The Family Nurse Partnership Natural Experiment study was commissioned by Scottish Government in 2015/16 and published on 8^th October 2024.

The aim of the study was to compare first time young mothers enrolled and receiving the FNP programme (FNP Clients) to a comparator group of Controls over a range of maternal and child outcomes.

This study was conducted by the Centre for Trials Research, Cardiff University with support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement.

Method

The study used a natural experiment approach to define the FNP Client group and a comparator (Control) group. This method was chosen due to the way FNP was rolled out across Scotland from 2010.

The study used routine health, education and social care data to evaluate outcomes of interest to FNP. The datasets were linked and an anonymised linked data set was used to undertake the analysis.

Outcomes of interest covered maternal and child outcomes and compared FNP clients with the comparator group (Controls). The outcomes were structured around the FNP Scotland logic model and availability of routine data.

The study population included all young women 19 years or younger, eligible for the FNP Programme from 1st January 2009 to 31st March 2016 and their first-born child(ren).

• The FNP Client group is all women (and first-born children) enrolled into FNP in the ten participating Scottish HBs since its initiation from 1^st January 2010 to 31^st March 2016.
• The Control population is all women eligible for enrolment in the FNP programme during a period when FNP recruitment was not offered in the same FNP catchment area, in the 12 months prior to initiation of FNP recruitment (starting 1^st January 2009), and interval periods of FNP recruitment (i.e. when recruitment was temporarily suspended due to caseload capacity being reached).

Study groups were followed up until their children reached the age of 5.

Further information on methods used can be found here: Executive summary - Family Nurse Partnership evaluation: methods and process - gov.scot (www.gov.scot)

Findings

Overall, there were five statistically significant differences in outcomes between all FNP Clients and Controls. Differences in favour of FNP were generally small but were consistent with other FNP evaluations:

• Breastfeeding at 10-14 days – FNP mothers had significantly higher rates of breastfeeding at 10-14 days post-birth (22% in FNP and 17% in Controls)
• Breastfeeding at 6-8 weeks  -  FNP mothers had significantly higher rates of breastfeeding at 6-8 weeks post-birth (11% in FNP and 9% Controls).
• Passive Smoking – FNP mothers were significantly more likely to reduce their child’s exposure to second hand smoke earlier in the child’s life (between 10-14 days and 6-8 weeks) – 11.2% reduction compared to 3.9% reduction in Controls.
• Dental Registrations – Significantly more children receiving FNP (61.8%) had been registered with a dentist by 24 months compared to Controls (60.7%).
• Child Development – Significantly more children in the Control group (22%) had a new developmental concern recorded at 27-30 months compared to the FNP group (19%), indicating that developmental concerns for children in FNP are identified at an earlier age.

There were no significant differences between FNP and Controls in overall achievement of the Curriculum for Excellence levels at the appropriate age and stage (when data from  P1 or P4 was combined or at P1 only) . However, there were statistically significant differences, evidencing FNP impact at a health board level with variation between health board:

• For Writing children receiving FNP were significantly more likely to achieve early or first level in NHS Greater Glasgow and Clyde and NHS Fife Health Board areas compared to Controls.
• For Literacy^[1] children that received FNP were more likely to achieve early or first in NHS Fife health board area compared to Controls.
• In other health board areas, the sample size was often too small for meaningful comparison. In NHS Lothian and NHS Tayside no significant differences were found for writing or literacy.

There were no findings in favour of Controls and thus no evidence that FNP is having a negative impact.

You can read the full report on the Family Nurse Partnership Natural Experiment study on Cardiff University’s website: