Mog Ball

Providing the Family–Nurse Partnership programme through interpreters in England

This study looks at the delivery of the Family-Nurse Partnership (FNP) in England with interpreters. This home-visiting programme for vulnerable, young first-time mothers is known in the USA as the Nurse-Family Partnership (NFP). FNP is manualised with a number of fidelity targets and stretch objectives. This study covers the first two phases, pregnancy and infancy (up to 12 months). The programme relies on the development of a close nurse-client relationship. Interpreters can be a barrier for therapeutic work with vulnerable groups. The aims are to determine from quantitative and qualitative data whether the FNP programme can be delivered with fidelity in the presence of an interpreter and to explore issues concerned with the impact of interpreters on relationships. Statistical comparisons were made of delivery objectives over 2 years, from April 2007 to February 2009, in the 10 sites in England, spread across all nine Government Office Regions providing FNP. Forty-three clients had an interpreter at some point and 1261 did not. Qualitative interviews were conducted between April and May 2009 with 30 stakeholders (nurses, clients, interpreters). In relation to quantitative indicators, the percentage of planned content covered in visits was lower with interpreters (pregnancy 90% vs. 94%; infancy 88% vs. 93%) and both understanding and involvement of clients, as judged by nurses on 5-point scales, were lower (understanding, pregnancy 4.3 vs. 4.6, infancy 3.8 vs. 4.5; involvement, pregnancy 4.4 vs. 4.7, infancy 3.7 vs. 4.5). The interpreter was not thought by nurses to impede the development of a collaborative client-nurse relationship unless the interpreter and client became too close, but some nurses and clients reported that they would rather manage without an interpreter. Some stress was noted for nurses delivering the programme with an interpreter. More research is needed to determine the extent to which interpreters accurately convey the programmes strength-based approach.

Predicting impact in an Early Years intervention: the design of a tool using qualitative and quantitative approaches

This article focuses on the design and application of an instrument, the Programme Variability Rating Scale (PVRS), to measure the effectiveness of a complex social intervention in the UK. Sure Start aimed to improve outcomes for children aged under four years living in disadvantaged areas on a wide range of health, educational and social indicators. The PVRS was devised for use in the National Evaluation of Sure Start (NESS) to measure programme proficiency. It consisted of 18 dimensions (eg. parental empowerment, user identification, flexibility of service delivery), each with seven levels of proficiency. It was applied to 150 Sure Start local programmes involved in a longitudinal study of the impact of the intervention on a range of child and parental outcomes. Ratings of more or less proficient processes were related, using discriminant‐function analysis, with the impact outcomes from the cross‐sectional study of almost 20,000 children. The 18 dimensions of proficiency of the PVRS made a significant differentiation between the most and least effective programmes.