A realist synthesis of literature informing programme theories for Well-child Care in primary health systems of developed economies

Abstract

Introduction: Well-child Care is the provision of preventative health care services for children. However the approaches to provide these services universally are contentious. Theory and Methods: We undertook a realist synthesis to enhance understanding of the theoretical mechanisms driving Well-child Care by searching for published and grey literature from multiple databases. Results: Well-child Care is re-conceptualised as an integrated program delivered in continuum during pregnancy, infancy and early childhood period. Depending on the context, Well-child Care can be a policy, a strategy, or an actual clinical practice that promotes child health and well-being. Seven main mechanisms are presented as "If" and "then" theoretical propositions that explain the substantial variability in the provision of Well-child Care. The main mechanisms include role, training and continuity of health providers, administrators' views on return for investments to achieve outcomes, access of services by families and the adaptation of programs to meet the dynamic needs of stakeholders. The evidence for many outcomes for Well-child Care is better when delivered in partnerships between community health, early childhood education, and social care sectors. Discussion: The term Well-Child Care is often used only in the context of a structured systematic delivery of anticipatory guidance; developmental screening and surveillance activities during either scheduled or unscheduled health visits. The outcomes of a single based program of Well Child Care delivered at doctors' practices is often not going to include the broad roles of other agencies and sectors who come in contact with families and thereby potentially impact the social determinants of child health outcomes. Conclusions: The program leaders for Well-child Care should shift their focus on integration of human and physical resources and policy and agreeable outcomes measures between health, social and educational sectors. Countries should work towards universal early education programs and improving parents' health literacy regarding child development. Lessons learned: Well-Child Care has to be delivered in an integrated framework and supporting primary health care providers is only one aspect of the program. Limitations: Majority of the empirical studies on Well-Child Care often lack acknowledgement of underlying program mechanisms and contexts. Suggestions for future research: There is a need for integrated policy formulation between social, education and health sectors for provision of Well-Child Care and the impact of this on child health outcomes will need to be further researched.