Design, Development, Implementation
Health Services Executive (HSE)
CES used implementation science to design, plan and support the HSE to implement a new child health programme aimed at supporting parents before pregnancy and during the first three years of their child’s life. An independent evaluation showed positive feedback from parents and the professionals involved in delivering the Nurture Programme.
The first three years of a child’s life lay the foundation for their health, development and future. During this time parents engage with many different professionals and services. Professional development, consistent public information messages and standard approaches benefit practitioners, parents and babies. Through funding from philanthropy, the Health Service Executive (HSE) engaged CES and the Katharine Howard Foundation to help design and deliver the Nurture Programme. The programme aimed to support parents before, during and after their pregnancy through standardised practice in universal child health and wellbeing services.
Understand the challenge
The team began by gathering evidence from a wide range of perspectives and subject areas to inform decision making on the programme. They produced rapid evidence reviews, facilitated workshops, and designed consultations with professionals and parents.
Design the approach
Understanding that the views of parents, providers and professionals were essential to success, CES helped to conduct and analyse extensive consultation with those delivering on the service, along with parents using it. Over 4,000 parents were consulted through surveys and focus groups, taking account of a wide range of factors including education, culture and literacy.
"Implementation science was overwhelmingly considered to be a beneficial framework. It was appreciated for being stage-based, focusing attention on change enablers, drivers and barriers within the HSE…"
(Process Evaluation of the Nurture Programme, Quality Matters)
Throughout the design and implementation of the programme we drew from our knowledge of Implementation Science. Implementation teams are widely recognised as enabling implementation of large programmes like the Nurture Programme. With help from CES, six implementation teams were established, involving over 100 professionals from the child health workforce, bringing together skills in everything from public health nursing to midwifery and knowledge and communications.
The team supported implementation of the programme through the teams and also helped plan sustainability.
CES worked with the programme over a five-year period. Consultations with professionals and service users took part at different stages, not just at the beginning. Staff engagement was critical to introducing new approaches and tools, to embed and make them sustainable. Professional training and usability testing helped to demonstrate a wider commitment to staff engagement and encourage buy in.
The Nurture Programme was evaluated by Quality Matters together with Dublin City University. The evaluation showed a positive impact from the Programme, for example better information for parents, more consistency across services and the quality of antenatal education was reported to have improved. The Nurture Programme won the ‘Improving Our Children’s Health’ category at the 2020 Health Service Excellence Awards.
In addition, a process evaluation of the Programme was conducted to capture and share learning from the introduction of a large-scale health programme with other service providers.
The work of Nurture will continue to be implemented and further developed as part of the HSE’s National Healthy Childhood Programme.
The CES Nurture Programme combined practitioner expertise with implementation science expertise.