How healthcare managers and frontline staff influence the delivery and sustainability of a key infant abuse prevention initiative across the NHS has been revealed in a new study. The NIHR Applied Research Collaboration West (ARC West)-led evaluation of ICON, a UK-wide programme designed to reduce the risk of abusive head trauma (AHT) in infants, is published in BMC Public Health.
ICON has been widely adopted in hospitals and primary care. While most evaluations of AHT prevention focus on parents and carers, this research examined the perspectives of those responsible for implementing ICON in practice.
Researchers conducted interviews and focus groups with 53 managers and healthcare professionals across 6 regions of England between October 2022 and April 2023.
The analysis identified 4 enablers and associated challenges affecting ICON’s reach and long-term impact:
- Fidelity and consistency: Ensuring ICON’s messages were delivered at the recommended touchpoints in a consistent way was central to its effectiveness, but variable delivery reduced reach
- Tailoring to the family: Families were more receptive when staff tailored their approach, but this required time and flexibility
- Staff buy-in: Engagement was influenced by workload pressures and past exposure to AHT cases
- Leadership oversight: Strategic leadership and governance support were critical for adoption, sustained implementation and embedding ICON in routine care
The researchers conclude that staff are motivated to deliver ICON and adapt messages to family circumstances, provided adequate training and manageable workloads are in place. Leadership prioritisation emerged as pivotal for mainstreaming the programme.
Researchers suggest that recognising these organisational barriers and facilitators will be key to ensuring ICON can be scaled, sustained, and adapted to meet the needs of local families – ultimately strengthening policy efforts to prevent infant harm.
Dr Maria Barnes, Research Fellow at the Centre for Academic Primary Care, University of Bristol and senior author, said: "Healthcare professionals are passionate about keeping babies safe, and they see ICON as a valuable tool. But for ICON to reach every family, staff need the time, training and leadership support to deliver it well. Our findings show that with the right conditions, ICON can be embedded into everyday practice and make a real difference.”
Paper: Healthcare leaders and professionals’ perspectives of the ICON programme to prevent abusive head trauma in infants: a qualitative study
Further information
About the Centre for Academic Primary Care
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow on Bluesky: @capcbristol.bsky.social and LinkedIn.
About the National Institute for Health and Care Research (NIHR)
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
- Funding high quality, timely research that benefits the NHS, public health and social care;
- Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
- Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
- Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
- Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
Funding applied global health research and training to meet the needs of the poorest people in low- and middle-income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.
