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Updated: Jun 23, 2025

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Development of an outcome indicator framework for a universal health visiting programme using routinely collected

Margaret Horne1, Louise Marryat2,3, D Helen Corby1

  • 1Salvesen Mindroom Research Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.

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|June 14, 2024
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Summary

Scotland developed a new Universal Health Visiting Pathway (UHVP) to improve child health. An indicator framework using routine data was created to evaluate its effectiveness, focusing on key child development outcomes.

Keywords:
Administrative dataFrameworkHealth visitingHome visitingMethodsPublic health nurses

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Area of Science:

  • Public Health
  • Child Development
  • Healthcare Policy

Background:

  • Universal health visiting has been a key part of UK preventative healthcare for over a century.
  • Scotland implemented a new Universal Health Visiting Pathway (UHVP) in 2016, emphasizing early years home visits and developmental assessments.
  • An outcome indicator framework was developed to evaluate the UHVP using routine administrative data.

Purpose of the Study:

  • To describe the development of an outcome indicator framework for evaluating Scotland's Universal Health Visiting Pathway (UHVP).
  • To establish a system for monitoring child health outcomes within the context of evolving health visiting services.

Main Methods:

  • A logic model was created with stakeholders to define outcome domains.
  • Measures were refined through stakeholder discussions and data inspection.
  • Power calculations were performed, and initial data were described for selected indicators.

Main Results:

  • Eighteen indicators were selected across eight outcome areas including parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents/injuries, and child protection.
  • Data quality varied; review coverage was high (>90%), but individual item completion differed (e.g., breastfeeding data at 6-8 weeks: 92.2%, BMI at 27-30 months: 63.2%).
  • Prevalence of outcomes ranged widely, from 1.3% on the Child Protection register to 93.6% receiving all immunisations by age two.

Conclusions:

  • Routinely collected data were used to develop a set of indicators for evaluating the UHVP, minimizing participant burden and response bias.
  • The developed indicator framework supports the assessment of changes in child outcomes within evolving health visiting programs.
  • Further research is recommended to assess the transferability of this indicator framework to different settings.