences the timing of the introduction of solid food to infants?

The aim of the present study was to assess the factors which may influence the timing of the introduction of solid food to infants. The design was a prospective cohort study by interview and postal questionnaire. Primiparous women (n 541) aged between 16 and 40 years were approached in the Forth Park Maternity Hospital, Fife, Scotland. Of these, 526 women agreed to participate and seventy-eight were used as subjects in the pilot study. At 12 weeks we interviewed 338 women of the study sample. The postal questionnaire was returned by 286 of 448 volunteers. At 12 weeks 133 of 338 mothers said that they had introduced solids. Those that said that they had introduced solids early (<12 weeks) were compared with those who had introduced solids late (>12 weeks) by bivariate and multiple regression analysis. Psychosocial factors influencing the decision were measured with the main outcome measure being the time of introduction of solid food. The early introduction of solids was found to be associated with: the opinions of the infant's maternal grandmother; living in a deprived area; personal disagreement with the advice to wait until the baby was 4 months; lack of encouragement from friends to wait until the baby was 4 months; being in receipt of free samples of manufactured food. Answers to open-ended questions indicated that the early introduction appeared to be influenced by the mothers’ perceptions of the baby's needs. Some of the factors influencing a woman's decision to introduce solids are amenable to change, and these could be targeted in educational interventions.