Evaluation of a universal 3-4 month Healthy Child Programme visit in a local area of England: a mixed methods study.

Authors

Nathan Davies, Denise Kendrick, Jessica Eve Jackson, Elizabeth Orton, Miriam Avery, Jo Leonardi-Bee, Hayden Bird, Holly Knight

Published in

Public health in practice (Oxford, England). Volume 12. Pages 100837. Epub Jul 31, 2026.

Abstract

The interval between the 6-8 week and 9-12 month mandated reviews in the Healthy Child Programme is lengthy and may lead to delayed intervention. In Rotherham, northern England, an additional universal 3-4 month review was introduced to support child development and earlier identification of parent and child needs. We aimed to evaluate its reach, acceptability, and association with developmental outcomes.
Mixed methods study using administrative records, qualitative interviews and focus groups with parents (n = 31), nursery nurses (n = 7), and commissioners (n = 4).
The association between uptake and recording of maternal mood by deprivation, ethnicity, maternal age, and parity for babies aged 3-4 months between January 2024 andFebruary 2025 was analysed using mixed-effects logistic regression. Developmental outcomes were compared (Ages and Stages Questionnaire (ASQ-3) scores at 9-12 months) for children eligible for the universal review versus pre-intervention cohort. Qualitative data were analysed using the Consolidated Framework for Implementation Research.
Uptake was approximately 80%, around 15% points lower than mandated reviews. Uptake was equitable across deprivation and ethnicity but lower among multiparous mothers (adjusted odds ratio (AOR) 0.29, 95% CI 0.22-0.37). Maternal mood recording was lower for mothers <20 years and for multiparous mothers (AOR 0.78, 95% CI 0.64-0.94). At 9-12 months, eligible children had higher odds of scoring above the close monitoring cut-off for problem solving (AOR 1.41, 95% CI 1.03-1.93), with no significant differences in other ASQ-3 domains. Parents valued reassurance, tailored developmental advice, and local signposting, though some noted inconsistent advice, maternal mood assessment and unclear visit purpose. Staff endorsed the visit's developmental focus but reported capacity pressures.
The universal 3-4 month review was broadly acceptable, and associated with higher ASQ-3 problem-solving scores. Communicating visit purpose and consistent mood assessment is required.

PMID:
42602242
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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