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What is usual care for teenagers expecting their first child in England? A process evaluation using key informant mapping and participant survey as part of the Building Blocks randomised controlled trial of specialist home visiting
  1. Michael Robling1,
  2. Rebecca Cannings-John1,
  3. Sue Channon1,
  4. Kerenza Hood1,
  5. Gwen Moody1,
  6. Ria Poole2,
  7. Julia Sanders3
  1. 1 Centre for Trials Research, Cardiff University, Cardiff, UK
  2. 2 School of Medicine, Cardiff University, Cardiff, UK
  3. 3 School of Healthcare Sciences, Cardiff University, Cardiff, UK
  1. Correspondence to Prof Michael Robling; roblingmr{at}


Objectives We compared the US-derived Family Nurse Partnership (FNP) home visiting programme when added to usually provided health and social care for first-time teenage mothers, to usual care alone. We aimed to: establish the nature of usual care, measure service usage and assess performance bias in core usual care services.

Design Within trial process evaluation. Local professionals completed a survey mapping local health and social care services in seven domains. This focused on services available to young women, especially those relevant to pregnant teenagers. Descriptive data were assessed thematically to establish the range of services. Quantitative data collection with FNP supervisors enumerated service provision by site. Services identified were included in main participant trial follow-up interviews at four time points to quantify usage. Usage was described descriptively by domain. We explored predictors of health visitor visits.

Setting 18 partnerships of local authority and healthcare organisations in England.

Outcomes Descriptive framework of services. Rates of service usage reported by trial participants.

Results 161 separate services were identified, with multiple service models in each domain, broadly categorised as universal or specialist (eg, for teenage mothers). FNP supervisors identified 30–63 universal services per site and 22–67 specialist services. Use of core maternity care services was similar across trial arms and with only small differences in use of health visiting services. Participants accessed a wide range of services. Women who had ever been homeless, who had a higher subjectively defined social status, and poorer mental health received more visits from a health visitor.

Conclusions The large number of services available to teenage mothers in England may limit the incremental benefit achievable through enhanced home visiting. There was little evidence of compensatory practice, such as additional care for women in the usual care arm. Measuring usual care when trialling complex interventions is challenging and essential.

Trial registration number ISRCTN23019866.

  • organisation of health services
  • paediatrics
  • child protection
  • public health

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  • Contributors MR, KH and JS conceived the study and all authors contributed to the development of its protocol. MR wrote the first draft with further contributions from all authors. RP, JS and GM were involved in data collection and management. RP was responsible for developing the survey of local stakeholders, and GM was responsible for managing data collected from trial participants used in the analysis. RP, RC-J, GM and MR were involved in analysis and developing summary tables for publication. SC and JS were responsible for the management of this package of work within the trial overall. MR was responsible for obtaining study funding. All authors contributed to data interpretation, reviewed successive drafts and approved the final version of the manuscript.

  • Funding The Centre for Trials Research, Cardiff University is funded by the Welsh Government through Health and Care Research Wales and the authors gratefully acknowledge the Centre’s contribution to study implementation. This is an independent report commissioned, sponsored and funded by the Policy Research Programme in the Department of Health (reference no. 006/0060).

  • Competing interests Prior to working on the Building Blocks trial, SC facilitated two workshops on motivational interviewing for supervisors within the FNP.

  • Patient consent Not required.

  • Ethics approval The trial was approved by the Wales NHS Research Ethics Committee (09/MRE09/08) and received governance approval from all participating NHS sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets generated and analysed during the current study are not publicly available as contributors/participants may be identifiable and are also subject to sponsor approval, but may be available from the corresponding author on reasonable request.

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