Chadd Katie, Malik Mariam, Kapilashrami Anuj
School of Health & Social Care, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK.
Centre for Global Health & Intersectional Equity Research, Institute for Public Health & Well- being, Knowledge Gateway, University of Essex, Clingoe House, Wivenhoe Park, Colchester, Essex, CO4 3ZL, UK.
BMC Public Health. 2025 Mar 10;25(1):947. doi: 10.1186/s12889-025-22183-8.
Early years interventions are critical to children's health and development and are emerging as core to public health programmes in the UK and globally. Evaluating such interventions is complex. The study reported in this article evaluates a place-based public health initiative 'A Better Start Southend' (ABSS) aimed at facilitating early years' development specifically. It centres on examining the access barriers and facilitators experienced by parents and young children, as perceived by health professionals providing these services.
This paper illustrates the utilisation of participatory action research (PAR) approach, employing creative methods, including spider grams, service mapping and photovoice, with health professionals delivering ABSS services. PAR methods enabled exploration of community resources that facilitate or impede early childhood development in the local context.
Operationalising PAR yielded critical providers' perspectives on key challenges of delivering these programmes, and the factors that in their view impeded their uptake by families and hence effectiveness. The approach provided space for authentic knowledge production through critical reflexive enquiry, exchange, collaborative dialogue and transformation. Through the process, participants revealed the social and commercial determinants of childhood development and how these determined the reach and success of ABSS. Health professionals especially highlighted poor-quality housing, poor public transport, the cost-of-living crisis and harmful commercial marketing practices as key barriers to promoting good early childhood development. System-wide barriers were also reported and included poor resourcing of health and social care services, lack of culturally and linguistically accessible provisions, and exclusionary practices creating inequitable access to health for many families and children.
PAR is a potentially valuable tool for healthcare evaluations with the ability to generate nuanced reflexive perspectives and considerations that go beyond identifying the outcomes and gaps in interventions. It draws participants into a reflexive process to define pathways for change. Health professionals identified social inequities as the most significant barrier to promoting early childhood development. These inequities were not addressed in the design and implementation of the early year programme under study. The study supports the need for a multi-level, multi-systems and intersectional framework for place-based public health programmes to have the desired impact and reduce inequalities in access to early years interventions.
早期干预对儿童的健康和发展至关重要，并且正在成为英国乃至全球公共卫生项目的核心内容。评估此类干预措施很复杂。本文所报告的研究评估了一项基于地点的公共卫生倡议“绍森德更美好的开端”（ABSS），该倡议专门旨在促进儿童早期发展。它主要关注提供这些服务的卫生专业人员所感知到的家长和幼儿遇到的获取障碍及促进因素。
本文阐述了参与式行动研究（PAR）方法的运用，采用了包括蛛网图、服务映射和照片发声法在内的创新方法，与提供ABSS服务的卫生专业人员合作。PAR方法有助于探索在当地背景下促进或阻碍儿童早期发展的社区资源。
实施PAR得出了关键提供者对实施这些项目的主要挑战以及他们认为阻碍家庭接受这些项目从而影响其效果的因素的看法。该方法通过批判性反思探究、交流、协作对话和变革为真实知识的产生提供了空间。通过这个过程，参与者揭示了儿童发展的社会和商业决定因素，以及这些因素如何决定了ABSS的覆盖范围和成效。卫生专业人员特别强调了住房质量差、公共交通不便、生活成本危机以及有害的商业营销行为是促进儿童良好早期发展的关键障碍。还报告了全系统的障碍，包括卫生和社会护理服务资源不足、缺乏文化和语言上可获取的服务以及排他性做法导致许多家庭和儿童无法公平获得医疗服务。
PAR对于医疗保健评估而言是一种潜在的有价值工具，它有能力产生细致入微的反思性观点和思考，而不仅仅是识别干预措施的结果和差距。它促使参与者进入一个反思过程以确定变革途径。卫生专业人员将社会不平等视为促进儿童早期发展的最重大障碍。在所研究的早期项目的设计和实施过程中，这些不平等问题并未得到解决。该研究支持需要一个多层次、多系统和交叉性的框架来实施基于地点的公共卫生项目，以产生预期影响并减少获取早期干预措施方面的不平等现象。
