Dataset Information

A realist review to explore how low-income pregnant women use food vouchers from the UK's Healthy Start programme.

ABSTRACT:

Objectives

To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, and which women might experience these impacts and why.

Design

A realist review.

Eligibility criteria for selecting studies

Primary or empirical studies (of any design) were included if they contributed relevant evidence or insights about how low-income women use food vouchers from the Healthy Start (UK) or the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programmes. The assessment of 'relevance' was deliberately broad to ensure that reviewers remained open to new ideas from a variety of sources of evidence.

Analysis

A combination of evidence synthesis and realist analysis techniques was used to modify, refine and substantiate programme theories, which were constructed as explanatory 'context-mechanism-outcome'-configurations.

Results

38 primary studies were included in this review: four studies on Healthy Start and 34 studies on WIC. Two main outcome strands were identified: dietary improvements (intended) and financial assistance (unintended). Three evidence-informed programme theories were proposed to explain how aspects of context (and mechanisms) may generate these outcomes: the 'relative value' of healthy eating (prioritisation of resources); retailer discretion (pressure to 'bend the rules'); the influence of other family members (disempowerment).

Conclusions

This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow's milk, whereas others may use them to reduce food expenditure and save money for other things.

SUBMITTER: Ohly H

PROVIDER: S-EPMC5594208 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A realist review to explore how low-income pregnant women use food vouchers from the UK's Healthy Start programme.

Ohly Heather H Crossland Nicola N Dykes Fiona F Lowe Nicola N Hall-Moran Victoria V

BMJ open 20170421 4

<h4>Objectives</h4>To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, and which women might experience these impacts and why.<h4>Design</h4>A realist review.<h4>Eligibility criteria for selecting studies</h4>Primary or empirical studies (of any design) were included if they contributed relevant evidence or insights about how low-income women use food vouchers from the Healthy Start (UK) or the Special Supplemental Nutrition Program f ...[more]

PMID: 28432063

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Project description:Poverty has a detrimental impact on health and wellbeing. Healthy Start food and vitamin vouchers provide support for low income families across the UK, but at least 25% of eligible women and children miss out. We set out to increase uptake, with an aim of 90% of eligible women and children (n~540 eligible, varying over time) receiving vouchers in the initial team's catchment area by December 2015. Starting with one midwife and one pregnant woman in March 2014 we used the model for improvement to identify ways to improve documentation, sign up, and referral. Weekly data on process measures and monthly data on voucher receipt were plotted on run charts. Comparing medians for January-June 2014 and March-August 2015 there was a 13.3% rise in voucher receipt in Lothian (increase from 313 to 355 women), versus an 8.4% decline for the rest of Scotland (fall from 1688 to 1546 women). Figures varied by team, influenced by staff, family, and area factors. The initial aim proved unrealistic, as signing up a woman for vouchers increases both the numerator and denominator. Accordingly, the percentage uptake has not increased at a regional level (remains at 75%), though the figure for the initiating team ("team 3" in graphs) has increased from 73.0% (January 2014) to 79.0% (November 2015). We have continued testing, achieving recent increases in the number of women referred for welfare rights advice on benefits, tax credits, employment rights, childcare, and debt, securing on average £4,500 per client during 2015/16 (£404k for 89 clients by mid September 2015). This improvement project, part of the Early Years Collaborative in Scotland, has had a measureable impact on pregnant women across Lothian. Success has relied on testing, an electronic maternity record, rapid dissemination of findings through direct engagement with clinical teams, and persistence. Our findings have relevance across the UK, particularly at a time of worsening finances for many families.

Project description:The rise in overweight and obesity among children is a global problem and effective prevention interventions are urgently required. Parents play an important role in children's lifestyle behaviours and body weight development and therefore there is a great need to investigate how to involve parents effectively in health promotion and prevention programmes. The aim of the study was to describe parents' experiences of barriers and facilitators of participating in the Healthy School Start Plus (HSSP) intervention study. HSSP is a parental support programme, conducted in Sweden, with the aim to promote a healthy diet, physical activity and preventing obesity in 5-7-year-old children starting school. In total 20 parents from 7 schools participated in semi-structured telephone-based interviews. The data was analysed using qualitative content analysis, with a deductive approach based on the Consolidated Framework for Implementation Research (CFIR). Parental experiences of barriers and facilitators informing the implementation of the HSSP intervention were identified within all five domains of the CFIR. Two additional constructs, not included in the CFIR were identified: Social factors and Cooperation. The findings of parental experiences of barriers and facilitators related to the importance of (1) adaptation of the intervention to fit the abilities of the parents with different social and cultural backgrounds; (2) the need for continuous delivery of information related to healthy behaviours; (3) the commitment and efforts of the deliverers of the intervention; (4) the need for repetition of information related to healthy behaviours given by the deliverers of the intervention; (5) encouragement and facilitation of the involvement of the family and key people around them through the intervention activities and by the deliverers of the intervention; (6) awareness of unexpected impacts and social and cultural conditions complicating the execution of the intervention and; (7) cooperation and a well-functioning interaction between parents and school staff. Barriers and facilitators indicated by the parents highlighted that interventions like the HSSP need to be adapted to fit the parents' abilities, with reminders, follow-ups and delivery of relevant information. Variations in social and cultural conditions need to be taken into consideration. The commitment of the school and the interaction between the school staff and the family as well as key people around them appears to be important. The Healthy School Start Plus trial was retrospectively registered in the International Standard Randomised Controlled Trial Number Registry on January 4, 2018 and available online at ClinicalTrials.gov: No. NCT03390725.

Project description:OBJECTIVE:To examine associations between receipt of an electronic food voucher (e-voucher) compared to food rations on the nutritional status of Rohingya children living in refugee camps in Bangladesh. METHODS:This is an associational study using cross-sectional data. We measured heights and weights of 523 children aged between 6 and 23 months in households receiving either a food ration consisting of rice, pulses, vegetable oil (362 children) or an e-voucher (161 children) that could be used to purchase 19 different foods. Data were also collected on the characteristics of their mothers and the households in which they lived, including household demographics, consumption and expenditure, coping strategies, livelihoods and income profiles, and access to assistance. Associations between measures of anthropometric status (height-for-age z scores, stunting, weight-for-height z scores, wasting, weight-for-age z scores and mid-upper arm circumference) and household receipt of the e-voucher were estimated using ordinary least squares regressions. Control variables included child, maternal, household and locality characteristics. The study received ethical approval from the Institutional Review Board of the International Food Policy Research Institute, Washington DC. RESULTS:Household receipt of an e-voucher was associated with improved linear growth in children. This association is robust to the inclusion of maternal, household and location characteristics. The magnitude of the association is 0.38 SD (CI: 0.01, 0.74), and statistically significant at the five percent level. We cannot reject the null hypothesis that these associations differ by child sex. Receipt of an e-voucher is not associated with stunting when a full set of control variables are included. There is no association between receipt of e-vouchers and weight-for-length, weight-for-age or mid-upper arm circumference. We cannot reject the null hypothesis that these associations differ by child sex. CONCLUSIONS:In a humanitarian assistance setting, Rohingya refugee camps in Bangladesh, household receipt of an electronic food voucher instead of a food ration is associated with improvements in the linear growth of children between 6 and 23 months but not in measures of acute undernutrition or other anthropometric outcomes. Our associational evidence indicates that transitioning from food rations to electronic food vouchers does not adversely affect child nutritional status.

Project description:BackgroundThe health visitors' role in many countries is changing. In Scotland, the role has undergone substantial changes through the introduction of an enhanced health visiting programme, which includes increased, structured home visits. This evaluation was conducted within NHS Ayrshire and Arran, one of the 14 Scottish Health Boards. Our aim was to understand and explain how, and why, the programme could contribute to improving health and wellbeing outcomes for children and families.MethodsWe used a realist evaluation approach, conducted in three phases. In phase one, eight managerial staff involved in developing and implementing the programme provided data, which were used to develop initial programme theories. In phase two, the programme theories were tested using qualitative data from 25 health visitors and 22 parents. The programme theories were refined through analyses and interpretation of data in phase three.ResultsThe home visiting context provided by the programme interacted with the mechanisms of the programme and produced outcomes such as early identification of health and wellbeing issues amongst families who needed more support, leading to referral and engagement with sources of additional help. The home visits facilitated development of parent-health visitor relationships, and parents considered health visitors as their first point of contact on children's wellbeing and developmental-related issues. Moreover, the programme provided more clarity to health visitors' role, which in turn enhanced partnership working. However, there were aspects of the programme that may require further development. For instance, both parents and health visitors were concerned about the wide gaps between some home visits.ConclusionsThe enhanced health visiting programme increased opportunities for monitoring and early identification of health and wellbeing concerns. It created structures for a more efficient partnership working and ensured that the needs of children and families were supported. These benefits need to be evaluated further in an effectiveness study.

Project description:IntroductionThe NHS Health Check aims to identify individuals at increased risk of cardiovascular diseases (CVDs) among the adult population in England. The Health Check includes calculation of CVD risk and discussion of pharmacological and lifestyle approaches to manage risk, including referral to lifestyle support services. The programme is commissioned by Local Authorities (LAs) and is delivered by a range of different providers in different settings. There is significant variation in activity, with uptake ranging from 25% to 85% in different areas, and clear evidence of variation in implementation and delivery practice.Methods and analysisWe aim to understand how the NHS Health Check programme works in different settings, for different groups, so that we can recommend improvements to maximise intended outcomes. To do so, we will undertake a realist review and a survey of LA public health teams. Our review will follow Pawson's five iterative stages: (1) locate existing theories, (2) search for evidence, (3) article selection, (4) extract and organise data and (5) synthesise evidence and draw conclusions. Our review will include documents describing local implementation alongside published research studies. We will recruit a stakeholder group (including Public Health England, commissioners and providers of Health Checks, plus members of the public and patients) to advise us throughout. Our survey will be sent to all 152 LAs in England to gather detailed information on programme delivery (including COVID-19-related changes) and available referral services. This will enable us to map delivery across England and relate these data to programme outcomes.Ethics and disseminationEthical approval is not required for this review. For the survey, we have received approval from the University of Kent Research Ethics Committee. Our findings will be used to develop recommendations on tailoring, implementation and design strategies to improve delivery of the NHS Health Check in different settings, for different groups.Prospero registration numberCRD42020163822.

Dataset Information

A realist review to explore how low-income pregnant women use food vouchers from the UK's Healthy Start programme.

Objectives

Design

Eligibility criteria for selecting studies

Analysis

Results

Conclusions

Publications

A realist review to explore how low-income pregnant women use food vouchers from the UK's Healthy Start programme.

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