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

## TL;DR

This paper outlines the creation of a framework to evaluate a health visiting program for children in Scotland using routine data, aiming to assess outcomes like breastfeeding and immunization rates.

## Contribution

The paper introduces a novel outcome indicator framework for evaluating a universal health visiting program using routinely collected data.

## Key findings

- Eighteen indicators were selected across eight outcome areas, including parental smoking and immunizations.
- Data coverage for key reviews was high, with over 90% of children receiving them.
- Data quality varied, with breastfeeding data at 92.2% completion versus 63.2% for BMI records.

## Abstract

Universal health visiting has been a cornerstone of preventative healthcare for children in the United Kingdom (UK) for over 100 years. In 2016, Scotland introduced a new Universal Health Visiting Pathway (UHVP), involving a greater number of contacts with a particular emphasis on the first year, visits within the home setting, and rigorous developmental assessment conducted by a qualified Health Visitor. To evaluate the UHVP, an outcome indicator framework was developed using routine administrative data. This paper sets out the development of these indicators.

A logic model was produced with stakeholders to define the group of outcomes, before further refining and aligning of the measures through discussions with stakeholders and inspection of data. Power calculations were carried out and initial data described for the chosen indicators.

Eighteen indicators were selected across eight outcome areas: parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents and injuries, and child protection interventions. Data quality was mixed. Coverage of reviews was high; over 90% of children received key reviews. Individual item completion was more variable: 92.2% had breastfeeding data at 6–8 weeks, whilst 63.2% had BMI recorded at 27–30 months. Prevalence also varied greatly, from 1.3% of children’s names being on the Child Protection register for over six months by age three, to 93.6% having received all immunisations by age two.

Home visiting services play a key role in ensuring children and families have the right support to enable the best start in life. As these programmes evolve, it is crucial to understand whether changes lead to improvements in child outcomes. This paper describes a set of indicators using routinely-collected data, lessening additional burden on participants, and reducing response bias which may be apparent in other forms of evaluation. Further research is needed to explore the transferability of this indicator framework to other settings.

The online version contains supplementary material available at 10.1186/s12913-024-11178-7.