A mixed methods realist evaluation of the MECSH parenting intervention investigating inequalities in access, engagement, retention and outcomes for birthing and non-birthing parents from Black and Asian communities in England.

Research question: What are the issues relating to equity of access, engagement, retention and equality of outcomes for Black and Asian minority ethnic parents (including non-birthing parents) receiving the MECSH programme in England? Background: In England, every family with children under the age of five is assigned a health visitor who offers a minimum of five contacts: • Antenatal visit • New baby review • Six-to-eight-week assessment • One-year assessment • Two-to-two-and-a-half-year review Through these visits health visitors support new parents and facilitate early identification of families at risk, enabling timely interventions. Families requiring additional support may be offered targeted services from the health visiting team. One such targeted service is the Maternal and Early Childhood Sustained Home Visiting (MECSH) programme, which provides a structured child development and parenting education programme delivered by health visitors from pregnancy to the child’s second birthday. The MECSH programme has not been specifically evaluated in the context of Black and Asian minority ethnic families. Aims and Objectives: The aim is to evaluate the MECSH programme to understand how it addresses issues of equity in access, engagement, retention, and outcomes for Black and Asian minority ethnic parents (including non-birthing parents) in England. The objectives are to evaluate the equity of: • Parental engagement with the MECSH programme • Programme retention rates • Programme fidelity • Parental satisfaction and experience • Health visitor experience • Referral and resource usage • Economic impact • Potential improvements in child health, development, and wellbeing And to provide recommendations for long-term impact on families from BAME backgrounds. Methods: A mixed-methods realist evaluation will explore "what works, for whom, under what conditions, and how," through four work packages. WP1: Scoping review of existing evidence and stakeholder workshops will be conducted to review and adapt the programme theory to meet the needs of Black and Asian families. WP2: All health visitors (approx. 546) across 48 MECSH sites in England will be invited to complete an online questionnaire about delivering MECSH to Black and Asian families. WP3: Four case study sites (two with MECSH, two without) are chosen based on population, geography, and deprivation factors. Interviews will be carried out with up to 20 health visitors per site. Up to 50 Black and Asian parents per site will complete an online survey, and up to 20 will be interviewed. An audit of 12 randomly selected parent/child health records for Black and Asian families will be conducted at each site. WP4: Routine data for families receiving MECSH over the past two years will be compared between Black and Asian families and majority ethnic parents. The study is designed with input from 10 Black and Asian parents, and a mother with recent MECSH experience is a co-applicant on the study. Timelines for Delivery: September 2025 – August 2028. Anticipated Impact and Dissemination: The study will provide insights into how the MECSH programme is implemented for Black and Asian parent groups in England, highlight potential improvements, and evaluate its impact on parents and children, as well as its cost-effectiveness. Findings will be disseminated through study advisory groups, parent events, academic publications, and presentations at conferences.