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UK-based national surveys and international longitudinal studies have shown that around a third of parents experience chronic or persistent loneliness. There is limited research about the experience of loneliness in parenthood, however blogs authored by parents, sharing their personal experiences about loneliness offer a potential rich data source. The purpose of this study was to identify and analyse blog narratives written by parents who had experienced loneliness to increase understanding of their experiences. One hundred and ninety-six relevant blog posts were identified, of which 157 had contact details to request permission to use the blog post in the study. Twenty-two parent bloggers gave their permission. Thematic network analysis was used to open code the blogs and 4 organising themes and subthemes emerged, which centred on a global theme of disconnection. Disconnection underpinned themes relating to a sense that being a parent was overwhelming, changes in identity linked to becoming a parent, difficulties in sharing feelings of loneliness with others, and a need for social connection. Findings point to parents being unprepared for the transition to parenthood, with implications for perinatal education and support, including further opportunities for parents to connect to reduce social isolation.

This study aimed to examine how parents develop personal resilience when facing the challenges of caring for a child with tracheostomy. This study employed a longitudinal qualitative design. Unstructured narrative interviews with 12 parents (from 9 families), whose child had a new tracheostomy, were undertaken at three time points over 12 months. Data were analysed using a socio-narratology method. Findings reveal the journey parents experienced, how their feelings changed, and the processes involved in developing resilience over the first 12 months of their child having a tracheostomy. Stories told by parents early in their journey revealed emotional upheaval, negative emotions, stress, and shock. Due to medical need, parents had little or no choice for their child to have a tracheostomy. Once their child’s life was out of danger, parents started to reframe their experiences and beliefs. Resilience played a major part in how parents perceived and faced their situation, allowing them to deal with what came their way and to move forward with their lives. Different aspects of resilience such as self-awareness, grit, gratitude, internal locus of control and reframing came to the fore at different time points. Parents talked feeling stretched by the challenges they faced and reframing their perspectives about their child’s tracheostomy. Parents’ resilience and reframing is discussed in relation to the ABC-X model. This study identifies a theoretical model (ABC-X Model of Parental Resilience and Reframing) that explains this process of change. This results in transferable knowledge, useful for understanding and explaining the experience of other parents and families.

Purpose: In this paper we report on insights from an evaluation of Birth Companions (a UK based charity) perinatal support in two prison settings in England. The initiative involved provision of group and/or one-to-one perinatal support and training women prisoners as peer supporters. Design/methodology/approach: A mixed-methods study was undertaken that involved observations of support groups and peer support supervision sessions (n=9); audio recorded interviews (n=33) with prison and healthcare staff, women in prison, peer supporters and Birth Companions; analysis of existing routinely collected data by Birth Companions and notes undertaken during regular meetings (n=10) with the Birth Companions Project Manager. Thematic analysis was undertaken supported by MAXQDA qualitative data analysis software. Findings: Birth Companions provided instrumental/practical support, emotional support, information support, signposting to services, and advocating for women to the prison concerning their perinatal needs and rights. Key themes revealed that support had an impact on the lives of perinatal women by creating a safe place, characterised by meaningful interactions and women centred approaches that facilitated access to wider care and support. The service made a difference by empowering women and providing added value for peer supporters, prison, health care and Birth Companions staff. Key enablers and strategies for the care of perinatal women and the delivery of perinatal support are also detailed. Originality: Through longitudinal data and the involvement of a range of stakeholders, this study evidences the subtleties of support provided by Birth Companions and the potential it has to make a difference to perinatal women in prison and those volunteering or working within the prison system.

PURPOSE: This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based charity) perinatal support in two prison settings in England. The initiative involved the provision of group and/or one-to-one perinatal support and training women prisoners as peer supporters. DESIGN/METHODOLOGY/APPROACH: A mixed-methods study was undertaken that involved observations of support groups and peer support supervision sessions (n = 9); audio recorded interviews (n = 33) with prison and health-care staff, women in prison, peer supporters and BC staff; analysis of existing routinely collected data by BC and notes undertaken during regular meetings (n = 10) with the BC Project Manager. Thematic analysis was undertaken supported by MAXQDA qualitative data analysis software. FINDINGS: BC provided instrumental/practical support, emotional support, information support, signposting to services and advocating for women to the prison concerning their perinatal needs and rights. Key themes revealed that support had an impact on the lives of perinatal women by creating a safe place characterised by meaningful interactions and women-centred approaches that facilitated access to wider care and support. The service made a difference by empowering women and providing added value for peer supporters, prison, health-care and BC staff. Key enablers and strategies for the care of perinatal women and the delivery of perinatal support are also detailed. ORIGINALITY/VALUE: Through longitudinal data and the involvement of a range of stakeholders, this study evidences the subtleties of support provided by BC and the potential it has to make a difference to perinatal women in prison and those volunteering or working within the prison system.

Background: Evidence for parenting programs to improve wellbeing in children under three is inconclusive. We investigated the fidelity, impact, and cost-effectiveness of two parenting programs delivered within a longitudinal proportionate delivery model (‘E-SEE Steps’). Methods: Eligible parents with a child ≤ 8 weeks were recruited into a parallel two-arm, assessor blinded, randomized controlled, community-based, trial with embedded economic and process evaluations. Post-baseline randomization applied a 5:1 (intervention-to-control) ratio, stratified by primary (child social-emotional wellbeing (ASQ:SE-2)) and key secondary (maternal depression (PHQ-9)) outcome scores, sex, and site. All intervention parents received the Incredible Years® Baby Book (IY-B), and were offered the targeted Infant (IY-I)/Toddler (IY-T) program if eligible, based on ASQ:SE-2/PHQ-9 scores. Control families received usual services. Fidelity data were analysed descriptively. Primary analysis applied intention to treat. Effectiveness analysis fitted a marginal model to outcome scores. Cost-effectiveness analysis involved Incremental Cost-Effectiveness Ratios (ICERs). Results: The target sample (N = 606) was not achieved; 341 mothers were randomized (285:56), 322 (94%) were retained to study end. Of those eligible for the IY-I (n = 101), and IY-T (n = 101) programs, 51 and 21 respectively, attended. Eight (of 14) groups met the 80% self-reported fidelity criteria. No significant differences between arms were found for adjusted mean difference scores; ASQ:SE-2 (3.02, 95% CI: -0.03, 6.08, p = 0.052), PHQ-9 (-0.61; 95% CI: -1.34, 0.12, p = 0.1). E-SEE Steps had higher costs, but improved mothers’ Health-related Quality of Life (0.031 Quality Adjusted Life Year (QALY) gain), ICER of £20,062 per QALY compared to control. Serious adverse events (n = 86) were unrelated to the intervention. Conclusions: E-SEE Steps was not effective, but was borderline cost-effective. The model was delivered with var

In many high-income countries such as the UK, inequalities in breastfeeding initiation and continuation rates exist, whereby socio-economically advantaged mothers are most likely to breastfeed. Breastfeeding peer support interventions are recommended to address this inequality, with non-profit breastfeeding organisations providing such support in areas of deprivation. As these organisations’ roots and membership are often formed of relatively highly resourced women who have different backgrounds and experiences to those living in areas of deprivation, it is important to understand their practices in this context. In order to explore how UK non-profit organisations practice breastfeeding peer support in areas of socio-economic deprivation, a systematic review and meta-ethnography of published and grey literature was undertaken. Sixteen texts were included, and three core themes constructed: (1) ‘changing communities’ reveals practices designed to generate community level change, and (2) ‘enabling one to one support’, explains how proactive working practices enabled individual mothers’ access to supportive environments. (3) ‘forging partnerships with health professionals’, describes how embedding peer support within local health services facilitated peer supporters’ access to mothers. While few breastfeeding peer support practices were directly linked to the context of socio-economic deprivation, those described sought to influence community and individual level change. They illuminate the importance of inter-professional working. Further work to consolidate the peer-professional interface to ensure needs-led care is required.

Background A proportionate universal (PU) approach to early years’ service provision has been advocated to improve children’s health and development and to reduce health inequality, by ensuring that services provide timely and high-quality parenting support commensurate with need. Process-oriented research is critical to examine the factors that contribute to, or hinder, the effective delivery/implementation of such a model in community-based family services. This study aimed to assess the delivery, acceptability and feasibility of a new PU parenting intervention model (called E-SEE Steps), using the Incredible Years® (IY) parent program, when delivered by trained health/family service staff in three “steps”—one universal step (the IY Babies Book), and two targeted steps (group-based IY Infant and Toddler programs). Methods An embedded mixed-methods process evaluation within a pragmatic parallel two-arm, assessor blinded, randomized controlled trial was conducted in community services in four local authorities in England. The process evaluation used qualitative data gathered via interviews and focus groups with intervention arm parents who were offered the targeted steps (n = 29), practitioners (n = 50), service managers (n = 7) and IY program mentors (n = 3). This was supplemented by quantitative data collected using group leader pre-training (n = 50) and post-delivery (n = 39) questionnaires, and research notes of service design decisions. Results The E-SEE Steps model was acceptable to most parents, particularly when it was accompanied by engagement strategies that supported attendance, such as providing childcare. Practitioners also highlighted the positive development opportunities provided by the IY training and supervision. However, participant views did not support the provision of the IY Babies book as a standalone universal component, and there were barriers to eligible parents—particularly those with low mood—taking up the targeted programs. Service provi

Traditionally, appointments between families and health visitors have taken place face-to-face in families’ homes, local community venues, and primary care settings alongside GPs.1 Working across these settings has been recognised as important for the early identification of problems and the delivery of early interventions.2 Despite the importance of health visiting support to primary care, the service has faced a decline in investment, a decline in numbers of staff, variation in services,3 and a lack of evaluative research.4 A previous article in the BJGP 5 documented significant annual budget cuts for the NHS and disinvestment by over 50% of local authorities since 2017, but during the COVID-19 pandemic the service needed to adapt even further. Health visiting currently faces a cumulation of new delivery models and lack of support and investment, which, without change, will damage efforts to address health inequalities, and will heighten the vulnerability of many families and their infants.

The findings from evaluations of parenting programmes can help inform policy and practice decisions, including how best to allocate scarce resources designed to support families. However, studies often fail to consider the extent to which the findings can be generalised to other settings or populations. One, yet unexplored solution, is to compare study findings and large-scale datasets including publicly available population data. The aims of this study were to assess the feasibility of assessing sample representativeness using publicly available data and to identify the challenges involved in considering the generalisability of study findings. Sociodemographic data from two community-based evaluations of parenting programmes conducted in England and Ireland between 2015-2018 were used in the study (N =395 parent-infant dyads). The results indicated some differences between the trial samples and the wider population. However, it is difficult to reach definitive conclusions about these findings due to the limitations associated with using the comparative datasets. Our study revealed three key challenges, including: (1) how best to define and conceptualise representativeness; (2) the availability of comparative datasets; and (3) the quality of the available data. Our study suggests that there is a need for up-to-date, good quality comparative datasets to allow for the assessment of representativeness. Further work is required to identify parameters for making claims about representativeness, specifically regarding the acceptable level of difference between the target population and the study sample. This is the first study to explore the feasibility of using publicly available population data in two jurisdictions, for the purpose of making judgements about the representativeness of the findings from parent programmes. It is hoped that our results will encourage further investigation around the reporting of trial external validity to enable effective decision making at

Background Mental disorders have become a public health crisis. Early prevention is key. Parenting programmes are effective for children aged ≥ 3 years; however, there is a lack of evidence of their effectiveness for children aged ≤ 2 years. Objectives To establish if the model named Enhancing Social–Emotional Health and Well-being in the Early Years (E-SEE) Steps can (1) enhance child social emotional well-being and establish whether or not it is cost-effective at 20 months of age when compared with services as usual; and (2) be delivered as a proportionate universal model with fidelity. Design A pragmatic two-arm randomised controlled trial and economic appraisal, with an embedded process evaluation to examine the outcomes, implementation and cost-effectiveness of the intervention, and intervention uptake, compared with services as usual. The study had an external pilot phase (which was originally planned as an internal pilot). Setting The intervention was delivered in community settings by early years children’s services and/or public health staff in four sites. Participants A total of 341 parents of infants aged ≤ 8 weeks were randomised in a ratio of 5 : 1 (intervention, n = 285; control, n = 56). The target sample was 606 parents. Intervention Two Incredible Years® parenting programmes (i.e. infant and toddler) delivered in a proportionate universal model with three levels [one universal (book) and two targeted group-based parenting programmes]. Main outcome measures Child social and emotional well-being (primary outcome) was assessed using the Ages and Stages Questionnaire: Social and Emotional, 2nd edition, at 2, 9 and 18 months after randomisation. Parent depression (secondary key outcome) was assessed using the Patient Health Questionnaire-9 items. Both questionnaires were eligibility screeners for targeted groups. Results The primary outcome analysis provided no evidence that the E-SEE Steps model was effective in enhancing child social and emotional well