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This thesis describes the development of a parent-to-infant attachment based questionnaire for use by health visitors as a discussion tool. An interpretive methodology was followed incorporating a sequential multi-method design. The original purpose of the study, to develop an attachment screening tool, changed due to reflexive decision making and the impact of changes in service delivery. This presented an opportunity to develop a tool that supported focused conversation between health visitors and parents about early relationships. Parallels between parent infant relationships and health visitor parent relationships were identified in four parent focus groups and four health visitor interviews. The resulting data were used to inform the development of the pilot questionnaire. Five parent-to-infant attachment relationship constructs were developed from attachment theory and current practice in infant mental health. These were combined with parent terminology preferences, and formed into a twenty-five item questionnaire. The twenty-five item questionnaire was used to collect data from twelve parents. Statistical testing on twenty-four test-retest completions of the tool resulted in a ten-item discussion tool that showed face and construct validity. Evidence of acceptability to practitioners and parents was gathered using a health visitor survey.

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No / Objectives: A review of the literature reveals little description of the advisory role of the health visitor in the child health clinic. This paper describes a study which examined content, clients' recall and value to the client of their discussion with the health visitor. Design: Descriptive study; non-participant observation; semi-structured interviews. Setting: One predominantly urban community Trust involving seven volunteer health visitors from seven different child health clinics. A total of 24 clinics were observed. Participants: One hundred clients attending seven child health clinics. Findings: Most mothers reported that speaking with the health visitor had been fairly or very important. Clients' discussion with the health visitors covered a wide range of child-centred issues and concerns. Mothers recalled 79% of all topics discussed during the clinic visit and initiated nearly 59%. Although weighing was considered an important reason for attending clinic by most mothers it did not preclude wanting to speak with the health visitor. However, some mothers did not wish to speak to the health visitor. Conclusion: The health visitor provided an advisory and support service for many of the attending mothers. Most clients reported valuing this intervention. This study support the notion that mothers do not attend the clinic simply for medical services or screening. Attention should be focused on research and development of services which reflect this consumer agenda. Consideration should be given to the appropriateness of health visitors weighing children.

No / Aims and objectives. The current study sought to identify how many mothers from 149 visits carried out by seven health visitors identified support as a feature of the visit, whether this type of support was unique to the health visitor and what support meant to them. These responses were then compared with the taxonomies of social support from the social support literature. . Some studies of client perceptions describe support as an element of home visits by health visitors. However, the importance, relevance and impact on the client of this support are not described in detail. Social support theory suggests that there are tangible benefits to people's well-being and their ability to cope with various challenges that may arise from individuals' perceptions of receiving support. Design. Qualitative study using semistructured interviews. Methods. Seven volunteer health visitors recruited 149 women into the study. These clients were interviewed by the researcher, usually within one week of the home visit by their health visitor. The discussions were audio-taped and the resulting transcripts analysed using content analysis. Findings. Thirty-seven women identified receiving support which they said was only available from the health visitor. The relevance of this support to the mother and the impact on her well-being varied within the group suggesting differing perceptions of support by clients according to their personal situation. There was a correspondence between the descriptions of support given by the women and the taxonomies of social support from the social support literature. Conclusion. For some interactions between clients and their health visitors the existing theory of social support may provide an explanation of how health visitors contribute to clients' perceived ability to cope and well-being. Relevance to clinical practice. Social support may be defined as a possible outcome of health visiting. This concept will have use within educational programmes to demonstrate to students how health visiting can have an impact on clients' well-being. Similarly, the concept could be used to investigate and record health visiting practice.