What processes will support effective shared decision making when health visitors and parent are planning to improve the wellbeing of babies and children within the context of the Getting It Right For Every Child (GIRFEC) Policy Framework?

Abstract

Two key policy documents are having an impact on health visiting practice in Scotland: Getting It Right for Every Child (GIRFEC) (2013), which seeks to promote all children’s wellbeing, and The Healthcare Quality Strategy for NHS Scotland (2010) which promotes person-centred care. ‘Shared decision making’ is integral to ‘person-centred care’; however no research studies to date have linked shared decision making with health visitor practice. This thesis reports on a descriptive, qualitative research study, which was conducted in two health board areas in Scotland, in order to explore the processes that support effective shared decision making in health visiting practice within the context of implementing GIRFEC. The design was in three phases and used Elwyn’s Framework, of ‘Choice, Options and Decision Talk’ as a structure (2012). Phase 1 consisted of audio recordings of 2 x health visitor: parent encounters when decisions were being made; Phase 2 consisted of semi-structured interviews with 9 x health visitors and 9 x parents who had made decisions within the last 6 months; Phase 3 involved 3 x focus groups reviewing the findings to date and reflecting on current issues when implementing GIRFEC. The framework method was used for analysis and two additional themes were identified: ‘Issues’ and ‘Relationships’. The health visitors demonstrated that they built up trusting relationships with parents; however there was lack of understanding and application of decision making theory which supports analysis, and an outcome focused approach to person-centred planning. This thesis identifies areas for health visitor practice development.