Title: Evaluation of Baby Express in Greater Manchester
Funder: Economic and Social Research Council

Abstract: In order to (1) estimate whether BE improves outcomes for babies when compared to a group of mothers and babies who receive regular services and (2) explore how BE is being implemented in GM, we will carry out the following phases of work: 1. Development phase This will include the following activities: -Workshop with relevant stakeholders to map out the mechanisms of BE that create a change in child outcomes. This will inform our final research design and development of questionnaires. -Accessing ward level data and testing feasibility of ward level randomisation. This will be used to confirm the final design. -Recruit Assistant Psychologists and Volunteer Psychologists to support the research team. -Stakeholder engagement event in GM. -Set up Advisory Board. -Develop questionnaires for collecting child outcomes from mothers at around 12 months and online survey of health visitors. -Securing ethical approval from the National Research Ethics Service and the NHS, and R&D in each site to carry out the study and ensure that all mothers of interest will have sufficient information about the study to sign informed consent to participate in our study. This will require final versions of questionnaires and materials. -Pilot questionnaire. 2. Baby Express evaluation Mothers-to-be who present for their 36-week midwife appointment will be identified and recruited into our study by midwives and the assistant psychologists. The outcome measures will be collected during a face-to-face interview when children are 12-14 months old by NatCen interviewers. If needed, we will also collect outcome data from a cohort of mothers in the BE wards and control wards whose infants were born before BE was introduced to enable us to adjust our analysis for any individual level differences between the BE and control wards. Their outcomes will be measured in much the same way as those in the trial. We will also seek access to information about mothers' 'antenatal pathway factors' during pregnancy from the data collected as part of the Maternity Pathway Maternity Tariff Payment by Results system. This would include mothers in the BE and control areas as well as in two pre-BE cohorts. Our approach to data analysis will be determined by whether it has been possible to randomise wards into BE and control groups. Ideally, we will compare the post-BE outcomes in BE wards with those in control wards while taking into account clustering at the ward level. 3. Health Visitor survey We propose to gather the views and experiences of those involved in the delivery of the BE activities such as health visitors. The specific questions to be addressed will be developed in the initial stages of the project but overall, we aim explore: -How practitioners adhered to, adapted, dropped, or altered BE delivery? -What are the key contextual or supporting enablers and constraints in delivering BE successfully? -What worked and didn't work in delivering BE? -What is their overall perception of the value of BE and how well implementation is going? -Whether/how initial delivery intentions are being realised in current operations? -What are the challenges they have faced? -How have these challenges been addressed? The survey will be analysed using descriptive statistics, reported in charts and tables, and used to interpret and contextualise the impact findings from the BE trial described above. 4. Dissemination Our dissemination plan will be agreed at the start of the project. The activities will include public engagement opportunities at various stages of our project and publications targeted at key practitioner audiences, peer-reviewed journals, seminars/conferences and other events and through media.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE;REPRODUCTIVE HEALTH AND CHILDBIRTH