Health visitor and community health nurse perspectives of supporting parents caring for unsettled babies: a qualitative interview study

Abstract Objectives: The aims of this study were to explore how health visitors (HVs) and community health nurses (CHNs) assess unsettled baby behaviours, how their perceptions of these behaviours influence decisions about support offered, and how able they feel to deliver support to families of unsettled babies. Design: Qualitative semi-structured interviews were conducted, recorded and transcribed. Data were analysed using Reflexive Thematic Analysis. Setting: Potential participants were invited nationally via social media and via Health Visiting Service managers from an NHS Trust. Interviews took place remotely. Participants: 17 HVs and 3 CHNs were purposively selected to include a wide range of perspectives. Results: Three themes were developed, (1) HVs' perceptions of parents' sense-making which explains how HVs/CHNs understand parents' beliefs around unsettled babies; (2) care pathway which highlights the importance HVs place on creating emotional space for the baby, the parent and the health visitor within the pathway (containment); and (3) service delivery decline, which outlines the impact of funding cuts to the services on the HVs' ability to provide support for families. Lastly, a new concept - the Tipping Point model - was created to holistically conceptualise the experiences of HVs providing support for unsettled babies in the UK. Conclusions: Policy makers need to organise services to value and support the role of the health visiting team in 'containment'. HVs identified a training need around assessing and advising about unsettled babies to place them in a stronger position to support families. Further research is needed into different models of support for families of unsettled babies from the wider primary care team and/or from digital services.