Healthcare leaders and professionals’ perspectives of the ICON programme to prevent abusive head trauma in infants: a qualitative study

Abstract

Background

Abusive head trauma (AHT) in infants is the most common abusive injury in young children, and increased awareness has resulted in the development of prevention programmes. Most research evaluating AHT prevention programmes report parental and carer perspectives. Little is known about barriers and facilitators to adopting, implementing, and maintaining educational programmes from the perspectives of managers and staff delivering the education. ICON is an AHT prevention programme currently being delivered in National Health Service hospital and primary care settings in the United Kingdom.

Methods

This study evaluated the ICON programme from the perspective of managers and healthcare professionals through the RE-AIM framework using qualitative methods. Fifty-three managers and healthcare professionals across six geographical areas in England participated in individual interviews and focus groups between October 2022 and April 2023. Data collection and analysis were concurrent, systematic, and iterative, using framework analysis as a guide to explore factors impacting ICON’s reach and the key enablers and obstacles to its effectiveness, adoption, implementation, and maintenance.

Results

Four primary enablers and related challenges to the ICON programme’s impact were identified. Fidelity to the programme’s recommended touchpoints and message impacted ICON’s reach to new parents and carers. Parental receptiveness to the programme was affected by staff individualising their approach. Staff buy-in was related to staff workload and previous experiences with AHT. Managers with strategic leadership responsibility for reducing infant mortality and able to provide governance oversight fostered successful adoption, implementation, and maintenance of the programme.

Conclusions

Staff are willing and able to deliver the ICON programme, including, where necessary, delivering the key messages in a format acceptable to families varying situations, if given the workload and training to do so. Those in leadership positions influence the likelihood of successful adoption, delivery and longer-term mainstreaming, if they are able to prioritise the programme. Understanding the barriers and facilitators to ICON’s delivery has the potential to inform policy by facilitating the uptake of the programme by settings, enabling delivery of ICON to reach the needs of local families, and ensuring sustainability of the ICON programme.