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

ABSTRACT Objectives 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 an area of 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. Study design Mixed methods study using administrative records, qualitative interviews and focus groups with parents (n=31), nursery nurses (n=7), and commissioners (n=4). Methods The association between uptake and recording of maternal mood by deprivation, ethnicity, maternal age, and parity for babies born January 2024-February 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. Results 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 (AOR 3.08, 95% CI 1.74–5.46) and for multiparous mothers (AOR 0.77, 95% CI 0.63–0.94). 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 1.03–1.95), 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. Conclusions 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.