The feasibility of delivering group Family Nurse Partnership

DOIhttps://doi.org/10.1108/JCS-12-2015-0035
Pages170-186
Publication Date20 June 2016
AuthorJacqueline Barnes,Jane Stuart
SubjectHealth & social care,Vulnerable groups,Children's services
The feasibility of delivering group Family
Nurse Partnership
Jacqueline Barnes and Jane Stuart
Jacqueline Barnes is a Professor of
Psychology at the Department of
Psychological Sciences, Birkbeck,
University of London, London, UK.
Jane Stuart is based at the
Department of Psychological
Sciences, Birkbeck, University of
London, London, UK.
Abstract
Purpose The purpose of this paper is to evaluate the feasibility of delivering the group family nurse
partnership (gFNP)programme, which combines elements of the family nurse partnership (FNP) programme
and CenteringPregnancy and is offered fromearly pregnancy to 12 months postpartumto mothers under 25.
Design/methodology/approach A mixed method descriptive feasibility study. Quantitative data from
anonymised forms completed by nurses from November 2009 to May 2011 (pilot 1) and January 2012 to
August 2013 (pilot 2) reporting referrals, attendance and client characteristics. Qualitative data collected
between March 2010 and April 2011 (pilot 1) and November 2012 and November 2013 (pilot 2) from
semi-structured interviews or focus groups with clients and practitioners.
Findings There were challenges to reaching eligible clients. Uptake of gFNP was 57-74 per cent,
attendance ranged from 39 to 55 per cent of sessions and attrition ranged from 30 to 50 per cent. Clients
never employed attended fewest sessions overall compared to those working full time. The group format and
the programmes content were positively received by clients but many struggled to attend regularly. FNP
practitioners were positive overall but involving community practitioners (pilot 2) placed more stress on them.
Research limitations/implications Further feasibility and then cost and effectiveness research is
necessary to determine the optimal staffing model.
Practical implications The content and style of support of the home-based FNP programme, available
only to first time mothers under 20, could be offered to women over 20 and to those who already have a child.
Social implications A range of interventions is needed to support potentially vulnerable families.
Originality/value This new complex intervention lacks evidence. This paper documents feasibility, the first
step in a thorough evaluation process.
Keywords Parenting, Nurses, Pregnancy, Early infancy, Group support, Parent-child relationship
Paper type Research paper
Introduction
This paper presents evidence from two pilot feasibility studies of group family nurse partnership
(gFNP), a new intervention aimed at helping young parents develop their health, well-being,
confidence and social support in pregnancy and their childrens health and parenting in the first year
of life (Family Nurse Partnership National Unit, 2015). In addition the programme aims to raise
aspirations about future education and employment to increase support for the family in the future.
Early intervention is promoted as a means of improving child and family outcomes (Allen, 2011). With a
strong US evidence base, the nurse family partnership (NFP) programme offers home-visiting to
potentially vulnerable first-time mothers from a specially trained family nurse (FN), starting early in
pregnancy until infants are 24 months of age, using a manualised curriculum (Olds, 2006). US
evidence indicates that it improves maternal self-concept, parenting skills, family relationships and
future life-course development, with some support from research in the Netherlands (Mejdoubi et al.,
2015) though as yet the UK evidence has failed to support this (Robling et al., 2016). NFP was
Received 7 December 2015
Revised 30 December 2015
Accepted 3 January 2016
The authors would like to express
the thanks to all the clients, their
partners, the FNP Family Nurses
and other professionals who took
the time to take part in the
interviews and to the FNP Family
Nurses, supervisors and
administrators who made sure that
all relevant programme forms were
completed and submitted while
they delivered this new
programme. The authors would
also like to express the thanks to
Mary Griffiths, FNP National Unit
Service Development and New
Projects Lead with responsibility
for managing the development and
refinement of gFNP, for her
ongoing discussions about gFNP
delivery and to Samantha Mason,
FNP National Unit Research and
Implementation Director for her
feedback on all research reports.
Thanks are also due to Beth
Howden for organising and
converting data from the various
forms, to Juliet Henderson for
conducting and interpreting pilot 1
interviews and to Elizabeth Klauber
for conducting some pilot 2
interviews. Pilot 1 was funded by a
grant to Professor Barnes from the
Department of Health (ITT 53166)
and pilot 2 was funded by grants
to Professor Barnes from the
Department of Health (ITT 58587)
and the Family Nurse Partnership
National Unit at the Tavistock and
Portman NHS Trust.
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VOL. 11 NO. 2 2016, pp. 170-186, © Emerald Group Publishing Limited, ISSN 1746-6660 DOI 10.1108/JCS-12-2015-0035
introduced into England in 2007, renamed the family nurse partnership (FNP, Barnes et al., 2008) and
is offered widely to first-time teen mothers (Family Nurse Partnership National Unit, 2012). Responding
to enquiries for a programme that could be offered to women ineligible for FNP, a group delivered
structured learning programme based on FNP was developed in England in collaboration with the
NFP National Office at the University of Colorado, Denver (Family Nurse Partnership National Unit,
2015). The programme was designed on the basis that group care prenatally can improve pregnancy
outcomes (Ickovics et al., 2007; Williams et al., 2009), may be less costly than individual support
(Serçekuşand Mete, 2010) and that postnatal groups have been proposed as a way to support
potentially vulnerable mothers (De Jonge, 2001; Stevenson et al., 2010). Meeting in a group with other
mothers can be perceived by non-teenage mothers as more helpful than one-to-one support
(Hoddinott et al., 2006). However young mothers can be uncomfortable in groups and are less likely
than older ones to attend, especially if they include predominantly older mothers (Public Health
England, 2015). The main difference from existing group support in the UK, such as that offered by
midwives and health visitors delivering the universal Healthy Child Programme (Shribman and
Billingham, 2009) and other support provided in Start Childrens Centres (Anning and Ball, 2008), is
that gFNP spans both pregnancy and infancy with ongoing support over 18 months. Other group
services are more time limited and focus either on pregnancy well-being or on specific infant issues
such as sleep problems or breastfeeding, although the Preparation for Birth and Beyond materials
(Department of Health, 2011) are designed to address this by incorporating approaches to supporting
families in pregnancy that are holistic and practical.
The gFNP programme uses the materials and approach of the NFP programme (Olds, 2006),
aiming not only to improve maternal and infant health but also to promote close mother-infant
attachment, develop sensitive parenting and effective family relationships and to help women to
explore life choices as they become parents (Barnes and Henderson, 2012). In addition, it
includes aspects of Centering Pregnancy, an intervention developed in the USA which provides
groups of 8-12 women with antenatal care during nine two hourly sessions, with time for
discussion about issues such as smoking, healthy eating and breastfeeding and allowing women
to understand their own health status by encouraging them to be actively involved in all the health
checks (Ickovics et al., 2007). It is reported that the group-based Centering Pregnancy is
preferred to traditional (individual) antenatal care (Ickovics et al., 2003, 2007; Robertson et al.,
2009) and has led to improved prenatal outcomes such as fewer preterm births among high-risk
women (Grady and Bloom, 2004; Williams et al., 2009). As part of the gFNP programme, during
pregnancy clients receive routine midwifery care in accordance with UK NICE guidelines (National
Institute for Health and Care Excellence (NICE), 2008) and in the postnatal phase infants are
monitored according to the Healthy Child Programme (Shribman and Billingham, 2009)
guidelines. To allow for this, one of the nurses delivering the programme must also be a practising
midwife and the FNP nurses have health visitor training.
While NFP (Kitzman et al., 1997; Olds et al., 1997; Olds, 2006) and Centering Pregnancy
(Baldwin, 2006; Grady and Bloom, 2004; Ickovics et al., 2007; Robertson et al., 2009) have
substantial evidence outside the UK, it was necessary to provide evidence for gFNP, merging and
adapting the two approaches. The gFNP programme is a complex intervention made up of many
components designed, through education, nurse contact and peer support to change parent
behaviour (Craig et al., 2008; Medical Research Council (MRC), 2000). According to Medical
Research Council (MRC) guidelines (Craig et al., 2008; MRC, 2000) and in line with a framework
proposed for developing and evaluating NFP innovations (Olds et al., 2013), the stages for
effectively evaluating and implementing complex interventions are: programme development;
piloting for feasibility; evaluation of effectiveness and cost effectiveness, ideally with an RCT;
and translation into mainstream practice.
Following progra mme development, the UK Department of Health and the FNP National Unit
commissioned two f easibility evaluation studie s of gFNP. Based on these two pilot stud ies, the
aim of this paper is to evaluate the feasibility of delivering the gFNP programme for young
mothers from approximately 16 weeks pregnancy to 12 months postpartum, by addressing the
following questions:
Are there barriers to reaching the intended population?
Are any client factors related to attendance?
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