Baldwin Sharin, Fanner Michael, Beauchamp Hilda, Gilroy Vicky, Morton Alison, May Carl, Barlow Jane
Innovation & Research, Institute of Health Visiting, London, UK
School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.
BMJ Paediatr Open. 2025 Mar 18;9(1):e002997. doi: 10.1136/bmjpo-2024-002997.
The Alarm Distress Baby Scale (ADBB) is a validated observation tool, designed for use by healthcare practitioners to identify infant social withdrawal. A modified version (m-ADBB) was later developed as a clinically useful behavioural tool. However, neither version has been tested in the UK context. This study aimed to test the feasibility and acceptability of using the ADBB and m-ADBB within universal health visiting practice in England.
A mixed methods convergent parallel design was used. Five health visitors were trained in the ADBB and 20 in the m-ADBB, from two National Health Service (NHS) community sites in England. Quantitative data were collected from health visitors, while qualitative semistructured interviews were conducted with health visitors and service managers, guided by Normalisation Process Theory (NPT). Thematic analysis was used to analyse the qualitative data and descriptive analysis for the quantitative data. NPT provided a framework for analysing the implementation process in routine health visitor practice.
The m-ADBB was used with 225 babies and behaviour concerns were identified in 23 babies (10%). Eleven themes were identified, aligned with the four NPT constructs: (1) Coherence: perceived uniqueness of the scale, new vocabulary for articulating baby behaviour, enrichment of existing knowledge and skills; (2) Cognitive participation: commitment to the use of the ADBB/m-ADBB, consolidation of new practice; (3) Collective action: implementation of the m-ADBB scale in routine practice, organisation and management support, existing systems and pathways for children and families and (4) Reflexive monitoring: perceived benefits of integrating the scales in practice, quality assurance for embedding the scales in practice, appraisal of the training and scales in practice.
The ADBB/m-ADBB was perceived to have enhanced the health visitors' skills and knowledge in infant observation. The m-ADBB required minimal additional time and was highly acceptable to health visitors. These findings have significant implications for health visiting practice and future research.
警报苦恼婴儿量表（ADBB）是一种经过验证的观察工具，供医疗从业者用于识别婴儿社交退缩情况。后来开发了一个修订版（m - ADBB）作为一种具有临床实用性的行为工具。然而，这两个版本都未在英国背景下进行过测试。本研究旨在测试在英格兰全民健康访视实践中使用ADBB和m - ADBB的可行性和可接受性。
采用了混合方法收敛平行设计。从英格兰的两个国民健康服务（NHS）社区站点中，有5名健康访视员接受了ADBB培训，20名接受了m - ADBB培训。从健康访视员那里收集定量数据，同时在规范化过程理论（NPT）的指导下，对健康访视员和服务经理进行定性半结构化访谈。采用主题分析法分析定性数据，对定量数据进行描述性分析。NPT为分析常规健康访视实践中的实施过程提供了一个框架。
m - ADBB应用于225名婴儿，在23名婴儿（10%）中发现了行为问题。确定了11个主题，与NPT的四个构建要素一致：（1）连贯性：量表的独特性感知、用于描述婴儿行为的新词汇、对现有知识和技能的丰富；（2）认知参与：对使用ADBB/m - ADBB的承诺、新实践的巩固；（3）集体行动：在常规实践中实施m - ADBB量表、组织和管理支持、针对儿童和家庭的现有系统和途径；（4）反思性监测：在实践中整合量表的感知益处、将量表嵌入实践的质量保证、对培训和实践中量表的评估。
ADBB/m - ADBB被认为提高了健康访视员在婴儿观察方面的技能和知识。m - ADBB所需额外时间极少，且健康访视员对其接受度很高。这些发现对健康访视实践和未来研究具有重要意义。
