Karen Whittaker - Academia.edu (original) (raw)
Papers by Karen Whittaker
Maternal and Child Health Journal, Jan 26, 2023
Objective To explore the predictors of emergency department attendance and admission for mothers ... more Objective To explore the predictors of emergency department attendance and admission for mothers and their infants. Methods Self-reported emergency department (ED) attendance and admission, sociodemographic, mental health, and other measures were recorded at baseline and at 12 months at 4 sites in England between May 2017 and March 2020. Results Infants' gestational age (OR 0.73, 95% CI 0.61 to 0.88, p = 0.001), mothers' mental health (OR 2.40, 95% CI 1.30 to 4.41, p = 0.005) and mothers' attendance at ED (OR 2.34, 95% CI 1.13 to 4.84, p = 0.022) predicted infant ED attendance. Frequency of attendance was predicted by ED site (IRR 0.46, 95% CI 0.29 to 0.73, p = 0.001) and mothers' age (IRR 0.96, 95% CI 0.92 to 1.00, p = 0.028). Infant hospital admissions were predominantly for respiratory (40%) and other infectious diseases (21%) and were predicted by previous health problems (OR 3.25, 95% CI 1.76 to 6.01, p < 0.001). Mothers' ED attendance was predicted by mixed or multiple ethnic origin (OR 9.62, 95% CI 2.19 to 42.27, p = 0.003), having a male infant (OR 2.08, 95% CI 1.03 to 4.20, p = 0.042), and previous hospitalisation (OR 4.15, 95% CI 1.81 to 9.56, p = 0.001). Hospital admission was largely for reproductive health issues (61%) with frequency predicted by having attended the ED at least once (IRR 3.39, 95% CI 1.66 to 6.93, p = 0.001), and being anxious or depressed (IRR 3.10, 95% CI 1.14 to 8.45, p = 0.027). Conclusions for Practice Improving the reproductive and mental health of mothers may help to avoid poor maternal and infant health outcomes and reduce emergency service utilisation and hospitalisation.
Public health research, Jun 1, 2022
is a trustee for Children's Early Intervention Trust (CEIT) (Bangor, Wales). Early Intervention W... more is a trustee for Children's Early Intervention Trust (CEIT) (Bangor, Wales). Early Intervention Wales Training (EIWT) (Bangor, Wales) is owned by CEIT and offers training courses, including Incredible Years ®. Trustees do not benefit financially from trainings or CEIT/EIWT activities.
PLOS ONE
BackgroundA proportionate universal (PU) approach to early years’ service provision has been advo... more BackgroundA proportionate universal (PU) approach to early years’ service provision has been advocated to improve children’s health and development and to reduce health inequality, by ensuring that services provide timely and high-quality parenting support commensurate with need. Process-oriented research is critical to examine the factors that contribute to, or hinder, the effective delivery/implementation of such a model in community-based family services. This study aimed to assess the delivery, acceptability and feasibility of a new PU parenting intervention model (called E-SEE Steps), using the Incredible Years® (IY) parent program, when delivered by trained health/family service staff in three “steps”—one universal step (the IY Babies Book), and two targeted steps (group-based IY Infant and Toddler programs).MethodsAn embedded mixed-methods process evaluation within a pragmatic parallel two-arm, assessor blinded, randomized controlled trial was conducted in community services ...
PLOS ONE
Background Evidence for parenting programs to improve wellbeing in children under three is inconc... more Background Evidence for parenting programs to improve wellbeing in children under three is inconclusive. We investigated the fidelity, impact, and cost-effectiveness of two parenting programs delivered within a longitudinal proportionate delivery model (‘E-SEE Steps’). Methods Eligible parents with a child ≤ 8 weeks were recruited into a parallel two-arm, assessor blinded, randomized controlled, community-based, trial with embedded economic and process evaluations. Post-baseline randomization applied a 5:1 (intervention-to-control) ratio, stratified by primary (child social-emotional wellbeing (ASQ:SE-2)) and key secondary (maternal depression (PHQ-9)) outcome scores, sex, and site. All intervention parents received the Incredible Years® Baby Book (IY-B), and were offered the targeted Infant (IY-I)/Toddler (IY-T) program if eligible, based on ASQ:SE-2/PHQ-9 scores. Control families received usual services. Fidelity data were analysed descriptively. Primary analysis applied intention...
Nurse Education Today, Sep 1, 2022
Journal of Child Health Care
This study aimed to examine how parents develop personal resilience when facing the challenges of... more This study aimed to examine how parents develop personal resilience when facing the challenges of caring for a child with tracheostomy. This study employed a longitudinal qualitative design. Unstructured narrative interviews with 12 parents (from nine families) whose child had a new tracheostomy were undertaken at three time points over 12 months. Data were analysed using a socio-narratology method. Findings reveal the journey parents experienced, how their feelings changed and the processes involved in developing resilience over the first 12 months of their child having a tracheostomy. Stories told by parents early in their journey revealed emotional upheaval, negative emotions, stress and shock. Due to medical need, parents had little or no choice for their child to have a tracheostomy. Once their child’s life was out of danger, parents started to reframe their experiences and beliefs. Resilience played a major part in how parents perceived and faced their situation, allowing them...
This is the second of two papers reporting evidence from a programme of research that focused on ... more This is the second of two papers reporting evidence from a programme of research that focused on how health visiting works, including service user and workforce perspectives. Evidence and professional expertise indicate that a set of essential features enable health visitors to achieve the desired impact of improving child public health. These include organising services in a way that enables positive parent/health visitor relationships, continuity and co-ordination and the flexibility to use professional knowledge and autonomy in practice. Where service specifications give careful attention to this evidence, it is more likely that health visitors will be able to deliver a successful child health programme for the early years.
Archives of Disease in Childhood, 2016
Children with neuropathic bladder are at risk from the short and long term consequences of urinar... more Children with neuropathic bladder are at risk from the short and long term consequences of urinary tract infections. Early identification of infection can reduce morbidity and improve the management. This longitudinal study used a concurrent mixed methods (qualitative and quantitative) research design, to evaluate a telehealth intervention that aimed to support parents to monitor their child’s urine and identify clinical signs of infection. The study was theoretically underpinned by a framework of self-efficacy. The telehealth intervention was run from the children’s urology service within a single paediatric tertiary referral centre. The evaluation aimed to explore stakeholders’ experiences and perceptions of the telehealth intervention. The stakeholders included parents of the index children, clinicians and technical experts. The index children were all aged <5 years and had spina bifida and/or neuropathic bladder. Face-to-face and remote one-to-one interviews, surveys and group interviews were undertaken with key stakeholders at three time points. Secondary data were also utilised. Thematic analysis and structured evaluation analysis were used for the qualitative data. Simple descriptive statistics were used with the quantitative data. Findings show that remote monitoring benefited the children, the parents and the clinicians. The parents were very positive about the benefits accruing from remote monitoring; these benefits included more effective use of parental time and feeling more confident due partly to the ‘hard evidence’ from the print-out of results from the home urine testing. Collectively these experiences contributed to a greater sense of parental control over the daily management of their child’s health which parents identified as empowering. Clinical and technical stakeholders invested considerable time into the set up of the intervention not least in navigating the specific processes for implementing paediatric telehealth. This required a shift in team resources to ensure alerts triggered by the telehealth system received timely responses and appropriate actions. Lessons learned from this intervention include the need to set alerts sufficiently sensitively and the increased workload on top of usual service provision.
'A positive thing by mentioning it': a qualitative study of experiences of brief physical health ... more 'A positive thing by mentioning it': a qualitative study of experiences of brief physical health interventions for individuals diagnosed with severe mental illness in primary care.
Journal of Child Health Care, 2022
Transition services for young people with long-term conditions often fall short. This qualitative... more Transition services for young people with long-term conditions often fall short. This qualitative study explored perspectives on service features that enable effective transition in epilepsy and juvenile idiopathic arthritis. Patients, parents, clinicians and service commissioners took part in semi-structured interviews ( n = 18). Thematic analysis was used to identify key features, barriers and facilitators of effective transition across participant groups. Analysis led to the development of nine sub-themes which mapped to overarching domains of communication, capability, continuity and capacity. Findings include the need for age appropriate communication, the link between parental dependence, self-care and patient knowledge, the value of service integration for continuity and the impact of capacity on flexible and age appropriate transition services.
International Journal of Prisoner Health, 2022
Purpose This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based ch... more Purpose This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based charity) perinatal support in two prison settings in England. The initiative involved the provision of group and/or one-to-one perinatal support and training women prisoners as peer supporters. Design/methodology/approach A mixed-methods study was undertaken that involved observations of support groups and peer support supervision sessions (n = 9); audio recorded interviews (n = 33) with prison and health-care staff, women in prison, peer supporters and BC staff; analysis of existing routinely collected data by BC and notes undertaken during regular meetings (n = 10) with the BC Project Manager. Thematic analysis was undertaken supported by MAXQDA qualitative data analysis software. Findings BC provided instrumental/practical support, emotional support, information support, signposting to services and advocating for women to the prison concerning their perinatal needs and rights. Key theme...
Public Health Nursing, 2022
Health & Social Care in the Community, 2021
The findings from evaluations of parenting programmes can help inform policy and practice decisio... more The findings from evaluations of parenting programmes can help inform policy and practice decisions, including how best to allocate scarce resources designed to support families. However, studies often fail to consider the extent to which the findings can be generalised to other settings or populations. One, yet unexplored solution, is to compare study findings and large-scale data sets including publicly available population data. The aims of this study were to assess the feasibility of assessing sample representativeness using publicly available data and to identify the challenges involved in considering the generalisability of study findings. Sociodemographic data from two community-based evaluations of parenting programmes conducted in England and Ireland between 2015 and 2018 were used in the study (N = 395 parent-infant dyads). The results indicated some differences between the trial samples and the wider population. However, it is difficult to reach definitive conclusions about these findings due to the limitations associated with using the comparative data sets. Our study revealed three key challenges, including: (1) how best to define and conceptualise representativeness; (2) the availability of comparative data sets; and (3) the quality of the available data. Our study suggests that there is a need for up-to-date, good-quality comparative data sets to allow for the assessment of representativeness. Further work is required to identify parameters for making claims about representativeness, specifically regarding the acceptable level of difference between the target population and the study sample. This is the first study to explore the feasibility of using publicly available population data in two jurisdictions, for the purpose of making judgements about the representativeness of the findings from parent programmes. It is hoped that our results will encourage further investigation around the reporting of trial external validity to enable effective decision-making at policy and practice level.
Journal of health visiting, 2021
The organisation of health visitor work is an important part of service design, which can have an... more The organisation of health visitor work is an important part of service design, which can have an impact on when and where services are provided and who gains access. This article reports a 2018 su...
BMJ Open, 2018
Introduction Behavioural and mental disorders have become a public health crisis and by 2020 may ... more Introduction Behavioural and mental disorders have become a public health crisis and by 2020 may surpass physical illness as a major cause of disability. Early prevention is key. Two Incredible Years (IY) parent programmes that aim to enhance child well-being and development, IY Infant and IY Toddler, will be delivered and evaluated in a proportionate universal intervention model called Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE) Steps. The main research question is: Does E-SEE Steps enhance child social emotional well-being at 20 months when compared with services as usual? Methods and analysis E-SEE Steps will be delivered in community settings by Early Years Children’s Services and/or Public Health staff across local authorities. Parents of children aged 8 weeks or less, identified by health visitors, children’s centre staff or self-referral, are eligible for participation in the trial. The randomisation allocation ratio is 5:1 (intervention to cont...
Maternal and Child Health Journal, Jan 26, 2023
Objective To explore the predictors of emergency department attendance and admission for mothers ... more Objective To explore the predictors of emergency department attendance and admission for mothers and their infants. Methods Self-reported emergency department (ED) attendance and admission, sociodemographic, mental health, and other measures were recorded at baseline and at 12 months at 4 sites in England between May 2017 and March 2020. Results Infants' gestational age (OR 0.73, 95% CI 0.61 to 0.88, p = 0.001), mothers' mental health (OR 2.40, 95% CI 1.30 to 4.41, p = 0.005) and mothers' attendance at ED (OR 2.34, 95% CI 1.13 to 4.84, p = 0.022) predicted infant ED attendance. Frequency of attendance was predicted by ED site (IRR 0.46, 95% CI 0.29 to 0.73, p = 0.001) and mothers' age (IRR 0.96, 95% CI 0.92 to 1.00, p = 0.028). Infant hospital admissions were predominantly for respiratory (40%) and other infectious diseases (21%) and were predicted by previous health problems (OR 3.25, 95% CI 1.76 to 6.01, p < 0.001). Mothers' ED attendance was predicted by mixed or multiple ethnic origin (OR 9.62, 95% CI 2.19 to 42.27, p = 0.003), having a male infant (OR 2.08, 95% CI 1.03 to 4.20, p = 0.042), and previous hospitalisation (OR 4.15, 95% CI 1.81 to 9.56, p = 0.001). Hospital admission was largely for reproductive health issues (61%) with frequency predicted by having attended the ED at least once (IRR 3.39, 95% CI 1.66 to 6.93, p = 0.001), and being anxious or depressed (IRR 3.10, 95% CI 1.14 to 8.45, p = 0.027). Conclusions for Practice Improving the reproductive and mental health of mothers may help to avoid poor maternal and infant health outcomes and reduce emergency service utilisation and hospitalisation.
Public health research, Jun 1, 2022
is a trustee for Children's Early Intervention Trust (CEIT) (Bangor, Wales). Early Intervention W... more is a trustee for Children's Early Intervention Trust (CEIT) (Bangor, Wales). Early Intervention Wales Training (EIWT) (Bangor, Wales) is owned by CEIT and offers training courses, including Incredible Years ®. Trustees do not benefit financially from trainings or CEIT/EIWT activities.
PLOS ONE
BackgroundA proportionate universal (PU) approach to early years’ service provision has been advo... more BackgroundA proportionate universal (PU) approach to early years’ service provision has been advocated to improve children’s health and development and to reduce health inequality, by ensuring that services provide timely and high-quality parenting support commensurate with need. Process-oriented research is critical to examine the factors that contribute to, or hinder, the effective delivery/implementation of such a model in community-based family services. This study aimed to assess the delivery, acceptability and feasibility of a new PU parenting intervention model (called E-SEE Steps), using the Incredible Years® (IY) parent program, when delivered by trained health/family service staff in three “steps”—one universal step (the IY Babies Book), and two targeted steps (group-based IY Infant and Toddler programs).MethodsAn embedded mixed-methods process evaluation within a pragmatic parallel two-arm, assessor blinded, randomized controlled trial was conducted in community services ...
PLOS ONE
Background Evidence for parenting programs to improve wellbeing in children under three is inconc... more Background Evidence for parenting programs to improve wellbeing in children under three is inconclusive. We investigated the fidelity, impact, and cost-effectiveness of two parenting programs delivered within a longitudinal proportionate delivery model (‘E-SEE Steps’). Methods Eligible parents with a child ≤ 8 weeks were recruited into a parallel two-arm, assessor blinded, randomized controlled, community-based, trial with embedded economic and process evaluations. Post-baseline randomization applied a 5:1 (intervention-to-control) ratio, stratified by primary (child social-emotional wellbeing (ASQ:SE-2)) and key secondary (maternal depression (PHQ-9)) outcome scores, sex, and site. All intervention parents received the Incredible Years® Baby Book (IY-B), and were offered the targeted Infant (IY-I)/Toddler (IY-T) program if eligible, based on ASQ:SE-2/PHQ-9 scores. Control families received usual services. Fidelity data were analysed descriptively. Primary analysis applied intention...
Nurse Education Today, Sep 1, 2022
Journal of Child Health Care
This study aimed to examine how parents develop personal resilience when facing the challenges of... more This study aimed to examine how parents develop personal resilience when facing the challenges of caring for a child with tracheostomy. This study employed a longitudinal qualitative design. Unstructured narrative interviews with 12 parents (from nine families) whose child had a new tracheostomy were undertaken at three time points over 12 months. Data were analysed using a socio-narratology method. Findings reveal the journey parents experienced, how their feelings changed and the processes involved in developing resilience over the first 12 months of their child having a tracheostomy. Stories told by parents early in their journey revealed emotional upheaval, negative emotions, stress and shock. Due to medical need, parents had little or no choice for their child to have a tracheostomy. Once their child’s life was out of danger, parents started to reframe their experiences and beliefs. Resilience played a major part in how parents perceived and faced their situation, allowing them...
This is the second of two papers reporting evidence from a programme of research that focused on ... more This is the second of two papers reporting evidence from a programme of research that focused on how health visiting works, including service user and workforce perspectives. Evidence and professional expertise indicate that a set of essential features enable health visitors to achieve the desired impact of improving child public health. These include organising services in a way that enables positive parent/health visitor relationships, continuity and co-ordination and the flexibility to use professional knowledge and autonomy in practice. Where service specifications give careful attention to this evidence, it is more likely that health visitors will be able to deliver a successful child health programme for the early years.
Archives of Disease in Childhood, 2016
Children with neuropathic bladder are at risk from the short and long term consequences of urinar... more Children with neuropathic bladder are at risk from the short and long term consequences of urinary tract infections. Early identification of infection can reduce morbidity and improve the management. This longitudinal study used a concurrent mixed methods (qualitative and quantitative) research design, to evaluate a telehealth intervention that aimed to support parents to monitor their child’s urine and identify clinical signs of infection. The study was theoretically underpinned by a framework of self-efficacy. The telehealth intervention was run from the children’s urology service within a single paediatric tertiary referral centre. The evaluation aimed to explore stakeholders’ experiences and perceptions of the telehealth intervention. The stakeholders included parents of the index children, clinicians and technical experts. The index children were all aged <5 years and had spina bifida and/or neuropathic bladder. Face-to-face and remote one-to-one interviews, surveys and group interviews were undertaken with key stakeholders at three time points. Secondary data were also utilised. Thematic analysis and structured evaluation analysis were used for the qualitative data. Simple descriptive statistics were used with the quantitative data. Findings show that remote monitoring benefited the children, the parents and the clinicians. The parents were very positive about the benefits accruing from remote monitoring; these benefits included more effective use of parental time and feeling more confident due partly to the ‘hard evidence’ from the print-out of results from the home urine testing. Collectively these experiences contributed to a greater sense of parental control over the daily management of their child’s health which parents identified as empowering. Clinical and technical stakeholders invested considerable time into the set up of the intervention not least in navigating the specific processes for implementing paediatric telehealth. This required a shift in team resources to ensure alerts triggered by the telehealth system received timely responses and appropriate actions. Lessons learned from this intervention include the need to set alerts sufficiently sensitively and the increased workload on top of usual service provision.
'A positive thing by mentioning it': a qualitative study of experiences of brief physical health ... more 'A positive thing by mentioning it': a qualitative study of experiences of brief physical health interventions for individuals diagnosed with severe mental illness in primary care.
Journal of Child Health Care, 2022
Transition services for young people with long-term conditions often fall short. This qualitative... more Transition services for young people with long-term conditions often fall short. This qualitative study explored perspectives on service features that enable effective transition in epilepsy and juvenile idiopathic arthritis. Patients, parents, clinicians and service commissioners took part in semi-structured interviews ( n = 18). Thematic analysis was used to identify key features, barriers and facilitators of effective transition across participant groups. Analysis led to the development of nine sub-themes which mapped to overarching domains of communication, capability, continuity and capacity. Findings include the need for age appropriate communication, the link between parental dependence, self-care and patient knowledge, the value of service integration for continuity and the impact of capacity on flexible and age appropriate transition services.
International Journal of Prisoner Health, 2022
Purpose This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based ch... more Purpose This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based charity) perinatal support in two prison settings in England. The initiative involved the provision of group and/or one-to-one perinatal support and training women prisoners as peer supporters. Design/methodology/approach A mixed-methods study was undertaken that involved observations of support groups and peer support supervision sessions (n = 9); audio recorded interviews (n = 33) with prison and health-care staff, women in prison, peer supporters and BC staff; analysis of existing routinely collected data by BC and notes undertaken during regular meetings (n = 10) with the BC Project Manager. Thematic analysis was undertaken supported by MAXQDA qualitative data analysis software. Findings BC provided instrumental/practical support, emotional support, information support, signposting to services and advocating for women to the prison concerning their perinatal needs and rights. Key theme...
Public Health Nursing, 2022
Health & Social Care in the Community, 2021
The findings from evaluations of parenting programmes can help inform policy and practice decisio... more The findings from evaluations of parenting programmes can help inform policy and practice decisions, including how best to allocate scarce resources designed to support families. However, studies often fail to consider the extent to which the findings can be generalised to other settings or populations. One, yet unexplored solution, is to compare study findings and large-scale data sets including publicly available population data. The aims of this study were to assess the feasibility of assessing sample representativeness using publicly available data and to identify the challenges involved in considering the generalisability of study findings. Sociodemographic data from two community-based evaluations of parenting programmes conducted in England and Ireland between 2015 and 2018 were used in the study (N = 395 parent-infant dyads). The results indicated some differences between the trial samples and the wider population. However, it is difficult to reach definitive conclusions about these findings due to the limitations associated with using the comparative data sets. Our study revealed three key challenges, including: (1) how best to define and conceptualise representativeness; (2) the availability of comparative data sets; and (3) the quality of the available data. Our study suggests that there is a need for up-to-date, good-quality comparative data sets to allow for the assessment of representativeness. Further work is required to identify parameters for making claims about representativeness, specifically regarding the acceptable level of difference between the target population and the study sample. This is the first study to explore the feasibility of using publicly available population data in two jurisdictions, for the purpose of making judgements about the representativeness of the findings from parent programmes. It is hoped that our results will encourage further investigation around the reporting of trial external validity to enable effective decision-making at policy and practice level.
Journal of health visiting, 2021
The organisation of health visitor work is an important part of service design, which can have an... more The organisation of health visitor work is an important part of service design, which can have an impact on when and where services are provided and who gains access. This article reports a 2018 su...
BMJ Open, 2018
Introduction Behavioural and mental disorders have become a public health crisis and by 2020 may ... more Introduction Behavioural and mental disorders have become a public health crisis and by 2020 may surpass physical illness as a major cause of disability. Early prevention is key. Two Incredible Years (IY) parent programmes that aim to enhance child well-being and development, IY Infant and IY Toddler, will be delivered and evaluated in a proportionate universal intervention model called Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE) Steps. The main research question is: Does E-SEE Steps enhance child social emotional well-being at 20 months when compared with services as usual? Methods and analysis E-SEE Steps will be delivered in community settings by Early Years Children’s Services and/or Public Health staff across local authorities. Parents of children aged 8 weeks or less, identified by health visitors, children’s centre staff or self-referral, are eligible for participation in the trial. The randomisation allocation ratio is 5:1 (intervention to cont...