Working in partnership: the application of shared decision making to health visitor practice

Abstract

Aim and objectives To explore the processes which support shared decision making when health visitors and parents are creating plans to improve the wellbeing of babies and children.  Background  Worldwide, there is a focus on promoting children's wellbeing in order to enhance population health. Within the United Kingdom, health visitors have a key responsibility for working in partnership with parents to support this agenda. Despite evidence that the application of ‘shared decision making’ frameworks can increase patient participation, improve patient satisfaction, and improve health outcomes, there is limited research linking shared decision making with health visitor practice.  Design  A qualitative, descriptive study.  Methods  The study was undertaken in two phases: in Phase 1, two parent: health visitor dyads, who were planning together as part of usual care, were audio-recorded and then the participants’ experiences were sought through individual questionnaires. In Phase 2 semi-structured interviews were conducted with nine health visitors and nine parents in relation to their recent experiences of planning care.  Results  Evidence of supportive processes included having a shared understanding around the issue needing to be addressed; being able to identify interventions which were accessible for the family; engaging in decision making through deep, meaningful conversations using sensitive and responsive approaches; and establishing positive relationships between health visitors and parents, significant others within the family, and other professionals.  Conclusion  Despite evidence of strong, trusting relationships between parents and health visitors, there were times when shared decision making was unable to take place due to the absence of supportive processes.