Related Experiment Video
Updated: Aug 16, 2026
Measuring the Functional Abilities of Children Aged 3-6 Years Old with Observational Methods and Computer Tools
Published on: June 20, 2020
Evaluation of a universal 3-4 month Healthy Child Programme visit in a local area of England: a mixed methods study
Nathan Davies1, Denise Kendrick2, Jessica Eve Jackson3
1Nottingham Centre for Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Hucknall Road, Nottingham, NG5 1PB, UK.
Insights
An early 3-4 month child review improved problem-solving skills, with 80% uptake. While broadly acceptable, consistent maternal mood assessment and clear visit purpose are needed for optimal child development support.
Area of Science:
- Child health and development
- Public health interventions
- Early years support
Background:
- The standard Healthy Child Programme has a long interval between 6-8 week and 9-12 month reviews, potentially delaying crucial interventions.
- An additional universal 3-4 month review was piloted in Rotherham to enhance early identification of parent and child needs and support development.
- This study evaluates the reach, acceptability, and impact of this early review on developmental outcomes.
Purpose of the Study:
- To assess the uptake and equity of the universal 3-4 month review across different socioeconomic factors.
- To examine the association between the early review and child developmental outcomes, specifically problem-solving skills.
- To explore parent and healthcare professional perspectives on the review's acceptability and implementation.
Main Methods:
- A mixed-methods approach combining administrative data analysis and qualitative interviews/focus groups with parents, nursery nurses, and commissioners.
- Statistical analysis using mixed-effects logistic regression to evaluate uptake and maternal mood recording associations.
- Comparison of Ages and Stages Questionnaire (ASQ-3) scores at 9-12 months between children eligible for the early review and a pre-intervention cohort.
Main Results:
- The review achieved approximately 80% uptake, equitable across deprivation and ethnicity but lower for multiparous mothers.
- Maternal mood recording was lower for younger mothers (<20 years) and multiparous mothers.
- Children attending the review showed higher odds of scoring above the problem-solving cut-off on the ASQ-3 at 9-12 months.
Conclusions:
- The universal 3-4 month review is broadly acceptable and positively associated with improved problem-solving development in children.
- Key areas for improvement include clearer communication of the visit's purpose and ensuring consistent maternal mood assessment.
- Addressing capacity pressures for healthcare staff is also essential for sustained implementation.
Objectives:
The interval between the 6-8 week and 9-12 month mandated reviews in the Healthy Child Programme is lengthy and may lead to delayed intervention. In Rotherham, northern England, an additional universal 3-4 month review was introduced to support child development and earlier identification of parent and child needs. We aimed to evaluate its reach, acceptability, and association with developmental outcomes.
Study Design:
Mixed methods study using administrative records, qualitative interviews and focus groups with parents (n = 31), nursery nurses (n = 7), and commissioners (n = 4).
Methods:
The association between uptake and recording of maternal mood by deprivation, ethnicity, maternal age, and parity for babies aged 3-4 months between January 2024 andFebruary 2025 was analysed using mixed-effects logistic regression. Developmental outcomes were compared (Ages and Stages Questionnaire (ASQ-3) scores at 9-12 months) for children eligible for the universal review versus pre-intervention cohort. Qualitative data were analysed using the Consolidated Framework for Implementation Research.
Results:
Uptake was approximately 80%, around 15% points lower than mandated reviews. Uptake was equitable across deprivation and ethnicity but lower among multiparous mothers (adjusted odds ratio (AOR) 0.29, 95% CI 0.22-0.37). Maternal mood recording was lower for mothers <20 years and for multiparous mothers (AOR 0.78, 95% CI 0.64-0.94). At 9-12 months, eligible children had higher odds of scoring above the close monitoring cut-off for problem solving (AOR 1.41, 95% CI 1.03-1.93), with no significant differences in other ASQ-3 domains. Parents valued reassurance, tailored developmental advice, and local signposting, though some noted inconsistent advice, maternal mood assessment and unclear visit purpose. Staff endorsed the visit's developmental focus but reported capacity pressures.
Conclusions:
The universal 3-4 month review was broadly acceptable, and associated with higher ASQ-3 problem-solving scores. Communicating visit purpose and consistent mood assessment is required.
