Why health visiting? Examining the potential public health benefits from health visiting practice within a universal service: A narrative review of the literature

INTRODUCTION: There is increasing international interest in universal, health promoting services for pregnancy and the first three years of life and the concept of proportionate universalism. Drawing on a narrative review of literature, this paper explores mechanisms by which such services might contribute to health improvement and reducing health inequalities. OBJECTIVES: Through a narrative review of empirical literature, to identify: DESIGN: The paper draws upon a scoping study and narrative review. REVIEW METHODS: We used three complementary approaches to search the widely dispersed literature: Our key inclusion criterion was information about health visiting practice. We included empirical papers from United Kingdom (UK) from 2004 to February 2012 and older seminal papers identified in search (3), identifying a total of 348 papers for inclusion. A thematic content analysis compared the older (up to 2003) with more recent research (2004 onwards). RESULTS: The analysis revealed health visiting practice as potentially characterized by a particular 'orientation to practice.' This embodied the values, skills and attitudes needed to deliver universal health visiting services through salutogenesis (health creation), person-centredness (human valuing) and viewing the person in situation (human ecology). Research about health visiting actions focuses on home visiting, needs assessment and parent-health visitor relationships. The detailed description of health visitors' skills, attitudes, values, and their application in practice, provides an explanation of how universal provision can potentially help to promote health and shift the social gradient of health inequalities. CONCLUSIONS: Identification of needs across an undifferentiated, universal caseload, combined with an outreach style that enhances uptake of needed services and appropriate health or parenting information, creates opportunities for parents who may otherwise have remained unaware of, or unwilling to engage with such provision. There is a lack of evaluative research about health visiting practice, service organization or universal health visiting as potential mechanisms for promoting health and reducing health inequalities. This paper offers a potential foundation for such research in future

Re-conceptualizing executive functions as social activity in children's playworlds

This paper presents the outcomes of a study into how some early childhood teachers conceptualized the process of creating the conditions for the development of higher forms of cultural activity, often referred to in the general literature as Executive Functions (EF). EF are usually defined as those interrelated processes or functions that manage and control thoughts and behaviors. The underpinning experimental studies feature interventions that early childhood teachers are asked to implement, which we argue is problematic. The research reported in this paper takes a different approach. First, EF is theorized as a cultural activity, where the environment acts as the source of development of specifically human characteristics. Second, the teachers used playworlds to frame EF activities. Conceptualizing EF activities through play, rather than focusing on functions in the brain, oriented the teachers to creating dramatic events and social practices for supporting higher mental functioning as part of everyday preschool activities. We argue that a conception of EF as a social practice is a more pedagogically productive way of creating the conditions to support children’s development because it speaks directly to teachers’ practice