Supporting early family life: the importance of public health programmes

Globally, women are generally offered maternity-specific care during their pregnancy through obstetricians, gynaecologists, nurses and/or midwives. While this care extends into the postpartum period, guidelines currently do not recommend visits to the mother beyond 6 weeks (World Health Organisation, 2014). However, in the Fair Society, Healthy Lives report, it is emphasised that the two first years of life represent a critical time point in which the obstacles to healthy brain development can lead to long-term disadvantages, and that interventions are required to prevent the emergence of health inequalities and to improve children’s life-chances (Marmot et al, 2010). In attempts to prevent ill health in infants, a number of countries provide services that traverse both the antenatal period and the early years of life. Examples of such services include the Healthy Child Programme in the UK, the Maternal and Child Health Service in Australia, and the Comprehensive Child Development Service in Hong Kong. While these services differ, they are structurally similar in that they provide a universal preventative service with a programme of care that encompasses screening, immunisation, health and development reviews, supplemented by advice around health, wellbeing and parenting. In accordance with the principle of ‘proportionate universalism’, the scale and intensity of intervention is proportionate to the level of disadvantage to ensure more vulnerable families receive increased care and that safeguarding takes place for children at increased risk (Marmot et al, 2010)

Reintroducing face-to-face support alongside remote support to form a hybrid stop smoking service in England: a formative mixed methods evaluation

Background During the COVID-19 pandemic, United Kingdom (UK) stop smoking services had to shift to remote delivery models due to social distancing regulations, later reintroducing face-to-face provision. The “Living Well Smokefree” service in North Yorkshire County Council adopted a hybrid model offering face-to-face, remote, or a mix of both. This evaluation aimed to assess the hybrid approach’s strengths and weaknesses and explore potential improvements. Methods Conducted from September 2022 to February 2023, the evaluation consisted of three components. First, qualitative interviews involved 11 staff and 16 service users, analysed thematically. Second, quantitative data from the QuitManager system that monitored the numbers and proportions of individuals selecting and successfully completing a 4-week quit via each service option. Third, face-to-face service expenses data was used to estimate the value for money of additional face-to-face provision. The qualitative findings were used to give context to the quantitative data via an “expansion” approach and complementary analysis. Results Overall, a hybrid model was seen to provide convenience and flexible options for support. In the evaluation, 733 individuals accessed the service, with 91.3% selecting remote support, 6.1% face-to-face, and 2.6% mixed provision. Remote support was valued by service users and staff for promoting openness, privacy, and reducing stigma, and was noted as removing access barriers and improving service availability. However, the absence of carbon monoxide monitoring in remote support raised accountability concerns. The trade-off in “quantity vs. quality” of quits was debated, as remote support reached more users but produced fewer carbon monoxide-validated quits. Primarily offering remote support could lead to substantial workloads, as staff often extend their roles to include social/mental health support, which was sometimes emotionally challenging. Offering service users a choice of support options was considered more important than the “cost-per-quit”. Improved dissemination of information to support service users in understanding their options for support was suggested. Conclusions The hybrid approach allows smoking cessation services to evaluate which groups benefit from remote, face-to-face, or mixed options and allocate resources accordingly. Providing choice, flexible provision, non-judgmental support, and clear information about available options could improve engagement and match support to individual needs, enhancing outcomes

Allied health professionals: A promising ally in the work against health inequalities- A rapid review.

OBJECTIVES: Allied Health Professionals (AHPs) have a crucial role in reducing health inequalities. However, there is a lack of evidence regarding the ways they can fulfil this role. This rapid review explores the ways in which AHPs can decrease health care or health outcome inequalities; address inequalities in the social determinants of health; and support disadvantaged groups at an individual, organisational and system level. STUDY DESIGN: Rapid review following Cochrane criteria and narrative synthesis. METHODS: MEDLINE, EMBASE, CINAHL, Web of Science and AMED were searched combined with grey literature, to identify quantitative or qualitative review articles published between January 2010 and February 2021. RESULTS: From 8727 references, 36 met the inclusion criteria. The methodological quality of the studies was assessed with the AMSTAR tool and was generally low. Meta-analysis was not possible due to the heterogeneity of the studies, and a narrative synthesis was produced. Three themes emerged at patient and organisational level: 1) access to AHP services; 2) quality of care; and 3) social determinants of health. Two themes emerged at system level: 1) unequal workforce distribution and 2) lack of inclusive clinical guidelines. CONCLUSIONS: This rapid review offers a broad range of evidence on the ways AHPs can contribute to the reduction of inequalities in health care, both in terms of access and quality of care and in health outcomes. More research is needed to further understand the impact of AHPs on inequalities affecting specific groups and their contribution to equitable distribution of social determinants of health