A Realist Synthesis of Literature Informing Programme Theories for Well Child Care in Primary Health Systems of Developed Economies

Abstract

Introduction: Well-child Care is the provision of preventative health care services for children and their families. The approach, however, to the universal provision of those services is contentious. Methods: We undertook a realist synthesis to enhance understanding of the theoretical mechanisms driving Well-child Care by searching for published and grey literature from multiple databases. Findings: Well-child Care is re-conceptualised as an integrated program delivered in the continuum of pregnancy, infancy and childhood. Depending on the context, Well-child Care can be a policy, a strategy, or an actual clinical practice that promotes child and family health. The main mechanisms include: role, training and continuity of health providers; administrators’ views of the return of investment on achieved outcomes; access to services by families; and the adaptation of programs to meet the dynamic needs of stakeholders. Evidence indicates that for most outcomes, Well-child Care is best delivered in partnerships between community health, social care, and early childhood education sectors. Conclusions: We conclude that Well-child Care policy and program leaders should shift their focus to the integration of: human and physical resources; policy instruments; and shared agreement on outcomes measures across health, social and education sectors. In addition, countries should work towards strengthening universal early education programs and parents’ health literacy regarding child development, health and safety.

Relationship between parents' health literacy and child health: systematic review

“…Parental health literacy might reduce the children's use of General Practitioner and Emergency health services (Perrin et al, 2020). So, Garg et al (2019) have suggested that early education programs should globally focus on increasing parental health literacy for the sake of child health and safety.…”

“…, 2020). So, Garg et al . (2019) have suggested that early education programs should globally focus on increasing parental health literacy for the sake of child health and safety.…”

STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

“…39,44 With the Critical Appraisal Skills Programme, study quality was considered low if half or less than half of the criteria were met, medium if more than half but less than three-quarters of the criteria were met, and high if most were met. 46 The scores were produced, summed and ranked high and medium quality for both randomised and non-randomised studies.…”

Exploring the impact of integrated health and social care services on child health and wellbeing in underserved populations: a systematic review

“…The integrated services that have emerged are delivered by various combinations of health care providers, social care practitioners, community advocates, and public institutions, and situated in a range of central and localised clinical and locality-based settings (20,21). Together they share the aim of providing widely accessible health and social care for CYP and their families that can help treat and manage acute and chronic health care alongside the necessary social support that can help mitigate the social determinants of ill-health such as poor housing, domestic violence, or food poverty (21,22). However, despite widespread investment in these systems in countries such as the United Kingdom (23), evidence of the benefits of integrating health and social care remains inconsistent, particularly amongst underserved CYP (24,25): Little is known of which integrated models are most effective, including the precise combination of services, the specific outcomes they improve, or the impact on the surrounding health economy (26,27).…”

“…The integrated services that have emerged are delivered by various combinations of health care providers, social care practitioners, community advocates, and public institutions, and situated in a range of central and localised clinical and locality-based settings (20, 21). Together they share the aim of providing widely accessible health and social care for CYP and their families that can help treat and manage acute and chronic health care alongside the necessary social support that can help mitigate the social determinants of ill-health such as poor housing, domestic violence, or food poverty (21, 22).…”