Health visitors' work in a multi-ethnic society: A qualitative study of social exclusion

Abstract

Health visiting is adopting an enabling model of practice, which may promote social inclusion, but is under pressure to justify itself. The article focuses on health visitors’ work with Pakistani women and comparable white women in Glasgow, examining the nature of health visiting and women’s responses to it. Health visitors’ perspectives involve the appreciation of cultural differences, building relationships with clients, and some stereotyping of clients. Techniques include highly valued home visiting, and processes of negotiation with clients. Problems faced include difficulties with interpreters, lack of training, relationships with other professions, recent changes in the NHS, and issues of stress and personal safety. Women’s views of health visitors are generally positive, especially concerning home visits, time spent with clients, and gate-keeping access to GPs. Negative views came mostly from white women, and concerned the more controlling models of health visiting. Thus, enabling health visiting practice was widely appreciated, and could act as an inclusionary force, facilitating access to and use of health services. Exclusion was operating at institutional level, towards minorities and women of lower socio-economic groups, but was being actively resisted by practitioners.