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Simple maternal-child health intervention has long-term resonance with parents

Becoming a parent is one of the greatest transitions in life, which many new parents find overwhelming. In many countries since the 1920s, mothers have been given a ‘baby book’ for recording key milestones and health issues in their child’s early life. Like many mothers, my mother still has and cherishes her children’s baby books, which are kept carefully in her top drawer.

The baby book is a very early example of providing parent held information. Over time, various iterations of baby books have evolved into comprehensive parent-held records, which are used universally. In a contemporary context, baby books are completed by parents and healthcare professionals, and include a range of health promotion material and advice.

Unlike today, introduction of baby books in the first half of the 20th Century did not follow a feasibility study and randomized controlled trial and there has been little evaluation of their effectiveness. Given the lack of robust evaluation of this long-standing universal intervention, I was interested to read Clendon and Dignam’s (2010) oral history of Plunket baby books in this issue of JAN (pp. 968–977).

The study examined the role and impact of the Plunket child health and development record book in New Zealand society since its inception in the 1920s. Oral history interviews were undertaken with 34 women and one man from a broad range of backgrounds, ages and experiences, some being parents and others healthcare professionals.

The study provides a fascinating account of how Plunket baby books were important, cherished, valued, kept, and in many cases passed on to children in adulthood. Clendon and Dignam (2010) found that Plunket baby books were used in multiple varying ways by both mothers and nurses when they met. The book was important to parents and professionals as a tool to facilitate an effective relationship and as a common shared document for identifying and recording information. Using an appropriate tone and the way in which information was recorded by nurses were important features of successful facilitation and sharing information.

In a contemporary context, implementation science is now a discipline in its own right. Successful long-term implementation and use of baby books serves as an exemplar documenting the translation and utilization of an intervention into routine practice over decades. The success factors identified from Clendon and Dignam’s study can be mapped easily against theoretical and conceptual models such as the Promoting Action on Research Implementation in Health Services (PARIHS) framework (Rycroft-Malone et al. 2002). The study helps explain the key contextual variables mediating the implementation and use of the baby book and the type of facilitation needed to ensure a successful process.

It would be very interesting to imagine what a trial would look like if baby books were going to be introduced for the first time today. The design would likely follow the MRC framework, and updated guidance for evaluating complex interventions in public health settings, and have an embedded process and economic evaluation (Craig et al. 2008). If found to be effective and cost-effective, it is likely that a policy impact assessment would be undertaken before scaling up and rolling out as a universal intervention for all parents and babies. This process would now take a number of years to complete.

Whilst acknowledging this study has limitations regarding generalizability, the key messages for nurses are that parents in this study liked and valued their baby book, they used it with nurses, and it helped to promote communication and build relationships. Nurses can maximize utility by developing a facilitative and respectful style of written and oral communication when sharing information and advice with parents in baby books. We still lack evidence from parents who did not find it helpful, or what formats are most effective and why.

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