Title: Realist Review: Health visiting in light Of the COVID-19 Pandemic Experience (RReHOPE)
Funder: Chief Scientist Office, Scotland

Abstract: What is this research about?_x000D_ This research is about learning lessons from the COVID-19 pandemic. We will focus on how health visiting services were delivered and received during that time. Health visiting services are a core part of child health programmes for children aged 0 to 5. They help to ensure every child has the best start in life. They include home visits and reach all new babies and their families. Health visitors work in partnership with parents and other health and social care workers to:_x000D_ • help protect babies and young children from harm,_x000D_ • support and promote good health and development, and_x000D_ • identify concerns early and ensure families get the support they need._x000D_ Health visiting services are organised and delivered differently across the UK. But the goal is the same: to improve outcomes for children._x000D_ COVID-19, which hit the UK in early 2020, placed a huge burden on health visiting services. The support they were able to provide families was scaled back. At the same time, many families faced increasing pressures due to the pandemic. These pressures include job worries, home schooling, and feeling isolated. In many places health visitors and families adapted. Some services were provided equally well in new and different ways. _x000D_ We will learn lessons about the impacts of COVID-19 – both good and bad - on health visiting services. This is so we can recommend improvements in how to organise and deliver them in the future. Improvements might help to make services more efficient, more effective, and fairer. This will help health visitors and others to deliver the best possible support to babies, young children and their families._x000D_ How do we plan to do it?_x000D_ Lots of research studies have described changes and impact during the pandemic. And there are many personal accounts from parents, health visitors and others during that time. These show the effects on children and families, on service providers, and on service delivery in different places. But there is a real need to pull this evidence together to find out what affect COVID-19 has had for who, in what circumstances, how and why. _x000D_ We will carry out a review of this evidence. The evidence will include any information about what has happened in health visiting services since March 2020. We will use an approach called realist review, which is a type of literature review. This involves finding and studying lots of different information. When put together, the information will tell us how the pandemic has affected services, service providers and families. We will work closely with the Institute of Health Visiting. We will also form two groups of people to work with us. One will include health visitors, service managers, policy makers and children’s charities. The other will include parents from across the UK. These groups will help us to find the evidence, interpret the findings, and identify important lessons._x000D_ What will the result be?_x000D_ We will provide findings and recommendations that could help people to organise and deliver health visiting services better. We will publish our findings and share them widely. We will develop a ‘how to’ guide, to help people put our recommendations into practice. And we will develop summaries of the findings for different audiences. Our review will be valuable because it will look across the whole of the UK. People in England, Wales, Scotland and Northern Ireland can learn from each other’s experiences about what improvements are possible.

Lay abstract: Research question_x000D_ How can the organisation and delivery of health visiting services in the UK be improved in light of COVID-19 pandemic, to provide equitable, effective and efficient services for young children and their families?_x000D_ Background_x000D_ Health visiting services are an essential part of the UK’s support structure for young children, helping to ensure every child has the best start in life. Whilst child health programmes share the same goals, there are different government policies across the four nations of the UK and competing opinions about how services are best organised and delivered. There is a paucity of research about both organisational arrangements and about how health visitors practise in order to achieve the best outcomes._x000D_ COVID-19 tested health visiting services in profound ways. Services rapidly adapted in response to the situation, with many providers developing innovative ways to ensure families continued to receive support through extraordinary ‘lockdowns’. Some innovations will have worked better for some people, in some contexts, than others. Furthermore, the impact of the pandemic on families and young children has been far-reaching and uneven, with important implications for post-pandemic health visiting services. There has been lots of data published since the start of the pandemic, but there is a need to synthesise this to understand how the organisation and delivery of health visiting services can be improved for a stronger post-pandemic recovery. _x000D_ Methods_x000D_ We will undertake a realist review of the literature relating to health visiting services during the COVID-19 pandemic since March 2020. We have chosen a realist review because health visiting services are a complex intervention and the impact of the pandemic will have been different for different people in different contexts. We will follow Pawson’s five iterative stages, namely: 1) locate existing theories; 2) search for evidence; 3) article selection; 4) extract and organise data; and 5) synthesise evidence and draw conclusions. We will recruit a stakeholder group of individuals, organisations or communities that are representatives, in different parts of the UK, of patients and the public, providers, commissioners, policy-makers, researchers and policy advocates. This group will advise and give us feedback throughout the project. _x000D_ Our review, which will follow the RAMESES quality standards, will last 18 months from June 2022, by which time we expect there to be a considerable body of evidence to include and synthesise. It will consider the differences in policy and service delivery across the UK and analyse, where possible, the differences in impact across the four constituent countries. _x000D_ Impact_x000D_ Our findings will be used to provide recommendations for improving the organisation and delivery of ongoing post-pandemic recovery of health visiting services in different settings, for different groups. We will collaborate closely with the Institute of Health Visiting (iHV) and our stakeholder group to ensure our findings are developed into a range of outputs suitable for a variety of audiences. These will include academic papers, a 'how to' publication and user-friendly summaries. Our stakeholder group, as individuals and organisations who are interested in the messages arising from our work, will help amplify our message, getting our research to different members of the policy and practice community in different ways.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE