An ethnographic study exploring health visitors' engagement with fathers of children under five years old: A Bourdieusian perspective

Abstract

The health visiting service within the United Kingdom (UK) provides an essential public health service for all families with children under the age of five years old, under the wider umbrella of the 0-19 service. Despite maternity and postnatal policy stipulating a ‘family-centred’ approach to care delivery, the wider literature suggests that fathers can often feel marginalised within the health visiting service. An indirect corollary to this is that men’s mental health (MH) illness has been steadily increasing over several years. This is an area that health visitors (HVs) are available to assess and offer support to fathers, yet do not appear to be doing. A critical ethnographic approach was used to explore HVs engagement with fathers, through a combination of observations of HV practice, semi-structured interviews and field notes. The research took place in a health visiting service in the Northwest of England, with a sample of qualified HVs. Spradley’s framework for data analysis was employed to make sense of the findings and a Bourdieusian lens was used as a conduit for exploring individual HV practice within the wider scope of organisational custom and practice. Three themes emerged from the findings which include man in a van - barriers to HV engagement with fathers; toxic masculinity and feminist health visiting - a disconnect; and the ‘forgotten husband’s club - father’s mental health and the health visiting service. The findings highlight that organisational barriers exist, which impede HV engagement with fathers, alongside toxic masculinity, which has gathered momentum as a concept in contemporary society. Similarly, men’s MH remains an underassessed area of practice for HVs, leaving fathers feeling ‘forgotten’ by services. Implications for practice include policy review surrounding paternity leave, a review of commissioning of health visiting services, including delivery of universal antenatal contacts, designated electronic records for fathers and increased screening of paternal MH at routine HV contacts.