Mackenzie Mhairi
Department of Urban Studies, University of Glasgow, 25 Bute Gardens, Glasgow G12 8RS, UK.
Soc Sci Med. 2008 Sep;67(6):1028-37. doi: 10.1016/j.socscimed.2008.05.021. Epub 2008 Jun 21.
Public health policy has arguably taken a new direction in the UK since 1997. This is typified by a review of the public health workforce. A key profession within this workforce is that of health visiting. Starting Well, a Scottish National Health Demonstration Project is one attempt to develop the public health role of health visitors. The project aimed to improve child health by providing intensive home visiting to families in Glasgow. This paper reports on a process study focused on whether Starting Well, an intervention exemplifying contemporary public health policy, could be operationalised through health visiting practice. Semi-structured interviews were conducted with a purposive sample of 44 staff responsible for developing and implementing the programme. Whilst greater contact with families allowed health visitors to develop their understanding of the life circumstances of their case-load families, the evaluation raised issues about the feasibility of systematically changing practice and demonstrated the difficulties of implementing an approach that relied as much on individual values and organisational context as formal guidelines and standardised tools. Furthermore, the ability of the systems and structures within which practitioners were operating to facilitate a broad public health approach was limited. The policy context for public health demands that increasing numbers of health workers are familiar with its principles and modus operandi. It remains, however, a contested area of work and its implementation requires change at a number of levels. This has implications for current policy assumptions about improving population health.
自1997年以来，英国的公共卫生政策可谓朝着新方向发展。这一点在对公共卫生工作人员的审查中得到了体现。该工作人员队伍中的一个关键职业是健康访视。“良好开端”是苏格兰国家卫生示范项目，是为发展健康访视员的公共卫生角色所做的一次尝试。该项目旨在通过为格拉斯哥的家庭提供密集的家访来改善儿童健康。本文报道了一项过程研究，重点关注“良好开端”这一体现当代公共卫生政策的干预措施能否通过健康访视实践得以实施。对44名负责制定和实施该项目的工作人员进行了有目的抽样的半结构化访谈。虽然与家庭的更多接触使健康访视员能够加深对其工作对象家庭生活状况的了解，但评估提出了系统性改变实践的可行性问题，并表明实施一种既依赖个人价值观和组织背景又依赖正式指南和标准化工具的方法存在困难。此外，从业者所处的系统和结构促进广泛公共卫生方法的能力有限。公共卫生的政策背景要求越来越多的卫生工作者熟悉其原则和运作方式。然而，这仍然是一个存在争议的工作领域，其实施需要在多个层面进行变革。这对当前关于改善人群健康的政策假设具有启示意义。
