Family Nurse Partnership

Who was involved?

The study population included all young women 19 years or younger, eligible for the FNP Programme from 1st January 2009 to 31st March 2016 and their first-born child(ren).

Centre for Trials Research, Cardiff University with support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, carried out the study.

The cost of the research was under £200,000. This is much lower than for a similar evaluation of the FNP programme in England that collected new data rather than reusing existing datasets. The English study cost over £5,000,000.

What data was used?

In Scotland, we have a wealth of high-quality administrative data that is collected throughout the course of people’s lives.

Making the best use of this data by linking it maximises the insights that can be gained, which in turn enables patterns and relationships within the data to become clearer.

This study demonstrates the value of using linked administrative data to a programme such as the FNP.

This programme makes use of datasets on use of healthcare services including; prescriptions (PIS), A&E Attendance, hospital admissions, maternity data for both children and mothers, the child health surveillance programme data (CHSP-PS and CHSP-S) that runs from birth into school, education data including qualifications, attendance and free school meals, social work data including looked after children and child protection, and NRS data such as the census, births and death records as well as the FNP datasets. These datasets were all linked to enable evaluation of the programme by comparing mother and children that received FNP to a comparator control group. This allowed researchers to measure 54 outcomes of child and family wellbeing.

What have they found, and what are the next steps?

The research found that the programme is targeted well with the majority of young parents that enter FNP completing the programme (84%).

FNP clients are young first-time mothers, often with complex social challenges. The natural experiment found the following:

Breastfeeding

• At the 10-14 days post-partum child health assessment, breastfeeding was statistically significantly higher in the FNP group (22%) compared to the Controls (17%).

• Breastfeeding rates remained statistically significantly higher in the FNP group by the 6-8 weeks post-partum child health assessment (11% in FNP vs. 9% Controls)

• The percentage of mothers breastfeeding increased with the number of FNP visits received during the pregnancy period

• Rates of child exposure to second hand smoke substantially reduced between 10 -14 days and 6-8 weeks post-partum with a statistically significantly larger reduction in rates observed in the FNP Clients (from 36.9% to 25.7%) compared to the Controls (from 34.2% to 30.3%).

• A statistically significantly higher proportion of children in the FNP group were registered with a dentist by age 24 months, with differential effect across health boards.

Child Development

There was evidence to suggest a statistically significant difference between study groups in any new child development concerns recorded at 27-30 months, with a higher proportion in the Controls (FNP Clients: 19.2% vs Controls: 21.7%).

A higher proportion of children in the Control group (13.4%) had a concern recorded for social/emotional development at 27-30 months compared to the FNP group (11.0%) but there was no evidence of a statistically significant difference between groups.

Children's BMI

No statistically significant differences in rates of children with a healthy BMI were found between the study groups at the 27-30 months and the Primary 1 review. At the 27-30 months review: 68% (FNP) and 69% (Controls) of children had a healthy BMI. However, at the Primary 1 review, the proportion of FNP children (71%) having a healthy BMI increased while the proportion of children in the Controls having a healthy BMI (67%) fell.

Attainment

There were no significant differences in the proportion of children achieving their age-related Curriculum for Excellence (CfE) Level (P1 or P4 combined) for any of the subjects overall (Reading, Writing, Listening and Talking, Numeracy and Literacy).

Sensitivity analyses on age related achievement of the P1 Level, supported the findings of the primary analysis but also found a statistically significant differential FNP programme effect in Reading for child sex, and in Writing by health board.

FNP has been expanded over the last 10 years and is now delivered in all mainland health boards in Scotland. Over 10,000 families have received the programme, and 6,000 have graduated from the programme. The FNP reaches around 3,000 families at any one time.

How could this research help inform policies and improve lives?

The Family Nurse Partnership was developed at the University of Colorado, Denver, USA, where it is known as the Nurse-Family Partnership (NFP). Over 40 years of research, the programme has been shown to produce many benefits, including:

• improvements in antenatal health

•  improved early language development and academic achievement

• reductions in children's injuries, neglect and abuse

• improved parenting practices and behaviour

• fewer subsequent pregnancies and greater intervals between births

• increased maternal employment and reduced welfare use

• increased involvement from fathers

Research Data Scotland’s work

This project used traditional routes of applying for data linkage with multiple approvals panels, multiple research identifiers and data classed as personal in the Safe Haven. This meant that the length of time taken between application and receiving access to the data for the study was approximately two and a half years.

This (not uncommon) wait period for a data linkage project means studies aren’t timely enough to answer pressing policy questions: the most up to date data is often excluded.

Research Data Scotland (RDS) exists to make it faster and simpler for researchers to access public sector data. We are starting to make the cycles of innovations faster.

Through the Researcher Data Access Pathway we enable streamlined access to data for research in the public benefit, reducing the time and resources required to undertake projects that could provide evidence for FNP and speed up research with data access in weeks and months rather than years. Launched in April 2024, the service initially enables access to nine of Public Health Scotland’s most frequently requested datasets through a streamlined pathway, where previously complex approvals and information governance processes are standardised using the Five Safes framework.

We are also working with Scotland's National and four Regional Safe Havens to simplify and streamline common systems, processes and services, making it easier for researchers to access data which falls outside of the Researcher Data Access Pathway.

For projects, which require researchers to obtain individual approvals through several local health boards, our work to federate processes will further improve the data access journey. Find out more about our work with the Scottish Safe Haven Network.

Find out more

Find out more about the Family Nurse Partnership in Scotland here.