5.6.6.1 Health visitor referral code (Child Health Surveillance data)
Health visitors enter a code on the 6-8 week Child Health Surveillance assessment form to indicate whether or not a child should be referred to a DHSW. The field can be completed as follows:
no referral is made- ‘N’
a referral to a DHSW made- ‘Y’
a parent has refused the offer of a DHSW referral- ‘R’ a health visitor has left the referral box incomplete- ‘I’
5.6.6.2 Attempted DHSW intervention (Health Informatics Centre data)
This binary variable is defined as any attempt made by a DHSW to deliver an intervention to a family, whether successful or not. If a record for a child
appears in the HIC database, this indicates that a DHSW has attempted to deliver an intervention (=1). A ‘0’ indicates that the family have not had an attempted intervention or that they were contacted solely to arrange the delivery of an intervention later.
5.6.6.3 DHSW Intervention
A tick box completed by DHSWs indicates whether they have delivered any of a number of intervention components to a family. No detail is provided on how this is done. We have defined a “successful” DHSW intervention (=1) as a
recorded intervention where at least one of the following components has been delivered:
Toothbrushing advice Dietary advice
Signposting
Referral to a health visitor Further home support
Family linked with dental services
This is different to the previously defined variable ‘attempted DHSW intervention’ because, here, a ‘0’ indicates that an intervention was never attempted or that an attempt was not ‘successful’ (e.g. the parent refused the intervention, the family were not at home when the DHSW attempted a home visit, the DHSW made contact with the family but did not deliver any of the aforementioned components).
5.6.6.4 Participation at dental practice (MIDAS data)
Participation at dental practice is defined as a child being either registered at and/or attending a dental practice for treatment. This is the variable
recommended by ISD. The earliest date for either of these events was taken as the ‘date of participation’. In this way we overcame the problems where (1) some children in the dataset had a treatment date but no registration data and vice versa and (2) some treatment dates preceded registration dates.
5.6.6.5 Scottish Index of Multiple Deprivation (SIMD) (2009) (linked to datasets by ISD)
The SIMD is based on geographical area in which children live and provides a relative ranking of deprivation across Scotland. The geography of Scotland is divided into data zones and these data zones are ranked based on seven deprivation indicators. These indicators are income, employment, health, education, access to services, housing and crime (The Scottish Government, 2009). Ranks are then grouped into categories, such as the quintiles reported in this study with categories ranging from 1 (20% most deprived) to 5 (20% least deprived).
As this study tracked changes in health boards over time, we used the SIMD release for 2009 which is the year closest to the time the Childsmile referral box “went live” on the Child Health Surveillance form. Using one SIMD release
throughout the analysis is recommended for studies taking this approach (ISD, 2010).
National SIMD provides the rankings relative to national levels of the indicator measures, whereas local SIMD provides the rankings relative to levels within the health boards.
5.6.6.6 Urban/Rural classification (linked to datasets by ISD)
This variable indicates the urban/rural classification of the area in which a child lives based on the child’s postcode. There are six categories ranging from ‘large urban area’ as the most populated to ‘remote rural’ as the least populated.
5.6.6.7 Health Board of Exam (Child Health Surveillance data)
This variable indicates the health board within which the health visitor
conducting the 6-8 week CHS assessment is based. Data from the island boards have been grouped to limit potential disclosure of otherwise anonymous personal information. The health boards are as follows: NHS Ayrshire & Arran (AA); NHS Borders (B); NHS Fife (F); NHS Greater Glasgow & Clyde (GGC); NHS Highland (H); NHS Lanarkshire (La); NHS Grampian (G); NHS Lothian (L); NHS Tayside (T); NHS Forth Valley (FV); NHS Dumfries & Galloway (D&G); and, the Islands (ISL) which included NHS Orkney, NHS Shetland, and NHS Western Isles.
5.6.6.8 Feeding (Child Health Surveillance data)
This variable indicates whether a child is breastfed, bottle-fed or both breast and bottle-fed at the time of the 6-8 week CHS assessment.
5.6.6.9 Smoking (Child Health Surveillance data)
This variable indicates whether or not a health visitor recorded that a child resided in a household with a smoker at the time of the 6-8 week CHS
missing values for this variable. This was due to health visitors leaving this section of the CHS form incomplete.
5.6.6.10 Health Plan Indication (HPI) (Child Health Surveillance data)
This variable is used by health professionals to indicate whether a child has been assessed as requiring a core, additional or intensive programme of support. ‘Core’ indicates that the child requires only that support which is universally available to all children. ‘Additional’ indicates that structured support should be put in place in addition to the universal programme. ‘Intensive’ indicates that intensive inter-agency support is required.
5.6.6.11 Level of risk
We calculated the ‘level of risk’ for each individual child in the dataset. This is an aggregated risk score based on four factors: area-deprivation (SIMD), type of feeding, smoking, and health plan indicator. Each child in the dataset was given a score of 1 for each of these four risk factors, and a ‘0’ otherwise:
Living in the most deprived areas (SIMD 1) Being bottle-fed
Living in a smoking household
Being assigned an ‘intensive’ health plan by a health visitor at 6-8 weeks We report outcomes in relation to ‘0 risk factors’, ‘1 risk factor’ 2 ‘risk factors’ and ‘high risk’. ‘High risk’ is 3 or more risk factors.