BACKGROUND:The Family Nurse Partnership (FNP) is an intensive and structured person-centred home-visiting programme delivered by specially trained nurses, who offer support services to first-time young mothers. The COVID-19 pandemic prompted the quick adoption of telehealth within the FNP, as healthcare services moved rapidly to implement remote delivery systems in line with infection control measures. The aim of this study was 1) to understand the features of telehealth employed to deliver the FNP programme during COVID-19 in Scotland; 2) to examine how FNP nurses and clients responded to the delivery of FNP through telehealth; 3) to evaluate the challenges of delivering the FNP through telehealth during COVID-19 and its implications for future delivery of the programme. METHODS:The study employed a mixed-methods parallel design, where qualitative (one-to-one interviews and focus groups) and quantitative (survey) data were collected and analysed concurrently. Thirty-one family nurses took part in the focus groups and one-to-one interviews and a further 90 responded to the online survey. Fifteen FNP clients participated in one-to-one interviews. Interview data were analysed using thematic analysis and survey data were analysed by descriptive analysis. RESULTS:Family nurses combined both home visiting and remote delivery such as phone calls, SMS text messaging, emails, video calls to deliver the programme. Family nurses felt well equipped and supported to conduct their work remotely. Clients, particularly those who became isolated during COVID-19, overwhelmingly acknowledged this support and felt their family nurses provided stability, advice and care. However, both family nurses and clients found the rapid move to remote delivery challenging, because it affected both recruitment of clients with complex vulnerabilities to the programme and therapeutic relationship building. Nevertheless, 42% of family nurse respondents in the survey indicated that they would prefer mixed-mode delivery of face-to-face and telehealth as part of future FNP programme delivery. CONCLUSION:Despite the challenges of delivering the programme remotely during COVID-19, telehealth has the potential to play a valuable role in post COVID-19 FNP programme delivery. A hybrid delivery approach could be appropriate in certain instances, for example clients not deemed to have complex vulnerabilities or those living in remote locations. Future studies could robustly examine the impact of the quality of modes of FNP delivery, for instance home visiting, telehealth and hybrid delivery and how these influence outcomes across different client groups. An economic evaluation of the value for money of different modes of delivery could also be insightful for decision makers.

Background Universal health visiting has been a cornerstone of preventative healthcare for children in the United Kingdom (UK) for over 100 years. In 2016, Scotland introduced a new Universal Health Visiting Pathway (UHVP), involving a greater number of contacts with a particular emphasis on the first year, visits within the home setting, and rigorous developmental assessment conducted by a qualified Health Visitor. To evaluate the UHVP, an outcome indicator framework was developed using routine administrative data. This paper sets out the development of these indicators.Methods A logic model was produced with stakeholders to define the group of outcomes, before further refining and aligning of the measures through discussions with stakeholders and inspection of data. Power calculations were carried out and initial data described for the chosen indicators.Results Eighteen indicators were selected across eight outcome areas: parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents and injuries, and child protection interventions. Data quality was mixed. Coverage of reviews was high; over 90% of children received key reviews. Individual item completion was more variable: 92.2% had breastfeeding data at 6-8 weeks, whilst 63.2% had BMI recorded at 27-30 months. Prevalence also varied greatly, from 1.3% of children's names being on the Child Protection register for over six months by age three, to 93.6% having received all immunisations by age two.Conclusions Home visiting services play a key role in ensuring children and families have the right support to enable the best start in life. As these programmes evolve, it is crucial to understand whether changes lead to improvements in child outcomes. This paper describes a set of indicators using routinely-collected data, lessening additional burden on participants, and reducing response bias which may be apparent in other forms of evaluation. Further research is needed to explore the transferability of this indicator framework to other settings.

Accessible and high quality shared outdoor open spaces, both built and natural, can be particularly beneficial for health and wellbeing. The design and quality of shared outdoor spaces are often modifiable and the health and wellbeing-promoting potential of such spaces can, therefore, be enhanced. However, optimal modification of shared outdoor spaces requires a greater understanding of perceptions and experiences. Citizen Science projects can be particularly valuable for capturing experiences of wellbeing in different environments and shared outdoor spaces, although suitable validated scales are lacking. This paper aims to develop and conduct psychometric testing on the Perceived Wellbeing in Shared Outdoor Spaces (PWOSS) Scale. The study involves three key phases of scale development and evaluation: (i) identifying suitable domains and generating initial items for the PWOSS Scale; (ii) pre-testing the PWOSS Scale and conducting item reduction analysis and factor extraction to refine the scale items using a sample of potential users from Edinburgh, Scotland (n=137); and (iii) evaluating the PWOSS Scale by testing for dimensionality, reliability and validity. The final PWOSS Scale consisted of nine-items. The factor analysis indicated a two-factor solution (positive and negative wellbeing. The results of the three phases suggest the PWOSS Scale is a valid and reliable scale that can aid our understanding of the link between wellbeing and shared outdoor spaces and environments. The PWOSS Scale offers significant value to Citizen Science projects and to urban planning and public health practitioners interested in modifying and adapting shared outdoor spaces to increase wellbeing.

Overview:This rapid review sought to understand the use of telehealth in early parenthood programmes sharing similarities with the Family Nurse Partnership.Methods:A rapid review protocol was developed in accordance with Cochrane Rapid Reviews Methods Guidance. Medline, Cochrane Library, and CINAHL databases were searched. Inclusion criteria were developed using population, intervention, comparator, outcome, study design, and timeframe components. Two reviewers searched, screened, and extracted data. AMSTAR was used for critical appraisal. Results were synthesised narratively.Results:Searches yielded 18 studies out of 881 for inclusion. Findings were identified across seven domains: acceptability and accessibility; therapeutic relationships; flexibility offered by telehealth; participation and engagement; confidentiality and privacy; equipment and technical considerations; and training and support.Conclusion:Telehealth provides unique opportunities to improve access to early years health services for young mothers. However, considerable accessibility barriers remain in the form of connectivity issues, access to appropriate technology, and the acceptability of remote healthcare delivery. This review presents a timely overview of the opportunities and challenges associated with the use of telehealth in early parenthood and family-based programmes.

Background To reduce COVID-19 infection rates during the initial stages of the pandemic, the UK Government mandated a strict period of restriction on freedom of movement or ‘lockdown’. For young people, closure of schools and higher education institutions and social distancing rules may have been particularly challenging, coming at a critical time in their lives for social and emotional development. This study explored young people’s experiences of the UK Government’s initial response to the pandemic and related government messaging. Methods This qualitative study combines data from research groups at the University of Southampton, University of Edinburgh and University College London. Thirty-six online focus group discussions (FGDs) were conducted with 150 young people (Southampton: n = 69; FGD = 7; Edinburgh: n = 41; FGD = 5; UCL: n = 40; FGD = 24). Thematic analysis was conducted to explore how young people viewed the government’s response and messaging and to develop recommendations for how to best involve young people in addressing similar crises in the future. Results The abrupt onset of lockdown left young people shocked, confused and feeling ignored by government and media messaging. Despite this, they were motivated to adhere to government advice by the hope that life might soon return to normal. They felt a responsibility to help with the pandemic response, and wanted to be productive with their time, but saw few opportunities to volunteer. Conclusions Young people want to be listened to and feel they have a part to play in responding to a national crisis such as the COVID-19 epidemic. To reduce the likelihood of disenfranchising the next generation, Government and the media should focus on developing messaging that reflects young people’s values and concerns and to provide opportunities for young people to become involved in responses to future crises.

BACKGROUND:Contact centre staff spend up to 95 % of their day seated, which can lead to a range of negative health outcomes. The aim of this study was to develop a programme theory for a complex intervention to reduce sedentary behaviour in contact centres.METHODS:The 6SQuID model was used. A literature review, and focus groups at one contact centre were used to: understand the problem (step 1); identify modifiable factors (step 2); and develop a theory of change (step 3). A workshop shaped a theory of action (step 4), and the programme theory was refined after testing activities over 6 months (step 5). The intervention is currently undergoing further evaluation and feasibility testing in a larger scale stepped wedge randomised controlled study in 11 contact centres (Step 6).RESULTS:Step 1: Limited opportunity to sit less, and move more at work was identified as the main problem. Step 2: Modifiable factors were identified at four levels of the centre. Step 3: A theory of change was developed around cultural norms and individual behaviour change. Step 4: Actions were developed to 'activate' the theory of change. Step 5: Activities were implemented, and adapted over 6 months and the programme theory was refined.CONCLUSION:The programme theory behind this intervention is robust, evidence based, adaptive and transferable.

Introduction The growing political emphasis on the early years reflects the importance of these formative years of life. Health visitors in the UK are uniquely positioned to improve health outcomes for children and families and to reduce health inequalities. Recently, there has been a policy change in Scotland in an attempt to enhance the delivery of the universal health visiting service. This study aims to examine the extent to which the enhanced Universal Health Visiting Pathway is implemented and delivered across Scotland and to assess any associated impacts. Methods and analysis A mixed-methods study incorporating four methodological components and uses realist evaluation as the overall conceptual framework. It comprises three phases (1) initial programme theory development; (2) programme theory validation and (3) programme theory refinement. The programme theory validation will use interview and focus group data of parents and health visitors, and conduct a case note review at five study sites. It also involves a national survey of parents and health visitors and routine data analysis of existing secondary data. The analyses of the ensuing qualitative and quantitative data will be carried out using a convergent mixed-methods approach to ensure continuous triangulation of multiple data. The findings of the evaluation will provide contextually relevant understanding of how the Universal Health Visiting Pathway works and evidence the impact of increased investments in health visiting in Scotland. Ethics and dissemination This protocol has been approved by the School of Health in Social Science Research Ethics Committee, University of Edinburgh. Additional approvals have been granted/will be sought from the Public Benefit and Privacy Panel for health and social care in Scotland for the case note review,survey and routine data analysis elements of the evaluation. The findings will be prepared as reports to the funders and presented at conferences. It will be submitted for publication in peer-reviewed journals.

Background Sickle cell disease (SCD) is a common haematological disorder, affecting millions of people worldwide. It is most prevalent in malarial endemic areas in the tropics where outcomes are often poor due to resource constraints, resulting in most children dying before reaching adulthood. As increasing progress is made towards reducing under 5 mortality from infectious causes, non-communicable diseases (NCDs) including SCD have risen to the forefront of the global health agenda. Despite this, the global mortality burden of SCD remains poorly understood. This study aimed to estimate the incidence and mortality of SCD in children under 5 years of age in order to inform policy and develop sustainable strategies to improve outcomes. Methodology We performed a systematic literature search of Medline, EMBASE, Journals@Ovid, and Web of Science for studies on the incidence and mortality of SCD in children under 5, with search dates set from January 1980 and July 2017. We conducted random effects meta-analysis to obtain pooled meta-estimates of birth prevalence and mortality rates globally, and for each World Health Organization (WHO) region. Results 67 papers were found with relevant data. 52 contained data on incidence and prevalence and 15 contained data on mortality. The overall pooled estimate of mortality from the limited data available was 0.64 per 100 years of child observation (95% CI = 0.28-1.00) with the highest rate seen in Africa 7.3 (95% CI = 4.03-10.57). The global meta-estimate for the birth prevalence of homozygous sickle cell disease was 112 per 100 000 live births (95% CI = 101-123) with a birth prevalence in Africa of 1125 per 100 000 (95% CI = 680.43-1570.54) compared with 43.12 per 100 000 (95% CI = 30.31-55.92) in Europe. Conclusion There were a number of limitations in the depth and breadth of available data however it is clear that both the highest prevalence and highest mortality of SCD is in Africa. In order to address this burden, there is a need for national comprehensive newborn screening to identify patients, and the development of holistic SCD care programmes to provide therapeutics and education for families and children with SCD. This targeted funding should form part of a broader increased global focus on NCDs in childhood.

The city of Vijayanagara was the capital of a vast south Indian empire from the 14th through 16th century A.D. The authors use historic, epigraphic, and archaeological evidence to examine Vijayanagara control at the imperial capital. They argue that imperial control should best be viewed as multidimensional and variable in emphases and success over time and space. They focus on three dimensions of Vijayanagara control: ideology, militarism, and the production and distribution of agricultural and nonagricultural resources. While the first two do yield evidence for imperial intervention and concern, there is little evidence for direct control of production or distribution of either staple or wealth goods.