Healthy Start is the UK’s food voucher programme for low-income pregnant women and young children. Eligible women receive vouchers worth £3.10 per week, which can be exchanged for fruit and vegetables, plain cow’s milk or... [ view full abstract ]
Healthy Start is the UK’s food voucher programme for low-income pregnant women and young children. Eligible women receive vouchers worth £3.10 per week, which can be exchanged for fruit and vegetables, plain cow’s milk or infant formula. There has been limited evaluation of Healthy Start since its introduction in 2006. Previous studies have focused on the perceived value of the programme and its implementation (Lucas et al., 2013; McFadden et al., 2013) but there is a need for more in-depth examination of the contextual factors and causal mechanisms underpinning its effectiveness.
Realist methodology is increasingly used to explain why different individuals respond in different ways to interventions and experience different outcomes. It was chosen for this study to enhance our understanding of how the Healthy Start programme works, for whom, in what circumstances, and why. A realist review was conducted in two overlapping stages: 1) developing and 2) testing ‘programme theories’ about Healthy Start, which were constructed as ‘context – mechanism – outcome’ configurations. Context may be defined as the pre-existing conditions into which the programme is introduced, such as cultural norms, beliefs and values, geographical or political conditions. Mechanisms are the reasoning and reactions of individuals in response to the resources offered by the programme (Pawson, 2006).
A combination of creative and exploratory methods was used to develop and prioritise candidate programme theories: a scoping search, an intervention mapping exercise and multiple stakeholder consultations. The ways in which low-income pregnant women respond to being given food vouchers was identified as being understudied and extremely influential in terms of the potential impact of the programme on nutritional outcomes. Therefore, this became the focus of the review and earlier stages of the intervention pathway, such as the application process, were not explored.
Existing empirical evidence was used to test and iteratively develop the programme theories. After first examining evidence on the Healthy Start programme, the search strategy was expanded to the US food voucher programme – the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Purposive and systematic methods were used to identify, select, extract, appraise and synthesise evidence from relevant studies, in accordance with quality standards for realist synthesis (The RAMESES Project, 2014).
Interim findings suggest that some women use Healthy Start vouchers for nutritional benefits (intended outcomes) and other women use them for financial assistance (alternative or unintended outcomes). The programme theories explain that, if women value healthy eating and believe it is important (relative to other concerns), they are more likely to perceive the vouchers as an opportunity to achieve health benefits for themselves and the unborn baby, and use the additional income to increase their consumption of target foods. However, for many low-income women, other things take priority over healthy eating and they are more likely to perceive the vouchers as a way to save money, with no impact on nutritional outcomes.
The final evidence-based programme theories will be presented at the conference, and plans for further realist investigation of Healthy Start will be outlined.
Please select one of the following:: Realist synthesis , Please select a maximum of two themes from the following list:: Realist Methodology in Und
