title: Healthy Start vitamins--a missed opportunity: findings of a multimethod study.
abstract: OBJECTIVE
  To evaluate and provide a real-life view of the operation of the Healthy Start vitamins scheme.
  
  
  METHODS
  The study took place in primary care and community settings that served rural, urban and ethnically diverse populations, in two sentinel sites: London, and Yorkshire and the Humber. An online consultation and stakeholder workshops elicited views from across England.
  
  
  METHODS
  669 health and social care practitioners including health visitors, midwives, public health practitioners, general practitioners, paediatricians and support staff participated in focus group discussions (n=49) and an online consultation (n=620). 56 participants representing health and social care practitioners, policymakers, service commissioners, and voluntary and independent sectors took part in stakeholder workshops.
  
  
  METHODS
  Three-phase multimethod study comprising focus group discussions, an online consultation and stakeholder workshops. Qualitative data were analysed thematically and quantitative data from the online survey were analysed using descriptive statistics.
  
  
  RESULTS
  Study participants were concerned about the low uptake of Healthy Start vitamin supplements and the consequences of this for health outcomes for women and young children. They experienced Healthy Start vitamin distribution as logistically complex, requiring the time, resources and creative thinking of a range of local and regional practitioners from senior strategists to administrative support workers. In the light of this, many participants argued that moving to universal provision of vitamin supplements would be more cost-effective than the current system.
  
  
  CONCLUSIONS
  There is consistency of views of health practitioners that the current targeted system of providing free vitamin supplements for low-income childbearing women and young children via the Healthy Start programme is not fulfilling its potential to address vitamin deficiencies. There is wide professional and voluntary sector support for moving from the current targeted system to provision of free vitamin supplements for all pregnant and new mothers, and children up to their fifth birthday.
authors.affiliation: College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: McFadden
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Green
authors.affiliation: Freelance, Tunbridge Wells, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: McLeish
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Felicia
authors.initials: F
authors.lastname: McCormick
authors.affiliation: Food Matters, Brighton, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Williams
authors.affiliation: College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Renfrew
mesh_terms: D001291:Attitude of Health Personnel; D001361:Avitaminosis / Q000191:economics / Q000517:prevention & control*; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D019587:Dietary Supplements / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D017048:Health Care Costs; D006801:Humans; D008297:Male; D011203:Poverty; D011247:Pregnancy; D014815:Vitamins / Q000191:economics / Q000627:therapeutic use*
chemical_list: D014815:Vitamins
keywords: Child, pre-school; Healthy Start; Multi-method study; Pregnant women; Vitamins