Jenny McLeish

Can food vouchers improve nutrition and reduce health inequalities in low-income mothers and young children: a multi-method evaluation of the experiences of beneficiaries and practitioners of the Healthy Start programme in England

BackgroundGood nutrition is important during pregnancy, breastfeeding and early life to optimise the health of women and children. It is difficult for low-income families to prioritise spending on healthy food. Healthy Start is a targeted United Kingdom (UK) food subsidy programme that gives vouchers for fruit, vegetables, milk, and vitamins to low-income families. This paper reports an evaluation of Healthy Start from the perspectives of women and health practitioners.MethodsThe multi-method study conducted in England in 2011/2012 included focus group discussions with 49 health practitioners, an online consultation with 620 health and social care practitioners, service managers, commissioners, and user and advocacy groups, and qualitative participatory workshops with 85 low-income women. Additional focus group discussions and telephone interviews included the views of 25 women who did not speak English and three women from Traveller communities.ResultsWomen reported that Healthy Start vouchers increased the quantity and range of fruit and vegetables they used and improved the quality of family diets, and established good habits for the future. Barriers to registration included complex eligibility criteria, inappropriate targeting of information about the programme by health practitioners and a general low level of awareness among families. Access to the programme was particularly challenging for women who did not speak English, had low literacy levels, were in low paid work or had fluctuating incomes. The potential impact was undermined by the rising price of food relative to voucher value. Access to registered retailers was problematic in rural areas, and there was low registration among smaller shops and market stalls, especially those serving culturally diverse communities.ConclusionsOur evaluation of the Healthy Start programme in England suggests that a food subsidy programme can provide an important nutritional safety net and potentially improve nutrition for pregnant women and young children living on low incomes. Factors that could compromise this impact include erosion of voucher value relative to the rising cost of food, lack of access to registered retailers and barriers to registering for the programme. Addressing these issues could inform the design and implementation of food subsidy programmes in high income countries.

Peer support during pregnancy and early parenthood: a qualitative study of models and perceptions

BackgroundPeer support is a flexible concept used in healthcare across diverse areas to describe the activities of individuals acting in a non-professional capacity offering support to others with whom they have some experience in common. There is little research on peer supporters and women supported in the context of the transition to parenthood and disadvantage. This study particularly focuses on peer support for women experiencing a range of vulnerabilities during pregnancy and the postnatal period, in projects which assigned trained volunteers to individual pregnant women. There were three core elements to the volunteers’ support in these projects: active listening, providing information, and signposting to local services in the area. Many also offered practical support.MethodsThis was an descriptive qualitative study, informed by phenomenological social psychology, exploring experiences and perceptions of giving and receiving voluntary peer support during pregnancy and early parenthood in England, with a particular focus on disadvantaged women. Participants took part in semi-structured, audio-recorded interviews, the transcripts of which were analysed using thematic analysis.ResultsForty-seven volunteers and 42 mothers were interviewed, from nine peer support projects. The overarching themes identified were (1) ‘What is peer support?’, containing two themes: ‘befriending or mentoring’, and ‘responding to the individual’; (2) ‘Who is a peer supporter?’, containing two themes: ‘someone like me’, and ‘valuing difference’; (3) ‘The peer support relationship’, containing five themes: ‘a friend or a ‘professional friend’, ‘building relationships of trust’, ‘avoiding dependency’, ‘managing endings’, and ‘how peer supporters differ from professionals’.ConclusionA variety of models of volunteer peer support have been offered to pregnant women and new mothers in England. All create a structure for meaningful relationships of trust to occur between volunteers and vulnerable women. In the absence of agreed definitions for the nature and boundaries of peer support during pregnancy and early parenthood, it is important that projects provide clear information to referrers and service users about what they offer, without losing the valued flexibility and individuality of their service.

Healthy Start vitamins—a missed opportunity: findings of a multimethod study

Objective To evaluate and provide a real-life view of the operation of the Healthy Start vitamins scheme. Setting The study took place in primary care and community settings that served rural, urban and ethnically diverse populations, in two sentinel sites: London, and Yorkshire and the Humber. An online consultation and stakeholder workshops elicited views from across England. Participants 669 health and social care practitioners including health visitors, midwives, public health practitioners, general practitioners, paediatricians and support staff participated in focus group discussions (n=49) and an online consultation (n=620). 56 participants representing health and social care practitioners, policymakers, service commissioners, and voluntary and independent sectors took part in stakeholder workshops. Methods Three-phase multimethod study comprising focus group discussions, an online consultation and stakeholder workshops. Qualitative data were analysed thematically and quantitative data from the online survey were analysed using descriptive statistics. Results Study participants were concerned about the low uptake of Healthy Start vitamin supplements and the consequences of this for health outcomes for women and young children. They experienced Healthy Start vitamin distribution as logistically complex, requiring the time, resources and creative thinking of a range of local and regional practitioners from senior strategists to administrative support workers. In the light of this, many participants argued that moving to universal provision of vitamin supplements would be more cost-effective than the current system. Conclusions There is consistency of views of health practitioners that the current targeted system of providing free vitamin supplements for low-income childbearing women and young children via the Healthy Start programme is not fulfilling its potential to address vitamin deficiencies. There is wide professional and voluntary sector support for moving from the current targeted system to provision of free vitamin supplements for all pregnant and new mothers, and children up to their fifth birthday.

'The greatest feeling you get, knowing you have made a big difference': survey findings on the motivation and experiences of trained volunteer doulas in England.

BackgroundSupport from a doula is known to have physical and emotional benefits for mothers, but there is little evidence about the experiences of volunteer doulas. This research aimed to understand the motivation and experiences of volunteer doulas who have been trained to support women during pregnancy, birth and the postnatal period.MethodsA postal questionnaire survey was sent to volunteer doulas at five volunteer doula projects working in low-income areas in England. Quantitative and qualitative data were analysed in parallel using summary statistics and content analysis respectively.ResultsEighty-nine volunteer doulas (response rate 34.5 %) from diverse backgrounds responded to the survey. Major motivators for volunteering included a desire to help others and, to a lesser extent, factors related to future employment. Most reported that the training was effective preparation for their role. They continued volunteering because they derived satisfaction from the doula role, and valued its social aspects. Their confidence, skills, employability and social connectedness had all increased, but many found the ending of the doula-mother relationship challenging. For a minority, negative aspects of their experience included time waiting to be allocated women to support and dissatisfaction with the way the doula service was run.Discussion and conclusionsMost respondents found the experience rewarding. To maintain doulas’ motivation as volunteers, services should: ensure doulas can start supporting women as soon as possible after completing the training; consider the merits of more flexible endings to the support relationship; offer opportunities for ongoing mutual support with other doulas, and ensure active support from service staff for volunteers.

Maternity experiences of mothers with multiple disadvantages in England: A qualitative study

Background Disadvantaged mothers and their babies are at increased risk of poor perinatal outcomes and have less positive experiences of maternity care. Aim To explore the maternity care experiences of mothers with multiple disadvantages. Methods A qualitative descriptive study based on semi-structured interviews with 40 mothers with multiple disadvantages, using thematic analysis. Findings Four themes emerged: ‘A confusing and frightening time’, ‘Longing to be respected as an individual’, ‘The importance of choice and control’, and ‘Needing trust to feel safe’. Mothers brought feelings of powerlessness and low self-esteem to their encounters with maternity professionals, which could be significantly worsened by disrespectful care. They needed support to navigate the complex maternity system. Positive experiences were much more likely where the mother had received continuity of care from a specialist midwife or small team. Discussion and conclusion Mothers with multiple disadvantages value being treated as an individual, making informed choices, and feeling safe, but they may lack the confidence to ask questions or challenge disrespectful treatment. Training and supervision should enable maternity professionals to understand how confusing maternity care can be to very disadvantaged mothers. It should emphasise the need to provide accessible and empowering information and guidance to enable all mothers to make choices and understand the system. Leaders of maternity services need to do more to challenge negative staff attitudes and ensure that that all mothers are treated at all times with kindness, respect and dignity. Specialist midwives can deliver a high quality service to mothers experiencing multiple disadvantages.

Organisation of postnatal care affects parents’ confidence and security following hospital discharge at 72 h or less

Commentary on : Nilsson I, Danbjorg DB, Aagaard H, et al. Parental experiences of early postnatal discharge: a meta-synthesis. Midwifery 2015;31:926–34.[OpenUrl][1][CrossRef][2][PubMed][3] In many Western countries the period of hospitalisation after birth is now 72 h or less, and the risks and benefits of this ‘early’ discharge have been debated.1 Becoming a parent is a time of significant social and emotional change and many new parents experience a lack of confidence in the early days after … [1]: {openurl}?query=rft.jtitle%253DMidwifery%26rft.volume%253D31%26rft.spage%253D926%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.midw.2015.07.004%26rft_id%253Dinfo%253Apmid%252F26250511%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/j.midw.2015.07.004&link_type=DOI [3]: /lookup/external-ref?access_num=26250511&link_type=MED&atom=%2Febnurs%2F19%2F3%2F73.atom