1. Understanding the use of vouchers and vitamins: an evaluation of women’s and health practitioners’ views and experiences of Healthy Start in England Alison McFadden, Julia Fox-Rushby, Josephine M Green, Victoria Williams, Subhash Pokhrel, Jenny McLeish, Felicia McCormick, Nana Anokye, Melina Dritsaki, Mary J Renfrew Background Healthy Start aims to improve the health and nutrition of low-income childbearing women and children. Healthy Start provides vouchers which can be exchanged for fresh or frozen fruit and vegetables, plain cows’ milk or infant formula, and coupons for free vitamin supplements. Healthy Start is claimed by around 80% of people who are eligible for the scheme. but only 1% of vitamin supplements are claimed. Aims To examine how Healthy Start works from the views of women and practitioners To provide evidence for how Healthy Start could work better Methods The study was conducted in 2011/2012 Focus groups, a national electronic consultation, participatory workshops and telephone interviews explored the views of health practitioners and user advocates (n=669 of which 228 were health visitors), and low-income women (n=113). Two cross-sectoral workshops, attended by practitioners, service commissioners, policy-makers and advocacy groups (n=56) identified barriers and positive strategies to the study recommendations. Findings Practitioners and women thought that Healthy Start has a positive impact on the health of women and young children I used to live on junk food - now I'm eating healthy - without vouchers I wouldn’t buy fruit and veg. provides a nutritional safety net by providing financial support for the purchase of fruit, vegetables, plain cows’ milk and infant formula. increases the quantity and range of fruit and vegetables in family diets and establishes good eating habits A children's centre offer £5 worth of fruit and veg. for £3.10 voucher. is not easily accessible for women who do speak or read English or whose household income is variable I have five kids, m husband is self-employed - I want to access the vouchers when my husband has no work. will be undermined if the value of the vouchers does not keep pace with the rising cost of fruit and vegetables vitamins are not reaching the women and children who need them I knew I was entitled to vitamins but where do you go to get them? In our PCT, we fund Healthy Start vitamins for ALL childbearing women and ALL children under five years Key recommendations 1.Maintain and develop Healthy Start e.g. provide application forms in different languages; index-link the vouchers to food prices 2.Make vitamin supplements free and universally available for childbearing women, and children up to their fifth birthday 3.Develop a communication strategy to increase awareness of Healthy Start 4.Develop an overarching strategy for vulnerable women to increase early engagement with health services. 5.Provide training for practitioners in all sectors regarding their role in Healthy Start 6.Clarify that the inclusion of infant formula reflects Healthy Start’s aim to provide a nutritional safety net 7.Evaluate the costs and effectiveness of Healthy Start vouchers and vitamins. Contact: Alison McFadden: a.m.mcfadden@dundee.ac.uka.m.mcfadden@dundee.ac.uk You can download the full report at: http://nursingmidwifery.dundee.ac.uk/mother-and-infant-research-unithttp://nursingmidwifery.dundee.ac.uk/mother-and-infant-research-unit The scheme is the most complicated one to implement that I have ever come across.