Research type 
Year of report 

Summary of findings



Across the sample, regardless of age, socio economic group, parenting experience or ethnic background, mothers had the key role in engaging with services in general and HCP in particular.  Some mothers had particular needs:

  • ABC1 mothers tended to lack large informal support networks and were the most proactive formal service seekers  
  • Younger mothers and single mothers reported feeling ‘looked down on’ and ‘patronised’ when accessing services.  Interaction with other young mothers would encourage this group to engage with HCP
  • Somali mothers require an independent (i.e. non-familial) interpreting service to support them to speak openly about personal issues

Typically, fathers adopted a ‘providing’ role and were only indirectly engaged with the service.  A minority (including single fathers) attended appointments.  Although a traditional support role was considered adequate, both male and female partners were interested in fathers becoming more involved.  To involve working men, services will need to be accessible (evenings/weekends). 

Parents of children with single disabilities and/or long-term conditions engaged with the HCP service, complemented by specialised NHS care.  Parents of severely disabled children (e.g. children with multiple disabilities) tended to disengage from the HCP, feeling that the ‘universal schedule’ was not relevant to children with particular needs.  For this audience, a specialised service providing practical and emotional support is required.

Overall, the research supports the ‘progressive universalist’ approach to delivery: 

  • First time parents are likely to remain the heaviest users of the service
  • Second time parents were less needy (with the exception of single parents).  An ‘open invitation’ to access services when needed is required
  • Lower income parents need considerable support, but the service must also respond to higher income parents who may well lack informal support
  • Ethnic minority parents and parents of children with disabilities require a flexible service that can accommodate their specific concerns

When communicating the HCP offer, it will be important to communicate that this is a universal service (i.e. something for everybody), in order to challenge perceptions of bias towards disadvantaged groups. 

Service needs at developmental milestones

One month: parents need practical guidance about caring for their newborn.  The service needs to promote the opportunity to ask for guidance whilst in hospital, and - if hospital guidance proves insufficient - to contact the Health Visitor.  To include fathers, the 14 day review will need to be more accessible - either before paternity leave ends or ‘out of hours’.

Three months:  as Health Visitor contact decreases, signposts to services available to parents as and when needed are required.  There is potential to enhance the experience of immunisation appointments, currently not perceived as an opportunity for discussion and therefore not perceived as a formal contact.

Four to six months:  parents begin to lose a sense of being supported by a service as scheduled contacts cease.   Some become unsure where to go for advice.  Parents who used ongoing services were the most satisfied; those who did not were more likely to become anxious and use other services inappropriately (e.g. GP).

One year: the one year review is well timed.  In future:

  • Safety advice needs to be delivered earlier.  Many are already toddling
  • A transparent discussion about the MMR jab will assist concerned parents to make an informed decision
  • Parents from ethnic minority backgrounds would appreciate guidance     about how to help their child learn two languages simultaneously

Two years: the content and timing of this review were appropriate.  In future:

  • Advice about learning English and even English lessons would support non English speaking parents to prepare their children for school
  • Guidance about diet would be appreciated (particularly by fathers)
  • C2DE parents would benefit from advice to manage problematic behaviour

Three to four years: there is not perceived to be a service at this stage and therefore the HCP offer for this age group needs to be promoted.  More specifically, support for parents when choosing schools would be appreciated.

Service delivery

Currently, parents are heavily reliant on the proactive nature of the HCP. Perceptions of the service focus on scheduled contact points: 

  • The most valued contact point was the Health Visitor.  A one-to-one relationship with the Health Visitor was expected, considered essential within the first three months.  It was also critical to building trust and confidence in the service.
  • The vaccination programme was also perceived as a key part of the service.  Vaccination appointments could be perceived as another formal contact point, if the opportunity for discussion is promoted.
  • Well-timed one-to-one reviews were another vital component.   Parents need reassurance that their child is developing ‘normally’ and the opportunity to raise any concerns.

Ideally, parents would like even more proactive contact from HCP (monthly check ups until the age of one).  To meet this desire for increased contact, the programme needs to promote services available for parents to access on an ongoing basis.  Currently, parents were only motivated to pursue services when they perceived they were in difficulty.  Increased emphasis on ‘drop in’ services will create a perception of ongoing support.

Local ‘drop in’ centres were very well regarded.  The idea of group support was generally appealing, but particularly to disadvantaged parents (especially young or single) and ethnic minority mothers.  These services need to be promoted as opportunities to meet other parents, as well as talk to professionals one-to-one. 

In future, parents’ expectations need to be managed by communicating that:

  • One-to-one care is provided in the early months
  • After this time, the service is still supporting parents, but being delivered in a different way (i.e. on a reactive basis, in the community)
  • There are a wide range of additional sources of support (face-to-face, telephone, print, web).  Parents need to be encouraged to broaden their perceptions of HCP beyond the NHS

This messaging would be supported by a service schedule.

Promoting the Healthy Child Programme

The HCP needs to be promoted as a service: 

  • To help parents understand the offer.  Currently, perceptions of HCP focus on formal contact points rather than a service with formal contact points, ongoing contact and support from other media.
  • To promote a distinct identity.  Currently, HCP was commonly assumed to be part of the NHS.  Whilst the majority trusted the service, home visits sometimes led to unhelpful associations with social services.

The HCP title received a broadly positive response.  The name reflects parents’ key aspiration – healthy children.  A small minority noticed a similarity between ‘Healthy Child’ and ‘Healthy Start’, but this association was not detrimental.  Parents of children with multiple/severe disabilities did not feel their children were ‘healthy’.  This title is unlikely to encourage this group to engage with HCP, but for this group, NHS services are more relevant.

The most effective times to promote the service are at scheduled contact points. Parents were open to reminders and often requested a programme schedule. 

To engage fathers, the following should be considered:

  • Father-specific messages: to encourage fathers to broaden their perception of their role beyond financial support (particularly important for younger fathers unable to ‘provide’ in the traditional sense)
  • Father-specific activities: fathers typically engage with their children through play

Father-specific or family-specific events: single and young fathers were interested in groups with other fathers or family events for those with strong family links (e.g. Pakistani and Bengali fathers) 


Research objectives


The research was required to map parents’ needs at the various developmental milestones and to assess how well the current programme meets these needs.



Qualitative research was required to contribute to the on-going strategic development of the Healthy Child Programme (HCP).  

Quick summary


Qualitative research was required to contribute to the on-going strategic development of the HCP.

The research supported the ‘progressive universalist’ approach to delivery.

When communicating the HCP offer, it will be important to communicate that this is a universal service (i.e. something for everybody), in order to challenge perceptions of bias towards disadvantaged groups. 


Audience Summary





White British, Black Caribbean, Pakistani, Somali




Social Class


Cross section




12 discussion groups; 14 depth interviews

Data collection methodology

Depth interviews
Focus groups

Other data collection methodology


Depth interviews by telephone

Sample size



Fieldwork dates


April 2009

Contact Name

Katie Jonas



Research Manager

Agree to publish



Research agency

Research Works

COI Number


Report format