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A do-it-yourself drive to spread the D word

A community nursing team in Surrey led by Pauline Bigwood was recognised in the 2015 Nursing Standard Nurse Awards for an innovative campaign to increase vitamin D awareness among parents and clinicians. The aim of the campaign is to improve child health by implementing Department of Health recommendations for vitamin D supplementation.

A local nurse-led initiative to increase vitamin D awareness and supplementation is attracting national attention.

Vitamin D for You and Me targets pregnant mothers, children under the age of five and at-risk groups, such as people with darker skin tones or children with additional needs who may spend little time outdoors.

The campaign was begun in September last year by community services provider and social enterprise CSH Surrey’s 0-19 nursing team.

The aim is to improve child health by implementing Department of Health (DH) recommendations for vitamin D supplementation (see box). Team lead Pauline Bigwood, a nurse, health visitor and professional practice teacher, says the evidence is clear that vitamin D is essential for healthy bone growth and children’s general development.

Department of Health recommendations on vitamin D

Nursing team lead Pauline Bigwood talking to a mother about the campaign

Picture credit: Andrew Aichison

All pregnant and breastfeeding women should take a daily supplement containing 10μg of vitamin D, to ensure the mother’s requirements for vitamin D are met and to build adequate fetal stores for early infancy.

All infants and young children aged six months to five years should take daily vitamin D drops to help them receive 7-8.5mg per day. However, infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D.

People aged 65 years and over and people who are not exposed to much sun should also take a daily supplement containing 10mg of vitamin D.

Go to tinyurl.com/npmfq7c for more information

‘The national evidence paints a picture of vitamin D deficiency,’ she says. ‘We need to initiate change.’

Locally, there was an incentive to act because staff did not always find the national recommendations helpful.

‘A team member came to me and she said she was confused about the recommendations and so was not delivering a clear message – or best practice,’ she recalls. ‘She wanted to know does a mother take vitamin D throughout pregnancy? What does “dark skin” or “low exposure for sun” actually mean?’

Ms Bigwood also felt her team was in the ideal position to engage mothers and motivate change in vitamin D supplementation: ‘As nurses, the team meets breastfeeding mothers to support early intervention every day in our working lives.

‘Conversations need to be had at every appointment or contact with pregnant women and mothers of young children.’

The lack of a national campaign prompted Ms Bigwood to design her own and inspire her team to get behind it. Simplicity was important – the initial budget was just £350.

Cost-effective approach

‘We are using an innovative pathway tool developed with our paediatric dieticians. It empowers our team to deliver consistent, evidence-based information at every appropriate client contact,’ says Ms Bigwood.

‘We wanted resources that could be used at home and clinic and were sustainable and cost-effective. The pathway tool is on an A5 laminated sheet and every health visitor and nursery nurse has it. It is not only a pathway, it includes guidance on food and dispels some of the myths that you only need sunshine.

‘But we also wanted to deliver a simple, eye-catching and memorable campaign that would promote discussion, so we worked with the communications manager and a local designer to develop the visuals. We wanted it to appeal to parents and children, and professionals.’

As well as a campaign poster, staffhave a badge that says ‘Ask me about vitamin D’ to wear when working with families, and a badge designed for children promotes discussion with their parents. The information provided by CSH Surrey’s website was improved and now includes all campaign materials to encourage its use as a resource for both parents and healthcare professionals. In a benchmarking survey in advance of the campaign, 42% of respondents said they wanted vitamin D information via their health visitor and 18% via their GP. Leaflets were only wanted by 11%.

‘Leaflets get lost and are expensive so we designed information labels summarising DH guidance to stick inside personal child health records because parents won’t lose them,’ says Ms Bigwood.

She collaborated with partner agencies and primary care, including children’s centres, GPs and acute paediatric teams.

She also involved hospital and community midwives. ‘I lead on an antenatal pathway meeting with midwives and breastfeeding leads, and went to midwifery units in hospitals to see how we could support them. We also put up our posters in antenatal clinics.’

Advice is offered on supplementation together with the information sticker at the 28-week antenatal contact, which is an important reminder if mothers have not started supplementation following their midwife contacts, says Ms Bigwood.

She has delivered further training, and runs awareness and education events for health professionals. And her team takes its message into the community and professional practice events and promotes the initiative via traditional and social media.

‘We have taken our poster to conferences but we knew we had to get into the heart of our community to make a difference,’ says Ms Bigwood.

‘We have a pop-up campaign and will take it anywhere to get our message heard. We have been to children’s centre events, and more than 200 families attended our stall to get advice from our team of health visitors, school nurses, dieticians and community nursery nurses at the Surrey Big Fun Day.’

The results of an evaluation in March to gauge the impact of the campaign’s first six months are not yet available but early figures show a rise in parents’ awareness of the need for vitamin D supplementation compared with the pre-campaign audit.

Ms Bigwood says interest in the campaign is continuing to grow. ‘Clinicians are asking for more of the sticky labels and the 0-19 team receives numerous requests from children’s centres, paediatricians, GPs and hospital stafffor the campaign resources and training.

‘It is cost-effective, sustainable and it works.’

The campaign is also attracting national attention. The team was runner-up in the Public Health Nursing category of the 2015 Nursing Standard Nurse Awards, sponsored by Public Health England. And it has produced a case study for NHS England to use on websites, at events, in bulletins and reports.

It produced a poster presentation for the Community Practitioners’ and Health Visitors’ Association national conference, where the Vitamin D for You and Me initiative received a Mac Queen Professional Practice Award.

‘The response to our campaign has been overwhelming,’ says Ms Bigwood. ‘I feel so proud of our teams’ commitment’.

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