Facilitators and barriers to promotion of and engagement in a parent-infant relationship intervention: a qualitative study

Abstract Background Parent-infant relationships have a significant impact on children’s health outcomes. Despite growing evidence that parenting interventions designed to improve parent-infant relationships can be effective, there is less information about what makes parenting interventions meaningful and helpful to parents, and what barriers and facilitators contribute to service accessibility and engagement. To address this knowledge gap, this paper explores the perspectives of both professionals and service users regarding the valued features of, and the barriers and facilitators influencing promotion and participation in, the Nottinghamshire (UK) Healthy Families Parent-Infant Relationship intervention (PIRi). Methods Primary qualitative data were collected employing purposive sampling. We undertook virtual/phone interviews with nine professional staff involved in the PIRi delivery and fourteen parents who had received support. Data were collected between May and July 2023, and analysed thematically using Nvivo 14. Results Several points in the PIRi process acted as barriers and facilitators to engagement and promotion. Health visitors are the key identification and referral route for the PIRi, but they reported lacking detailed knowledge of the specific support provided, impeding their ability to promote the intervention clearly and consistently. This led to misunderstandings around support for parents and concerns about stigma from their referral. Existing capacity challenges within the health visiting service meant limited family contact time, making it difficult to build rapport and identify those who would benefit from the PIRi. Further, confidence around discussing parent-infant relationship difficulties sensitively was reported as a barrier, with concern about relationship breakdown between professionals and families. Awareness of support options and the tailored nature of support were important in encouraging parents’ engagement. Parents who accepted PIRi support reported extremely positive experiences and outcomes. Support was seen as accessible, tailored and flexible, and perceived as improving bonding, connection and relationships. Conclusions Our study highlights the importance of effectively promoting and embedding knowledge of services, and supporting key referral routes and pathways of care. A clear understanding of service offerings can facilitate more appropriate referrals and better engagement through clear and consistent messaging about support. Further, ensuring that support is accessible, tailored and flexible is crucial in promoting engagement in parenting programmes.