In support of Sober October, we are delighted to share this Voices blog by Professor Lesley Smith (Professor of Women’s Public Health, Department of Nursing and Midwifery, Faculty of Health Sciences, University of Hull). Lesley shares the latest update on the PARENT research project which shows how health visitors can better support parents by asking about their alcohol use.

New research shows how health visitors can better support parents by asking about their alcohol use

Harmful alcohol use is a public health problem in the UK. Healthcare services can address this by asking people about their alcohol consumption. The PARENT research project led by a team at the University of Hull, in collaboration with the Institute of Health Visiting (iHV), found that there are opportunities within the Healthy Child Programme to have a conversation about alcohol with parents/ carers, and that an alcohol care pathway would enhance health visitors’ practice on this topic. PARENT research took place in Yorkshire, Humber and Derbyshire. 

Background to the DeveloPing an Alcohol Risk rEduction pathway with pareNts and health visiTors (PARENT) project

Alcohol consumption and parenthood can be a concern when we think about the effects it can have on the physical and mental health of parents and children, and on parenting and family dynamics. Alcohol use during pregnancy can negatively impact babies' and children’s health and wellbeing. Research has shown that the UK is among the countries with the highest reported alcohol use, before finding out about the pregnancy or during the rest of the pregnancy.

Because health visitors engage with families from pregnancy until a child turns five-years-old, they have a unique opportunity to engage with parents in conversations about alcohol consumption and to provide advice during the interpregnancy period. However, our literature review¹ showed that health professionals often do not feel adequately prepared to speak to women about their alcohol use in relation to periconception health (health at the time around when a baby is conceived – including the time before conception and the early weeks of pregnancy).

Practitioners wanted bespoke training and tools to support strengths-based discussions, and clearer policy guidance and pathways to inform their clinical practice. Importantly, the review also looked at the views of women about health professionals asking them about their alcohol habits in relation to pregnancy intentions and found that they were open to receiving advice if it was part of a reproductive health appointment. This led us to developing the PARENT study to understand health visitors’ practices around asking about alcohol consumption with parents/ carers during routine contacts; the perspectives of parents about this; and what an alcohol care pathway to support clinical practice within the Healthy Child Programme might look like.

What do Health Visitors currently do?

In this study, we gathered information in four stages: an online survey which 394 health visitors across England responded to; focus groups with 19 health visitors from Yorkshire, Humber and Derbyshire; in-depth interviews with 19 parents from the same regions; and a co-production workshop with 28 stakeholders (including parents) to explore what a pathway might look like.

Health visitors told us that conversations about alcohol already happen, particularly during pregnancy. But our findings suggest that these discussions can easily slip down the agenda once a baby is born. Whilst 90% of health visitors reported always or usually asking about alcohol during the antenatal visit, this fell to 58% by the 6-8-week review. At the same time, many health visitors reported having limited training and few tools to support their practice. This suggests that health visitors often navigate these conversations on their own.

When we asked health visitors, they told us that alcohol is often woven into other topics such as safe sleeping or breastfeeding as this can feel like a more natural and less intrusive way to raise the subject.

"My conversations around alcohol, especially for antenatals and new births, tie in around safe sleep."

However, health visitors also described a number of challenges. Many worried about adding yet another topic to scheduled contacts that are already packed with information for new parents. Others felt that organisational priorities, and the role being primarily focused on infant health and safeguarding left less space for conversations about parental health and wellbeing.

Parents, meanwhile, emphasised the importance of trust, and tailoring the approach to avoid a tick-box exercise. Our findings suggest that conversations about alcohol should be approached sensitively, without judgement, and within the context of a supportive relationship. Rather than targeting particular groups of parents, asking all parents routinely could help to normalise these discussions and reduce stigma.

"It is how she asked me, made me feel more comfortable...this is what we ask people. It’s not just that I am asking you..."

What could a pathway look like and what are we doing next?

These insights shaped our thinking about what an alcohol care pathway should look like: one that supports health visitors to have confident, compassionate conversations that place family health and wellbeing at the centre. We will be refining the pathway and testing it out in Yorkshire, Humber and Derbyshire over the next year.

📢Call to action

Learning from the research has demonstrated a clear need for all health visiting teams to consider their current practice in asking and providing support to parents and carers about alcohol use. Consider what you are currently offering, what training have you or your teams had?  What are your local pathways for support?

Look out for further updates on the PARENT study to inform your local delivery.

Join our PARENT project findings Webinar

Join us online to hear our findings from the PARENT research project which developed an alcohol risk reduction pathway in health visiting.

🗓️2 November
🕒3-5pm

Professor Lesley Smith (Professor of Women’s Public Health, Department of Nursing and Midwifery, Faculty of Health Sciences, University of Hull).

References

¹ Smith L, Hilton A, Walker J, Alfred L, Ahankari A, Schölin L. Prevention of alcohol related harm though preconception care: A scoping review of barriers and enablers. Dialogues Health. 2022 Aug 27;1:100040. doi: 10.1016/j.dialog.2022.100040. PMID: 38515881; PMCID: PMC10953971.

Footnote: This project is funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR207127). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care