title: Working in partnership: the application of shared decision-making to health visitor practice.
abstract: OBJECTIVE
  To explore the processes that support shared decision-making when health visitors and parents are creating plans to improve the well-being of babies and children.
  
  
  BACKGROUND
  Worldwide, there is a focus on promoting children's well-being to enhance the population health. Within the United Kingdom, health visitors have a key responsibility for working in partnership with parents to support this agenda. Despite evidence that the application of 'shared decision-making' frameworks can increase patient participation, improve patient satisfaction and improve health outcomes, there is limited research linking shared decision-making with health visitor practice.
  
  
  METHODS
  A qualitative, descriptive study.
  
  
  METHODS
  The study was undertaken in two phases: in Phase 1, data were collected by audio recording two health visitor-parent decision-making conversations, in the absence of the researcher, where decisions around planning for a baby or child were being made as part of usual care, and then the participants' experiences were sought through individual questionnaires. In Phase 2, semistructured interviews were conducted with nine health visitors and nine parents in relation to their recent experiences of planning care.
  
  
  RESULTS
  Evidence of supportive processes included having a shared understanding around the issue needing to be addressed; being able to identify interventions that were accessible for the family; engaging in decision-making through deep, meaningful conversations using sensitive and responsive approaches; and establishing positive relationships between health visitors and parents, significant others within the family and other professionals.
  
  
  CONCLUSIONS
  Despite evidence of strong, trusting relationships between parents and health visitors, there were times when shared decision-making was unable to take place due to the absence of supportive processes.
  
  
  CONCLUSIONS
  Health visitors are aware that planning interventions with parents can be complex. These findings indicate the value of using a shared decision-making framework to structure planning, as application of a framework identified the processes that support a collaborative approach in practice.
authors.affiliation: Children and Families Teams, NW Sector - Glasgow City HSCP, Glasgow, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Astbury
authors.affiliation: School of Health Sciences, University of Stirling, Stirling, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Shepherd
authors.affiliation: Nursing Midwifery and Allied Health Professions-Research Unit, University of Stirling, Stirling, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Cheyne
mesh_terms: D002648:Child; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D016389:Maternal-Child Nursing; D064691:Nurses, Community Health / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: health visiting; practice development; public health nursing; shared decision-making