A systems map of the determinants of child health inequalities in England at the local level

Jessiman, Tricia; Powell, Katie; Williams, Philippa; Fairbrother, Hannah; Crowder, Mary; Williams, Joanna G.; Kipping, Ruth

doi:10.1371/journal.pone.0245577

Cited by 20 publications

(26 citation statements)

References 39 publications

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“…Attendance rates were high and were higher for phone appointments than for face-to-face ones; the only sex difference was that women aged 20-24 had higher rates than men; for first phone appointments, this sex difference disappeared and was much reduced for follow-ups. In contrast to research showing persistent and systemic child health inequalities in the UK, 22 there was little variation in appointment numbers by IMD quintile.…”

Section: Summary Of Resultscontrasting

confidence: 84%

Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study

et al. 2022

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ObjectivesTo describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people.SettingAll National Health Service (public) hospitals in England.ParticipantsAll people in England aged <25 years.Outcome measuresOutpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation.ResultsCompared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages.ConclusionsCOVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.

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Section: Summary Of Resultscontrasting

confidence: 84%

Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study

et al. 2022

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“…Both online and face-to-face focus groups followed the same format (introductions, warm-up activity, main activity (in smaller breakout groups) and close and cool-down activity). The first focus group used a participatory concept mapping activity (for example see Jessiman et al 2021 [ 40 ]) to explore perceptions of what influences young people’s opportunities to be healthy in their local area (see Supplementary File S2 for an example of a map developed from participants’ discussions). The second looked at understandings of inequalities in health.…”

Section: Methodsmentioning

confidence: 99%

‘It All Kind of Links Really’: Young People’s Perspectives on the Relationship between Socioeconomic Circumstances and Health

Fairbrother

Woodrow

Crowder

et al. 2022

IJERPH

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Meaningful inclusion of young people’s perceptions and experiences of inequalities is argued to be critical in the development of pro-equity policies. Our study explored young people’s perceptions of what influences their opportunities to be healthy within their local area and their understandings of health inequalities. Three interlinked qualitative focus group discussions, each lasting 90 to 100 minutes, with the same six groups of young people (n = 42) aged 13–21, were conducted between February and June 2021. Participants were recruited from six youth groups in areas of high deprivation across three geographical locations in England (South Yorkshire, the North East and London). Our study demonstrates that young people understand that health inequalities are generated by social determinants of health, which in turn influence behaviours. They highlight a complex interweaving of pathways between social determinants and health outcomes. However, they do not tend to think in terms of the social determinants and their distribution as resulting from the power and influence of those who create and benefit from health and social inequalities. An informed understanding of the causes of health inequalities, influenced by their own unique generational experiences, is important to help young people contribute to the development of pro-equity policies of the future.

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“…The changing relationships between ActEarly and the local communities are also captured through mapping ActEarly projects and their links with individuals and partner organisations. We will use Jessiman et al’s [31] systems map of the determinants of child health inequalities in England at the local level as a starting point to develop specific ‘child health’ maps for Bradford and Tower Hamlets. Following an initial ‘proof of concept’ exercise to review the existing child health map [31] within the ActEarly team and partners, we will conduct two workshops with key ActEarly stakeholders to consider where ActEarly is operating within the map.…”

Section: Methodsmentioning

confidence: 99%

“…This approach will further investigate whether, why or how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. In addition to interviews and document analysis, we will employ ripple effects [33] and systems mapping [31] techniques to support the systematic analysis of multiple interventions. Details of the approach we will use to address each evaluation question (1, 2a-g, 3a-b) is displayed in Table 1 and discussed in further detail in the 'Methods and analyses in depth' section.…”

Section: Stage 4: Monitoring Dynamic Programme Output At Different Sy...mentioning

confidence: 99%

Meta-evaluation of a whole systems programme, ActEarly: A study protocol

Mansukoski

Lockyer

Creaser

et al. 2023

Preprint

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Introduction Living in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (>20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme’s impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making. Methods The ActEarly meta-evaluation will follow and adapt the five iterative stages of the ‘Evaluation of Programmes in Complex Adaptive Systems’ (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model (“LifeSim”) will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly’s dynamic programme outputs at different system levels and measure the programme’s system changes on early life health and well-being. Discussion This meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS-framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose.

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A systems map of the determinants of child health inequalities in England at the local level

Cited by 20 publications

References 39 publications

Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study

Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study

‘It All Kind of Links Really’: Young People’s Perspectives on the Relationship between Socioeconomic Circumstances and Health

Meta-evaluation of a whole systems programme, ActEarly: A study protocol

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