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Trusting relationships, nurtured through health visiting, is key to building parental confidence

16th September 2013

Research carried out by the National Nursing Research Unit at King’s College London has revealed good health visiting makes parents feel ‘known’, respected and really listened to, confirming earlier work by the NNRU that health visitors deliver real benefits to patients and families.

There has been very little research into users’ (i.e. parents’) experiences of health visiting services. This study interviewed 44 parents, in two different locations in England. The research showed the importance of trusting relationships, nurtured through health visiting, which help to build parental confidence and promote parents’ trust in their own decisions about child and family health.

Families expressed their desire for more and better co-ordination between services, especially at key times such as the transfer from midwifery to health visiting care and, for very vulnerable infants, on discharge from medical care.

Health visiting help, tailored to individual family circumstances and needs, was especially valued. Parents were very positive about home visits, but this research also drew attention to the high value afforded to centre-based services, such as health visitor-led child health clinics, which were seen as an important source of information and advice, as well as providing a gateway to other services.

Whether the service was offered in the home or out of it, or was delivered by a health visitor or health visiting team member, continuity, good co-ordination and trusting relationships were key to building parental confidence.

The project was led by Dr Sara Donetto with support from Professor Jill Maben, Director of the NNRU and Professor Dame Sarah Cowley, Emeritus Professor of Community Practice Development and Health Visitor, who was honoured with a DBE in the 2013 New Year’s Honour’s list for services to health visiting.


Dr Donetto said:

“This study highlighted the value of the in-depth qualitative exploration of parents’ experiences of health visiting services. Parents in this study gave us very clear insights into the professional approaches and the forms of service organisation that they found more or less helpful in supporting the health and wellbeing of their children and families. 

Tailored support, caring relationships, person- and family-centred practices, effective information and co-ordination of services were central aspects of supportive and enabling health visiting. The local organisation of services and the complementarity of service provision at home and outside the home were crucial in determining the extent to which parents perceived the service as a valuable and accessible resource.”

Professor Cowley said:

“Health Visitors play an essential role in supporting new parents and families, so they can make the best use of services and access help if and when they need it. The role health visitors have, such as helping mothers to feel more confident and to interact with their child, can have huge benefits for both parent and infant. Their one-to-one relationship with parents puts them in a unique position to offer health advice and support and they can often help families who may struggle to access services ordinarily. Uniquely, this study showed that parents can also benefit from good relationships with other team members, where the health visitor is clearly leading a well-co-ordinated team”


The project included a narrative review of the literature and an empirical research study conducted individual semi-structured interviews with 44 parents – 42 of whom were mothers – who had experienced health visiting services provided by health visiting teams at two sites in England. 

In particular, the study focused on trying to understand experiences of additional support for families who need extra health visiting input for a limited amount of time. Parents valued some continuity of contact with the same health visiting team member, which meant advice was better tailored and better accepted. Being given time and attention by a busy health visiting team member helped to develop trust and self-reliance.

When parents felt judged for their parenting approaches or lifestyle choices, or they perceived the advice to be ‘by the book’ and not tailored to their family’s circumstances, they became sceptical, which could affect subsequent encounters. Expressions of praise and reassurance from health visitors and health visiting team members helped parents to develop their self-confidence and trust in their judgement as parents. Fathers’ engagement with health visiting is a complex process which needs further study.

The report includes recommendations for researchers, community health organisations, and policy-makers.


Professor Viv Bennett, Director of Nursing at the Department of Health and Public Health England, said:

“Parents and parent groups tell us that on-going support from known health visitors is important. This report confirms this key role of health visitors and shows how services can be provided which parents find acceptable and how to maximise the impact of health visiting in building confidence for positive parenting which evidence shows is so vital for a healthy start and developing emotional resilience, which gives the best life choices. The report demonstrates that the direction of travel is the right one and helpfully draws attention to the needs of fathers; to the way the service is organised and the need to strengthen links between midwifery care and health visiting in the antenatal period.”

Health visiting: the voice of service users – Learning from service users’ experiences to inform the development of UK health visiting practice and services is available on the National Nursing Research Unit’s website (

This research was funded by the Department of Health Policy Research Programme. This is an independent report commissioned and funded by the Policy Research Programme in the Department of Health. The views expressed are not necessarily those of the Department.


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