Evaluation of PlayHome

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Evaluation of Play_at_Home Exercise Programme for
Children PRESENTATION Quantitative and
Qualitative Research June 2000
Prepared by SCOTT PORTER Research Marketing
Ltd 31 Bernard Street Edinburgh EH6 6SH
Prepared for Fife Primary Care NHS Trust Health
Promotion Department Cameron House Cameron
Bridge Leven KY8 5RG
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BACKGROUND AND RESEARCH OBJECTIVES

• Play_at_Home is a programme designed to encourage
  parents and carers to help the development of
  children from birth to five years through the use
  of exercise and physical activity, and to educate
  parents in ways of handling and exercising their
  children.
• This research covers the first stage of the
  programme, namely the play_at_home baby book for
  babies from birth to one year.
• The document has been split into two sections
• Section One
• Health Visitors Quantitative Survey and
  Qualitative Research
• Section Two
• Parents Qualitative Research.

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STAGE ONEHealth Visitors Qualitative and
Quantitative Research

• The objectives of this stage of the research,
  which was carried out amongst Health Visitors,
  were as follows
• to assess the efficiency of distribution of the
  baby book
• to understand Health Visitor perceptions of the
  baby book.
• This document details findings from the
  quantitative survey which was conducted in
  February / March, with the qualitative phase
  conducted in April 2000.
• N.B. Some health visitors felt that it was too
  early to properly assess the play_at_home baby book
  (had little experience of it / too recently
  introduced).

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SAMPLE AND METHODOLOGY

• Quantitative Survey
• 115 self completion questionnaires were sent to
  Health Visitors across Fife at the beginning of
  February. A database of Health Visitors was
  provided to Scott Porter Research for mail
  fulfilment.
• Respondents were given approximately two weeks to
  complete and return the questionnaire, after
  which a second reminder mailing was sent to
  non-responders. A total of 93 questionnaires
  were returned (81 response rate).
• Qualitative Survey
• 5 in-depth interviews were conducted amongst
  Health Visitors to further understand their
  perceptions of the play_at_home baby book. These
  findings have been incorporated throughout this
  section of the document.

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SUMMARY Quantitative Findings

• All 93 respondents claim to give the play_at_home
  baby book to all parents with new babies. The
  majority (88) will then discuss and explain the
  books to parents, but leave it up to them as to
  if and when they use it.
• Regarding the distribution most agree (82) that
  the books are easily attainable, with a minority
  (9) disagreeing with this. Again, a large
  majority (83) feel that they can get support
  easily regarding the programme, with 15 being
  unable to comment. 85 feel that they have
  received sufficient books, with 14 disagreeing
  with this. In relation to whether the books are
  available promptly when they need them 67 claim
  this to be the case, with 9 disagreeing with
  this and 24 being unable to comment. The
  majority (75) agree that the books are
  distributed efficiently to them, with a few (15)
  disagreeing with this.

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SUMMARY (Contd) Quantitative Findings

• 91 felt that there is a need to provide parents
  with the play_at_home baby book with key reasons
  being as follows
• encourages parents to interact / play with their
  children (33)
• educates parents on how to interact / play with
  their children / these skills have been lost
  (28)
• highlights the need for exercise / physical
  activity (20)
• offers guidance to parents who are unsure how to
  stimulate their child (19).
• Only 6 respondents felt that the book was not
  needed, with their reasons for this being more
  related to the fact that some parents wont read
  it / use it or will not be able to use it.
• Health Visitor responses regarding their
  understanding of the overall aim of the programme
  very closely match the programmes actual
  objectives
• to promote physical activity / exercise... stress
  its importance (45)
• to encourage parents to play with their children
  (38)
• to strengthen the parent / child relationship /
  family bonding (32)
• to encourage parent / child interaction (29)
• to improve health and fitness (23)
• to promote child development / guide parents
  through it (23).

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SUMMARY (Contd) Quantitative Findings

• Responses relating to the main perceived key
  strengths of the book itself related to either
  the format and presentation e.g. easy to read /
  understand, divided into sections, well laid out
  / simple format etc., or the benefits to parents
  / child e.g. encourages interaction between
  parents and children, gives practical ideas and
  suggestions, promotes child development etc..
• Health visitors were less able to highlight many
  weaknesses of the book with 11 stating that
  there were none and 19 unable to comment. Any
  weaknesses mentioned generally related to the
  fact that parents may not use it / may not be
  able to use it e.g. cant read, lack time etc..
  Some comments were also made regarding the
  presentation / format of the book e.g. poor
  illustrations, drab colours, too much writing
  etc..

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SUMMARY (Contd)Quantitative Findings

• Approximately one third of respondents were
  unable to comment on how effective the book has
  been, due to the short period of time that it has
  been available. However, from those who were
  able to comment, the book is perceived to be most
  effective in achieving the following
• encouraging parents talking with their babies
  (with 52 stating it was very or quite effective
  in doing this)
• developing body awareness (with 49 stating it
  was very or quite effective in doing this)
• encouraging the babys enjoyment of physical
  exercise (with 49 stating it was very or quite
  effective in doing this)
• encouraging loving touch in families (with 48
  stating it was very or quite effective in doing
  this)
• strengthening relationships between babies and
  parents (with 48 stating it was very or quite
  effective in doing this).

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BABY BOOK DISTRIBUTION BEHAVIOUR

• Findings from in-depth interviews were very
  consistent across Health Visitors, and were also
  consistent with the quantitative findings. Other
  issues emerging were as follows
• One of the key concerns arising from the in-depth
  interviews amongst health visitors was the timing
  of the distribution (e.g. books handed out on the
  1st visit)
• considered to be too busy a visit
• lots of visitors
• health visitors have a lot to cover
• sometimes I feel that you are not giving it its
  importance because you are trying to make the
  Parent Held record important
• Lack of time to introduce and explain book
  properly / keep check on and
• encourage its use.
• In addition to the above, the level of interest
  from the parents perspective at this time is
  also questioned
• parents are tired / anxious
• more concerned about other issues e.g. illnesses,
  immunisation etc.
• may feel overloaded with information at this
  point.

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BABY BOOK DISTRIBUTION BEHAVIOUR

• In light of the above, most agree that
  distribution pre-birth may be more appropriate
• parent had more time to look through in later
  stages of pregnancy e.g. stopped work
• gives health visitor more time to explain /
  discuss the book.
• Although the majority of Health Visitors are
  happy with the level of information they have
  been provided with regarding the book, some still
  lack confidence in explaining it
• lack time to familiarise themselves with the book
• have difficulty with pitching it at the right
  level for each individual (perceive some of the
  earlier / more basic sections as slightly
  patronising to some).
• Further guidance could be provided on how to
  explain the book properly and how to
• encourage its use / incorporate it into their
  visits. Although they feel that they could
• get support if required, most would be unlikely
  to actively seek this themselves.

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HEALTH VISITORS PERCEPTIONS OF DISTRIBUTION
(Contd)

• There are no major complaints regarding
  distribution of the books, although some would
  ideally like to order by phone (rather than in
  writing)
• easier / quicker to do
• books will arrive more promptly
• easy to forget / be too busy to send in an order
  in writing.

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PERCEIVED NEED FOR BOOK (Contd)

• It is generally considered to be a good idea to
  give the book to all parents
• different parts will appeal / be relevant to
  different people
• something in it for everyone.
• Although some Health Visitors are concerned that
  early sections of the book are slightly basic
  (particularly for more experienced parents) it is
  considered discriminatory to distribute it to a
  select audience
• everybody should get it, youd be making big
  assumptions about their
• experience if you didnt
• There is also some concern that the parents who
  need it most wont use it (e.g. younger / less
  experienced or potentially lower social groups
  perceived to need it most)
• put away in cupboard and forgotten about
• may have fear / dislike of reading books in
  general
• Reinforces need to encourage use / follow up on
  use.

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OVERALL PERCEPTIONS OF play_at_home BOOK

• Overall reactions to the book were positive, as
  the provision of a book which focuses on play,
  stimulation and interaction with babies is widely
  appreciated
• perceived to be fairly unique / offering
  different information than other books available
• It offers more on the nurturing side of
  things.
• Some of the activities, particularly within the
  0-3 months section are considered quite basic and
  obvious
• providing information on things that are
  instinctive / come naturally to parents
• HOWEVER
• Health visitors appreciate that it may reassure
  parents, (e.g. reinforce that they are
• doing the right things), as well as emphasising
  the benefits of it.

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OVERALL PERCEPTIONS OF play_at_home BOOK

• The format of the book and the way the
  information is presented have high appeal amongst
  the Health Visitors
• although the book is perceived to be quite big,
  the colour coded sections make it appear more
  manageable and, therefore, less daunting to
  parents
• bullet points make information clear and easy to
  understand
• clearly highlights the benefits and precautions
  of each activity.
• The only minor criticism is related to the
  colours and format of illustrations
• some would prefer brighter presentation and real
  photographs.

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FURTHER SUGGESTIONS

• Suggestions for improvements appear to be centred
  around the Health Visitor role, rather than the
  book itself
• Need to spend more time explaining book
• Need to be more proactive in encouraging use of
  book (e.g. could incorporate play_at_home into
  guidance checks under child development section)
• Opportunity to link in with local classes e.g.
  massage
• I get asked about the baby massage, people
  asking me where they can go for further
  information.

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STAGE TWOParent Qualitative Research
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BACKGROUND AND OBJECTIVES

• Key objectives for this stage of the research
  were defined as
• Parents
• to understand parents perceptions of the baby
  book
• to explore parents usage of the baby book, in
  terms of level of use, frequency of use and type
  of use
• to determine parental perceptions of key benefits
  arising from the baby book in terms of child
  development
• to identify any benefits of the baby book to
  parents themselves
• to assess whether or not demographic variables
  play a part in the level of usage of the baby
  book by parents.

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METHODOLOGY AND SAMPLEStage Two Parents
Qualitative Research

• A series of 18 in-depth (face-to-face) interviews
  was conducted amongst parents, each lasting 45
  minutes 1 hour.
• The sample was as follows
• Depth Parent type Socio- Geographic
• economic location
• 1 First time ABC1 Central
• 2 First time ABC1 West
• 3 First time ABC1 North East
• 4 First time ABC1 Central
• 5 First time C2DE West
• 6 First time C2DE North East
• 7              First time C2DE Central
• 8 First time C2DE West
• 9 First time C2DE North East
• 10 Experienced ABC1 Central

denotes parents who were involved in the pilot
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METHODOLOGY AND SAMPLE(Contd)Stage Two
Parents Qualitative Research

• Depth Parent type Socio- Geographic
• economic location
• 11 Experienced ABC1 West
• 12 Experienced ABC1 North East
• 13 Experienced ABC1 Central
• 14 Experienced ABC1 West
• 15 Experienced C2DE North East
• 16 Experienced C2DE Central
• 17 Experienced C2DE West
• 18 Experienced C2DE North East
• In addition to the above the sample also
  included
• a range of ages of babies
• a spread of ages of parents e.g. younger and
  older mothers
• a mix of different family structures e.g. single
  mum, married, co-habiting etc.

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SOURCES OF INFORMATIONGeneral Behaviour

• Information (in book format) is more likely to be
  sought / read at pregnancy stage
• evidence of Ready Steady Baby being followed
  closely at this stage then either forgotten about
  or used occasionally as a reference book post
  birth
• books going through different stages of pregnancy
  also mentioned e.g. Emmas Diary, Miriam
  Stoppards book.
• Any information sought or considered very
  important post-birth tended to focus on medical /
  health related issues
• immunisation
• cot death
• meningitis
• weaning
• breastfeeding
• solids etc..
• If there is information given on meningitis or
  something then I would read it through
  thoroughly. Single mum, C2DE

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SOURCES OF INFORMATIONGeneral Behaviour (Contd)

• Amount of written information required both pre
  and post birth varied across the sample depending
  on a number of factors
• However, there are a minority who are just
  generally keen information seekers regardless
  of the above factors e.g. buy books, search
  internet etc..
• In opposition to this, there are also those who
  prefer the more personal touch
• would rather talk to health visitor / doctor than
  read a book
• may dislike written information / books in
  general.

• Little experience of / contact with babies (own
  or others).
• Low levels of confidence.
• Lack of support / advice from friends / family.

LOW REQUIREMENT FOR ADDITIONAL INFO
HIGHER REQUIREMENT FOR ADDITIONAL INFO

• More experienced parents.
• High confidence levels.
• Lots of support / advice given from friends /
  family.

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play_at_home INITIAL REACTIONS

• Although all are initially pleased to receive the
  play_at_home book for free, some may find the
  prospect of actually reading the book slightly
  daunting
• She is expecting me to read that?! Parent
  C2DE
• Oh no, another book to read. Parent ABC1
• some still feeling slightly overwhelmed by the
  whole thing (birth, new baby)
• too busy
• too tired
• In the early days when baby is sleeping thats
  all you want to do as well.
• Parent C2DE
• However, consistent with Health Visitor findings,
  this is more linked to the timing of when it is
  given out rather than the look of the book
  itself
• very busy time, lots of visitors etc.
• Some spontaneous requests for giving out
  pre-birth or at a later / less busy
• stage / visit.

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play_at_home INITIAL REACTIONS (Contd)

• There was a varied level of understanding of the
  overall aim of the programme. Reasons observed
  for lower levels of understanding were
• lack of explanation when given out
• benefits not clearly highlighted / explained
• perception that Health Visitors not as
  knowledgeable about it as could be.
• Initial understanding / perception that is it a
  very basic / general book on how to play
• with your baby (which can negatively affect their
  motivation to read it).
• Indications are that this kind of material can be
  lost amongst other materials unless validated
  fully by Health Visitor.
• An opportunity exists for Health Visitors to
  highlight the benefits and encourage use of the
  play_at_home baby book.

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USAGE BEHAVIOUR

• The point at which parents would start using the
  book, and their subsequent usage behaviour varied
  greatly across the sample

• Some will read / look at straight away
• read / flick through first section or whole book.

Some will put away to be read later.
Will then be put away until ready / need to use.
Will be kept close at hand for imminent use.
Will pick up at their leisure to look through
(when have time).

• will intend to look at when baby a bit older
• perception that it is aimed at older babies.
• All they are doing at this stage (up to 3
  months) is eating and sleeping.
  Parent C2DE

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USAGE BEHAVIOUR (Contd)

• Again level of usage varied across the sample,
  although the majority are using it / had used it
  to some extent

Less confident / experienced mothers (or fathers)
tending to use it more frequently. More new
information / things to learn, therefore more
relevance. For a first time mother, it is quite
important, it gives a lot more involvement with
your child. It is interesting to read through
and just check that you are doing the right
thing Parent, ABC1
More confident / experienced mothers (or fathers)
using it irregularly (with a small minority not
perceiving any need to use it at all). Less new
information therefore less relevance. I think
it is more aimed at first time mums but I am glad
that Ive got it Parent, ABC1
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USAGE BEHAVIOUR (Contd)

• On the whole there is a tendency to dip in and
  out rather than read it through thoroughly
• layout and format encourages this type of usage
  (age ranges a natural split)
• can overcome lack of time / fear of reading
  books barriers.
• Im not that much of a reader but its not the
  type of book you have to read cover to cover
  its more of a reference book. Parent
  ABC1
• any initial feelings of apprehension regarding
  reading the book are quickly dispelled once read
• Once you get into it, it is actually very easy
  reading, its very well explained
• Parent C2DE
• can easily fit into busy lifestyle / find time to
  quickly read a section.
• Additionally, once read, main sections referred
  back to are massage and action songs rhymes
• need to remind themselves how to perform these
  activities (either new or forgotten information).

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USAGE BEHAVIOUR (Contd)

• The most popular section by far is the nursery
  rhymes and actions
• appealed across all ages / social classes /
  experienced and inexperienced mums
• relevant to both younger and older babies (could
  be used with older children in family also)
• nostalgia / flashback to own childhood
• fun for both adults and children
• easy to do.
• The second most popular section is the baby
  massage
• new information even to more experienced mums
• used to help reduce symptoms of colic
• helps relax baby and mum / dad
• gives dads permission to be involved physically
  with young babies.
• Even those who received the book later and were
  unable to use baby massage section (baby too
  active, wont stay still), look forward to using
  it / have used it on their next child.

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USAGE BEHAVIOUR (Contd)

• The following sections are also considered
  helpful, mainly amongst less experienced parents
• Touching and Stroking
• Suitable Toys
• Deep Warm Bathing
• Communication
• Baby Exercises, e.g. sit ups, lying on tummy
  etc..
• More basic sections e.g. Rocking, Carrying etc.
  tended to be overlooked by the majority.
• There was a polarised response to which age range
  within the book is the most useful
• some are looking more for ideas when baby is
  younger (0-6 months)
• They are easier to play with when theyre
  older.
• whilst others feel that there is not much you can
  do with babies when they are younger, therefore
  are more likely to use the later end of the book
  (6-12 months).

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AFFECT OF DEMOGRAPHICS ON USAGE

• There is no clear indication that social grouping
  strongly affects usage of the play_at_home book,
  however, of the minority who had little (or no)
  use of the book the reasons across the different
  social groupings differed

• ABC1
• May be more confident
• Less perceived relevance.
• I would have been doing what Ive been doing
  without the book.
• Parent C2DE

• C2DE
• May be less likely to refer to books as a source
  of information / feel overloaded with
  information.

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AFFECT OF DEMOGRAPHICS ON USAGE (Contd)

• In some (very few) cases parents from the ABC1
  social grouping found certain sections overly
  elementary e.g. showing you how to Peek-a-boo.
• Not for me - I dont know if its because Im
  a second time mum but the
• page that made me laugh was the page that had
  peek-a-boo. Parent ABC1
• HOWEVER
• there is an appreciation that it is catering for
  a very broad cross-section of people.
• As mentioned earlier the usage is more likely to
  be affected by the level of confidence and
  experience of the parent. However, in addition
  to this, age can also be an influencing factor
• younger mums may be less confident / unsure what
  to do
• When they come youre thinking what should I
  be doing? What should he be doing? Is he
  doing enough for his age? And how can I
  stimulate
• him? Young
  mum ABC1
• older mums may also feel out of touch e.g. lack
  of peers at same stage in life.
• It is suited to someone like me - a late
  mother who doesnt really know what to do
  with this little blob. Older
  mum ABC1

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OVERALL PERCEPTIONS OF THE play_at_home BABY BOOK

• The book is considered quite different / unique
• solely focusing on play / child development
• no other publications available like play_at_home.
• Weve looked in all the shops and there was
  nothing really like that in the
• shops, more health care, how to feed, sleeping
  and things like that but not
• actual play books. Parent ABC1
• It was also quite clear that many parents valued
  having the book as a reference
• would be reluctant to give it back
• intending to use again with next baby.
• I definitely will use it - youre as well
  taking all the help and advice you can get
• Parent C2DE

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OVERALL PERCEPTIONS OF THE play_at_home BABY BOOK

• It must be noted that the elementary nature of
  some sections of the book are not necessarily
  considered a negative aspect, and can, in some
  cases, add to its appeal
• prompts you to do these things more often
• makes you more aware of the benefits (and
  precautions) of what you are doing
• can reinforce some common misperceptions e.g.
  talking baby talk / repeating baby noises
  recommended, fresh air is good for baby, etc
• reassures you that you are doing the right thing
• makes you feel good that you do these things
  naturally.
• I liked it and this is probably just vanity
  but a lot of the things I did
• naturally.. Parent ABC1

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PERCEIVED BENEFITS OF USING play_at_home BABY BOOK

• In general, parents perceive the book offers more
  benefits to them than the baby (however, this may
  be due to the short length of time that they have
  had the book too early to see benefits to
  child). The key benefits to parents are
  perceived to be
• provides ideas / suggestions
• sometimes when theyre restless youve to try
  and think what to do.
• Parent C2DE
• this will give me a wider variety of things to
  try with her, rather than just what Ive been
  told or already know. Parent
  C2DE
• increases confidence in handling baby, e.g.
  touching stroking, massage etc (for both
  parents, especially dad)
• Touching stroking I think that was more
  good for my husband because he was really nervous
  about picking him up and he really enjoyed it
  he wouldnt have had the confidence to do that
  otherwise. Parent ABC1
• My partner, was not around much when she was
  born, but he is around now, he knows he can read
  this, without me saying Oh, you are doing it
  wrong, so it is more
• helpful for him really Parent ABC1

34
PERCEIVED BENEFITS OF USING play_at_home BABY BOOK
(Contd)

• gives guidelines ( reassurance) on babys
  development e.g. gives you an idea of what baby
  should be doing at each stage
• Its good to see the development stages
  because you forget after
• the 1st child what stages baby can do
  things. Parent C2DE
• comforting / calming in times of stress
• Its comforting to know that Ive got
  something if hes driving me
• insane then I can go and find the book and
  look at the nursery rhymes. Parent
  ABC1
• reassures / relaxes anxious parents
• If I had not had that book, I think I would
  have been more anxious about what to do and
  when, so it did help me. Parent ABC1
• strengthens bond with child by encouraging touch
• encourages parent to make regular efforts to
  play.

35
PERCEIVED BENEFITS OF USING play_at_home BABY BOOK
(Contd)

• At this stage in the development of the
  programme, most were only able to comment on the
  short term benefits to the baby
• helps relax baby / put baby to sleep (deep warm
  bathing, massage etc.)
• It relaxed him completely with the deep baths
  they recommended in the book.
  Parent ABC1
• can be used as an alternative to medicine
• Even having a warm bath and a massage settles
  him, whereas before I would have
• probably given him medicine or something to try
  and settle him - its made me look at the
• alternatives rather than going to the medicine
  cupboard Parent, ABC1
• However, for those who had used the book for a
  longer period (mainly pilot members), some long
  term benefits were beginning to emerge
• closer bond with parent / more affectionate
  child
• and he is really a touchy baby now - he is so
  affectionate and I think that is because of that
  as well.
  Parent ABC1
• baby may be more alert, sociable, happy
• may help in speeding up development e.g. walking,
  crawling, sitting up early.
• It is recognised, however, that there are many
  other factors that can be attributed to the
  childs development e.g. surroundings, family
  circumstances, experience of mum etc..

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FORMAT AND PRESENTATION

• The format, presentation and layout of the book
  appealed across the board
• good size
• sturdy format / durable and easy to keep clean
  (can wipe it clean)
• easy to find relevant section
• well laid out information
• not too much writing on each page
• benefits and precautions very clear.
• Some requests (consistent with Health Visitors)
  were made for more colour use of photographs,
  rather than illustrations, to brighten it up.

37
LANGUAGE AND TONE
very well explained / easy to understand
non-didactic
encouraging / helpful
experienced / written by someone who has own
children
PERCEIVED TONE
motherly Like your mum telling you what to do,
what not to do and why.
caring / concerned
advisory but not too prescriptive
down to earth / approachable
Considered (and appreciated as) a highly
appropriate tone
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ADDITIONAL SUGGESTIONS FOR play_at_home BABY BOOK

• Although the play_at_home book is considered to be
  very self explanatory and easy to use, there were
  some requests for supplementary activity, in the
  form of local group sessions e.g. demonstrations
  of massage / baby massage classes
• may encourage / stimulate usage (and continued
  use thereafter)
• May increase involvement of parents through
  interaction with other parents.
• In some cases parents wanted the book to
  incorporate information related to other aspects
  of childhood e.g. illnesses, first aid etc..
  However, other suggestions related to the
  programme (which may be incorporated into further
  stages of the programme) are as follows
• more songs / games
• activities encouraging good behaviour e.g. tooth
  brushing etc.
• information on taking baby swimming
• section devoted to fathers and play
• available on video.
• Apart from the above, the only other suggestion
  made relates to the introduction of the book
• require better / clearer explanation by Health
  Visitor, or a written synopsis to highlight
  overall aim and benefits
• hand out pre-birth.

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RECOMMENDATIONS

• There is an opportunity for Health Visitors to
  spend more time explaining the book, clearly
  highlighting the key benefits (to both parent and
  child) and encouraging its use. This may be
  particularly useful amongst less experienced /
  confident parents, and for all parents on issues/
  activities that may be new to them e.g. massage.
• Indications are that complementary local
  activities e.g. baby massage classes, may
  encourage and stimulate continued use of the
  book.
• Monitoring use of the book throughout the
  different monthly age ranges could also encourage
  its use by reminding parents of the activities
  that both parent and child could benefit from.
• Further books within the programme should remain
  similar to the baby book in terms of their format
  and presentation of the information i.e. bullet
  points.

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RECOMMENDATIONS

• Additional suggestions relating to the overall
  programme which may be taken into consideration
  are
• more songs / games
• activities encouraging good behaviour
• information on play outside the home e.g.
  swimming
• a section specifically devoted to fathers and
  play.