Health Visitors' Professional Identity and their Lived Experience of Service Change

Abstract

This qualitative extended study explored 20 health visitors’ (HVs’) perceptions of their professional identity and their experience of living through a time of significant service change. Specifically, it investigated, how, and in what ways the changes affected HVs and their professional identity. The study spanned from an initial restructuring of the health visiting and Children’s Centre services by one NHS trust in England in 2018, through to, and including, the initial peak of the Covid-19 pandemic in 2020. It was set in the wider context of the transformational NHS Long Term Plan (2019) and the radical service changes based on government directives in response to the Covid-19 health crisis. The study methodology was informed by phenomenology. Data were collected from face-to-face, one-to-one interviews using a visual art-based approach in the form of collages, complemented by entries in participants’ diaries. Analysis was conducted using interpretative phenomenological analysis (IPA). Of the original sample of 20 participants, 15 were interviewed after a year (plus) to compare data. A significant early finding was establishing HVs’ perception of their professional identity. An understanding of the effects of the service changes emerged through mapping the HVs’ experiences against core dimensions of their professional identity. The findings prior to the Covid-19 pandemic suggest that there were a number of changes that challenged HVs’ practice. The more radical changes necessitated by the pandemic further affected practitioners and their practice. Based on the evidence gathered, this research thesis is that HVs’ perception of their professional identity, and their aspirations, remained strong and stable, transcending the service changes. This is in spite of the challenges of the changes and the impact of these on HVs and their practice. The professional identity dimensions identified in this study are important if HVs are to be able to practise effectively as public health practitioners. This is in accordance with their professional principles, values and mission to ‘make a difference’ to the lives of their clients (Whittaker et al., 2013: 8, original emphasis). Acceptance of, or resistance to, externally-driven service changes appeared to depend on the maintenance or disruption of a number of inter-related aspects of practice and how the changes affected HVs as professionals and persons. The various aspects of practice included the core dimensions of their professional identity, the ‘three core practices’ of the HV-client relationship, home visiting and needs assessment established by Cowley et al. (2013: 12), and their principles and values. Individual HVs reported that the effect of the service changes often meant that they were unable to enact their role as they aspired and therefore considered leaving the profession. Consequentially, HVs’ professional identity and associated operational and aspirational factors need to be recognised and maintained by those designing and implementing service changes if they are to be more readily accepted by HVs, especially in light of the link between chronic work stress, absenteeism and high staff turnover (The King’s Fund, 2020e). While it is acknowledged that this study was limited to a relatively small group of HVs in one locality, the insights to be gained are important in a wider setting. It is suggested that this study’s findings are useful for policy and decision-makers, and all those actively engaged in educating, organising and directing the health visiting workforce. Through applying knowledge from the findings, the vision to optimise public health, reduce health inequalities, address health needs and safeguard children, shared by practitioners and those who direct their service, may be better realised.