A qualitative investigation of the perspectives and experiences women and families living on low income in Aberdeen City associated with the introduction of the Financial Inclusion Pathway in 2019/2020.

This research project aimed to investigate several things: 1) the lived experiences of parents/carers and mothers of infants and young children in relation to the challenges of parenting on very low incomes (including food coping strategies) in Aberdeen City; 2) the challenges parents may face talking to health professionals about financial problems; 3) their thoughts about nursing and midwifery clinical practice that would facilitate and support the aim of income maximisation through the "Financial Inclusion Pathway" (FIP) approach; 4) parents' perspectives of the acceptability and usefulness of the FIP policy concept. This interview study took place with parents who used or were supported by the Woodside or Community Foods North East (CFINE) food pantries or food bank between July-August 2020

Exploring the transition experiences of recently qualified health visitors to understand their support needs. [Protocol]

In this study the researchers are looking at the experiences of recently qualified health visitors (RQHVs) as they transition into health visiting practice and how they are supported (i.e. what kind of support do they need, what support is required and who currently provides support and does it meet their needs?

Low income parents’ perspectives and experiences of engaging with early years health professionals about financial challenges and income maximisation.

Background: Since the introduction of the Child Poverty Act (2017) in Scotland, all health visitors, midwives and family nurses in Scotland are expected to screen and offer a financial advice referral to at-risk pregnant women and parents/carers of families with children under five in Scotland. The so-called ‘Financial Inclusion Pathway’(FIP) emerged in 2019 as one of a number of strategies intended to tackle child poverty. At this early implementation stage, little is known about parents’ perspectives about the acceptability or impact of this initiative in relation to its aim. Methods: In 2020, low income parents with young children living in Aberdeen City were invited to take part in a qualitative study that aimed to determine any challenges they might face engaging with the FIP policy in practice, and their perspectives about financial discussions with professionals that could help to increase household incomes through this approach. One-to-one semi-structured telephone interviews lasting between 30–40 minutes took place during July and August 2020. Interviews were fully transcribed and thematically analysed. Results: Ten women, ranging from ages 20–41 years. Each participant had between one and five child(ren), ranging in age from 2 to 18 years and all had one child under school-age. All lived in multiply deprived postcode areas within Aberdeen City. Three main themes emerged: i. difficulties associated with discussing financial concerns; ii. how to talk about the issue; iii. intervention utility. Within each of these three main themes, nine-sub themes were apparent, ranging from those indicating potential unintended negative consequences, as well as intervention benefits. Discussion: Most participants considered health visitors to be a potentially good source of help about financial challenges; they were less clear about midwives’ role here. However, parents’ perceptions of the problems they may face associated with disclosing financial difficulties to health professionals, is a distinct barrier to conversations that could lead to a financial advice referral. Given the levels of unclaimed benefit in the UK, this is important to note. Establishing trust and rapport, careful and sensitive enquiry, and positive framing of financial maximisation were recommended to aid discussion of financial challenges. These findings are important given the current and predicted economic impact of the COVID-19. The study is limited by its sample size and recruitment site, but provides valuable insights to inform a larger scale investigation. The study also indicates the importance of understanding health professionals’ associated views and experiences

Parents’ perspectives and experiences of parenting and caring for young children on a low income in the North East Scotland.

Background: Families with young children, and lone parent families in particular, are at greater risk of poverty and food insecurity, compared to other UK population groups. Tackling child poverty has been a key Scottish Government policy since the introduction of the Child Poverty Act (2017) in which local authorities and health boards are required to report on their Local Child Poverty Action Plans. In north east Scotland little formal research had focused on the lived experiences of parents and parents of infants and young children in relation to the challenges they face parenting on very low incomes, and, on questions about income maximisation strategies to alleviate child poverty. This paper focuses on some key findings of a study undertaken to address this knowledge gap in Grampian in 2020. Methods: Parents with young children supported by an Aberdeen City-based poverty alleviation social enterprise were invited to take part in an interview study. One-to-one semi-structured telephone interviews lasting between 30–40 minutes took place during July and August 2020. Interviews were transcribed and thematically analysed. Results: Ten women took part; two participants lived with partners. Eight participants were unemployed and two worked part-time. Each had between one and five child(ren), and all had one child under school-age. Five key impact themes emerged, i. limited participation in paid employment; ii. insufficient social security income; iii. household food insecurity experiences; iv. practical and emotional challenges and anxiety associated with their children’s overall development; and v. anxieties related to treats and special occasions. Four coping strategy themes were also revealed, i.e. i. budgeting and bill prioritisation; ii. self-sacrifice; iii. relying on others, and iv. keeping up appearances. Food coping strategies were explored in more depth, and two broad themes emerged: acquisition methods and management techniques. Discussion: Parents with young children experience significant barriers accessing paid employment due to caring responsibilities. Consequently, generating sufficient household income from alternate income sources, such as social security, is problematic. Parents reported devoting significant emotional and physical energy to dealing with the challenges of raising children in poverty, and it was notable that participants employed a range of sophisticated coping strategies and skill to make ends meet and maximise food resources, within highly constrained budgets. This research challenges notions that budgeting education initiatives have much to offer low income parents already well-versed on this issue. Strategies to increase their incomes seem a more effective way of alleviating their related anxieties

Midwives', health visitors', family nurse practitioners' and women's experiences of the NHS Grampian's Financial Inclusion Pathway in practice: a qualitative investigation of early implementation and impact. [Report]

All Local Child Poverty Action Plans require midwives, health visitors and family nurses to identify families with children under five at risk of financial hardship, and to refer them for help to increase their household incomes. This strategy (the so-called Financial Inclusion Pathway) is one of the range of efforts outlined in the Child Poverty Action Plans, aimed at increasing household income and alleviating child poverty in Scotland. A qualitative study took place to increase understanding about the early implementation of the Financial Inclusion Pathway within the NHS Grampian area. The research set out to establish how this initiative was operating within and impacting on the clinical practice of those health professionals concerned with delivering on it. The project also aimed to learn more about these health professionals' experiences of benefit gained, from the perspectives of parents and their children. The study took place between April and August 2021, and was funded by an NHS Grampian Endowments grant. The analysis produced a number of themes and subthemes, which formed the basis for a series of recommendations that are detailed in full in this report

Midwives', health visitors', family nurse practitioners' and women's experiences of the NHS Grampian's Financial Inclusion Pathway in practice: a qualitative investigation of early implementation and impact. [Presentation]

All Local Child Poverty Action Plans require midwives, health visitors and family nurses to identify families with children under five at risk of financial hardship, and to refer them for help to increase their household incomes. This strategy (the so-called Financial Inclusion Pathway) is one of the range of efforts outlined in the Child Poverty Action Plans, aimed at increasing household income and alleviating child poverty in Scotland. A qualitative study took place to increase understanding about the early implementation of the Financial Inclusion Pathway within the NHS Grampian area. The research set out to establish how this initiative was operating within and impacting on the clinical practice of those health professionals concerned with delivering on it. The project also aimed to learn more about these health professionals' experiences of benefit gained, from the perspectives of parents and their children. The study took place between April and August 2021, and was funded by an NHS Grampian Endowments grant. This presentation summarises the key conclusions from the parts of the study covering health professionals and parents, and also summarises the projects' recommendations and recent ways in which these have been disseminated

Adults with type 1 and 2 diabetes and healthcare professionals' experiences of household food insecurity management in high income countries: a systematic review. [Protocol]

Protocol for a review, aiming to address the following questions: 1) What are the experiences of household food security self-management among adults with type 1 and 2 diabetes? 2) What are the experiences of household food security management among healthcare professionals in high income countries? 3) What evidence is there around household food security management of diabetes

Midwives', health visitors', family nurse practitioners' and women's experiences of the NHS Grampian's Financial Inclusion Pathway in practice: a qualitative investigation of early implementation and impact. [Briefing Paper]

All Local Child Poverty Action Plans require midwives, health visitors and family nurses to identify families with children under five at risk of financial hardship, and to refer them for help to increase their household incomes. This strategy (the so-called Financial Inclusion Pathway) is one of the range of efforts outlined in the Child Poverty Action Plans, aimed at increasing household income and alleviating child poverty in Scotland. A qualitative study took place to increase understanding about the early implementation of the Financial Inclusion Pathway within the NHS Grampian area. The research set out to establish how this initiative was operating within and impacting on the clinical practice of those health professionals concerned with delivering on it. The project also aimed to learn more about these health professionals' experiences of benefit gained, from the perspectives of parents and their children. The study took place between April and August 2021, and was funded by an NHS Grampian Endowments grant. This briefing paper summarises the project, and its conclusions and recommendations

A real time, longitudinal, qualitative evaluation of the first two cohorts to participate in the Queen’s Nurse Development Programme.

Background: The Queens Nurse Development Programme (QNDP) has been delivered to community nurses in Scotland since 2017, born out of a commitment to reintroduce the Queen’s Nurse title in Scotland after 50 years. The aim of the QNDP was to connect individuals with a shared passion for delivering high - quality nursing throughout Scotland’s communities, to create a safe space where participants could develop and grow on a personal level to become change makers, to inspire others, help those most in need and champion community nursing. As such, the participants selected were employed in a wide-range of diverse roles, from throughout Scotland. The programme takes place over a nine-months, during which participants engaged with a varied programme involving residential workshops, where they experienced a range of creative and contemplative awareness based change practices, the development of a practice issue, and individual coaching. This report presents an independent evaluation of the QNDP based on the first two cohorts of participants to engage with the programme (2017 & 2018). Evaluating the QNDP is important to optimise the programme for subsequent cohorts of Queen’s nurses and to inform the transferability of the programme to other professions and contexts. Methods: A comprehensive, longitudinal, qualitative evaluation, where data was collected at various time points, using interviews, focus groups and a ‘member-checking’ event with all 41 QNDP participants (20 fromcohort 1 and 21 fromcohort 2), as well as 12 community nursing managers and the 3 QNDP facilitators. The purpose was to uncover and explore perceptions and experiences of the QNDP: what was learned; how this was implemented into everyday practice; as well as the impacts and sustainability of changes. The data was analysed using Braun and Clarke’s six-point framework of analysis; familiarisation, coding, generating themes, reviewing themes, defining and naming themes and writing up (Clarke et al., 2015). Double coding and independent analysis ensured trustworthy, rigorous and valid findings. Summary and Conclusions: Participants were overwhelmingly positive about the programme, and appreciated its design, facilitation, approach and methods utilised, as well as the resulting impacts and outcomes. Engaging with the QNDP led to an unexpected ‘journey of self-discovery and transformation’, with notable self-development, growth and positive change. Essentially, the programme enabled participants to see through a new lens, re-position themselves and embody new (person-centred) ways of being and doing, which transcended both their personal and professional lives as community nurses, colleagues, ‘leaders’, service providers, networkers, family members and friends. The participants perceptions of this work and learning was that as it was personal, changing their thinking and identity and therefore, the impact of the programme and the personal and professional transformation and changes introduced were perceived to be sustainable for the rest of their professional life and beyond. The programme facilitated the building of close bonds with their peers which enabled them to confidently share problems and challenges, reinforce their learnings and new thinking, and engage them in a journey of transformation. As such, a community of practice has been created within and across the cohorts which has the potential to become a social movement as intended by QNIS. The programme also equipped them with novel, creative approaches, skills and tools that they were able to share with colleagues, friends and family. Thus, the programme achieved a key aim of connecting individuals and equipping QNDP participants with a range of new skills. The findings of this evaluation and the QNDP are likely to be transferable to other health and social care professionals and beyond the Scottish context

Policy, evidence and practice for post-birth care plans: a scoping review.

Background: Postnatal care continually attracts less attention than other parts of the childbirth year. Many regions consistently report poor maternal satisfaction with care in the post-birth period. Despite policy recommending post-birth planning be part of maternity services there remains a paucity of empirical evidence and reported experience using post-birth care plans. There is a need to report on post-birth care plans, identify policy and guideline recommendations and gaps in the current empirical research, as well as experiences creating and using post-birth care plans. Methods: This scoping review accessed empirical literature and government and professional documents from 2005 to present day to build a picture of current understanding of policy imperatives and existent published empirical evidence. The review was informed by the Arksey and O’Malley approach employing five stages. Results: The review revealed that post-birth care planning is promoted extensively in health policy and there is emergent evidence for its implementation. Yet there is a paucity of practice examples and only one evaluation in the UK. The review identified four over arching themes: ‘Positioning of post-birth care planning in policy; ‘Content and approach’ ; ‘Personalised care and relational continuity’; 'Feasibility and acceptability in practice’. Conclusions: Empirical evidence supports post-birth care planning, but evidence is limited leaving many unanswered questions. Health care policy reflects evidence and recommends implementation of post-birth care plans, however, there remains a paucity of information in relation to post-birth care planning experience and implementation in practice. Women need consistent information and advice and value personalised care. Models of care that facilitate these needs are focused on relational continuity and lead to greater satisfaction. It remains unclear if a combination of post-birth care planning and continuity of carer interventions would improve post-birth outcomes and satisfaction. Gaps in research knowledge and practice experience are identified and implications for practice and further research suggested