Determining how Health Visitors can be agents of change alongside parents in reducing the prevalence/mitigating the risk of alcohol related developmental disorders in England: exploratory mixed methods study

Research question: How can Health Visitors (HV) be agents of change alongside parents in reducing the prevalence/mitigating the risk of alcohol related developmental disorders in England? Background: Alcohol is a major risk factor for chronic diseases in the UK. Excessive drinking by parents, can have a long-term impact on parents and children s physical and mental health.

The UK has the 4th highest percentage of pregnancies where alcohol has been consumed either before pregnancy confirmation or during pregnancy.

Alcohol exposure is a risk factor for miscarriage, premature birth, intra-uterine growth restriction and Fetal Alcohol Spectrum Disorders - estimated to cost £2 billion/year.

Supporting reduction of alcohol consumption among individuals who may become pregnant and their partners, by intervening in the preconception period (post-birth and before a potential future pregnancy) could reduce alcohol-related harm, particularly from prenatal alcohol exposure.

Aims and objective: Aim - To explore current practice among HVs regarding alcohol assessment and advice alongside parental perceptions on the acceptance on this approach for raising awareness for preventing and limiting alcohol-related harms, informing the co-production of a HV-led care pathway in Yorkshire, Humber and Derbyshire.

Objectives - 1) Assess how and when HVs ask about alcohol consumption with new parents, what advice they give, and what actions they take (WS 1 & 2) 2) Identify barriers and facilitators of HVs practice behaviour regarding alcohol assessment, intervention, and support; (WS 1 & 2) 3) Understand how a dialogue about alcohol consumption could be embedded in routine contact visits between HVs and new parents; (WS 2 & 3) 4) Co-produce recommendations and develop a draft of a HV-led care pathway with stakeholders; (WS 4).

Methods: A Mixed-methods approach will be used to achieve the objectives using four interconnecting workstreams (WS) WS1 - a nationwide cross-sectional online survey of HVs. The questionnaire will be underpinned using the Theoretical Domain Framework to evaluate HV practice behaviours. This will give us breadth.

WS2 – Purposive sample of up to 20 HV ensuring maximum variation 4-5 focus groups, exploring views and experience to gainer depth. Recorded and transcribed verbatim, and analysed using thematic analysis. WS3 - Purposive sample of recent parents to give a total sample of (N = 20).

In-depth interviews (with interpreters/translators if needed) gathering views on how, when and whether a dialogue about parental alcohol consumption could be embedded in mandated contacts by HVs.

WS4 - Co-production of recommendations to inform development of a draft HV-led care pathway utilising online stakeholder event. Findings from WS1 –3 will be presented, and discussed.

Timelines for delivery: The project will be delivered over 14 months, following recognised project management approaches. A project advisory and management group will be formed to ensure governance and deliverable targets.

Anticipated Impact and Dissemination Co-produced draft of recommendations and draft of a care pathway to support HV working with families in the inter-pregnancy period, disseminated nationally which could prompt further implementation research.