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What is usual care for teenagers expecting their first child in England? A process evaluation using key informant mapping and participant survey as part of the Building Blocks randomised controlled trial of specialist home visiting

Robling, Michael, Cannings-John, Rebecca, Channon, Susan, Hood, Kerenza, Moody, Gwenllian, Poole, Ria and Sanders, Julia 2018. What is usual care for teenagers expecting their first child in England? A process evaluation using key informant mapping and participant survey as part of the Building Blocks randomised controlled trial of specialist home visiting. BMJ Open 8 (5) , e020152. 10.1136/bmjopen-2017-020152

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Abstract

Objectives We compared the US-derived Family Nurse Partnership (FNP) home visiting programme when added to usually provided health and social care for first-time teenage mothers, to usual care alone. We aimed to: establish the nature of usual care, measure service usage and assess performance bias in core usual care services. Design Within trial process evaluation. Local professionals completed a survey mapping local health and social care services in seven domains. This focused on services available to young women, especially those relevant to pregnant teenagers. Descriptive data were assessed thematically to establish the range of services. Quantitative data collection with FNP supervisors enumerated service provision by site. Services identified were included in main participant trial follow-up interviews at four time points to quantify usage. Usage was described descriptively by domain. We explored predictors of health visitor visits. Setting 18 partnerships of local authority and healthcare organisations in England. Outcomes Descriptive framework of services. Rates of service usage reported by trial participants. Results 161 separate services were identified, with multiple service models in each domain, broadly categorised as universal or specialist (eg, for teenage mothers). FNP supervisors identified 30–63 universal services per site and 22–67 specialist services. Use of core maternity care services was similar across trial arms and with only small differences in use of health visiting services. Participants accessed a wide range of services. Women who had ever been homeless, who had a higher subjectively defined social status, and poorer mental health received more visits from a health visitor. Conclusions The large number of services available to teenage mothers in England may limit the incremental benefit achievable through enhanced home visiting. There was little evidence of compensatory practice, such as additional care for women in the usual care arm. Measuring usual care when trialling complex interventions is challenging and essential.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Centre for Trials Research (CNTRR)
Healthcare Sciences
Publisher: BMJ Publishing Group: Open Access / BMJ Journals
ISSN: 2044-6055
Funders: Department of Health Policy Research Programme
Date of First Compliant Deposit: 21 May 2018
Date of Acceptance: 15 March 2018
Last Modified: 29 Nov 2018 21:44
URI: http://orca.cf.ac.uk/id/eprint/111608

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