McSweeney Lorraine, Bateson Karen, Hamilton Wook, Arnott Bronia
Population Health Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
Oxford Parent-Infant Project, Kidlington Centre, Oxford, OX5 2DL, UK.
BMC Health Serv Res. 2025 Aug 2;25(1):1020. doi: 10.1186/s12913-025-13215-5.
The earliest relationships between babies and their caregivers can act as a risk factor for social and emotional wellbeing in infancy and impact on later development. Difficulties in parent-infant relationships (PAIR) are characterised by inequalities, with families experiencing adversity at greater risk. In the absence of support, these relationship problems may require later, more expensive services. Interventions exist to address PAIR difficulties but are not widely commissioned, with regional disparities, and infants being under-served. This project qualitatively explored barriers and enablers to commissioning PAIR services.
Individuals with commissioning responsibilities relating to PAIR working in Clinical Commissioning Groups or Local Authorities in the North East North Cumbria (NENC) region were invited to participate. Qualitative semi-structured interviews were informed by a topic guide developed through practitioner involvement. Nine interviews were completed online between February and April 2022. Anonymised transcripts were analysed using Framework Analysis.
Barriers and enablers to commissioning were general, specific to PAIR services, or related to the pandemic context. General factors included the nature of the commissioning process, the importance of taking a collaborative approach to commissioning and the constraints of funding processes. Commissioners valued being able to demonstrate impact and value for money through service evaluation but faced challenges in doing so. Specific barriers relating to PAIR commissioning included a lack of awareness of the importance of infant mental health although there was an acknowledgement of the importance of maternal and parent-infant services/support during the early years. Factors amenable to change were mapped on to the Behaviour Change Wheel to inform the future co-development of a resource to address barriers and enablers.
This paper is the first to report a pragmatic, applied qualitative exploration of barriers and enablers to commissioning parent-infant relationship services. Insights from commissioners with a wide range of portfolios identified key factors operating at the individual level which were amenable to change. In addition, there were barriers beyond the individual level, such as funding. Using a pragmatic approach, we identified best-fit behaviour change initiatives to develop a commissioning support toolkit to increase access to support, improve outcomes, and decrease inequalities, addressing infants as an under-served group.
婴儿与其照料者之间的早期关系可能成为婴儿期社会和情感幸福的风险因素，并影响其后期发展。亲子关系困难（PAIR）的特点是不平等，经历逆境的家庭面临的风险更大。在缺乏支持的情况下，这些关系问题可能需要后期更昂贵的服务。现有的干预措施旨在解决亲子关系困难，但未得到广泛委托，存在地区差异，且婴儿得到的服务不足。本项目定性探索了委托提供亲子关系服务的障碍和促成因素。
邀请在东北坎布里亚（NENC）地区临床委托小组或地方当局中负责亲子关系工作的人员参与。通过从业者参与制定的主题指南进行定性半结构化访谈。2022年2月至4月期间在线完成了9次访谈。使用框架分析法对匿名访谈记录进行分析。
委托的障碍和促成因素分为一般性、特定于亲子关系服务或与疫情背景相关。一般因素包括委托过程的性质、采取合作委托方式的重要性以及资金流程的限制。委托方重视能够通过服务评估证明影响和性价比，但在这样做时面临挑战。与亲子关系委托相关的具体障碍包括对婴儿心理健康重要性的认识不足，尽管人们承认早年母婴和亲子服务/支持的重要性。将易于改变的因素映射到行为改变轮上，为未来共同开发一种资源以解决障碍和促成因素提供信息。
本文首次报告了对委托提供亲子关系服务的障碍和促成因素进行的务实、应用定性探索。来自具有广泛职责的委托方的见解确定了在个人层面可改变的关键因素。此外，还有个人层面之外的障碍，如资金问题。我们采用务实方法确定了最合适的行为改变举措，以开发一个委托支持工具包，增加获得支持的机会，改善结果，并减少不平等，将婴儿作为服务不足的群体来对待。
