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Supporting Parent-Infant Relationships Equitably (SPIRE): A mixed-methods evaluation of the Start for Life prompts for holding relationships in mind

Background

In the first two years of a baby’s life, loving and responsive relationships with their parents or caregivers help babies feel safe and understood and helps to give them the best start in life. Having a baby can bring up lots of different feelings and emotions, and many parents and caregivers find it challenging to build a strong relationship with their baby, and might need extra support. It is crucial to identify and support parents and caregivers experiencing parent-infant relationship difficulties. 

There was a lack of suitable tools that health visitors, midwives and other practitioners could use to identify this need. Consequently, in March 2024, some guidance was published by The Department of Health and Social Care - The ‘Reflecting on parent-infant relationships: a practitioners guide’. This guidance included 3 conversation prompts that practitioners could use to support them in starting conversations around bonding with their baby in a meaningful and sensitive way. 

• What 3 words or phrases would you use to describe your relationship with your baby?
• What brings you the most joy in the relationship with your baby?
• What is your biggest fear about your relationship with your baby?

Implementation of this guidance has not been mandatory for Local Authorities or services. 

Our Project

Through our project SPIRE,  we want to evaluate the guidance and conversation prompts to explore whether they are being used, and if so, the impact they are having on families and services. 

Our main objectives: 

Aim: to evaluate acceptability, feasibility, and impact of the new parent-infant relationship prompts, to inform practice and policy. 

The six key objectives are to:

1. Identify barriers and enablers to adopting the prompts
2. Describe how prompts are implemented within existing systems of support
3. Understand practitioner and parent experiences of the prompts
4. Understand how inequalities might influence implementation
5. Evaluate the impact of the prompts on referrals to relevant services
6. Develop co-produced guidance for equitable implementation of the prompts

To achieve our objectives, our 14-month project comprises three work packages (WPs).

1. WP1 will explore practitioners’ and parents’ perceptions of the guidance, where it is being used. Purposive sampling will be used to invite participants from marginalised groups. Stakeholder interviews will be conducted in sites not using the guidance, to explore why it has not been adopted.
2. WP2 uses quantitative methods to evaluate the impact of the guidance on referrals to relevant services, and see how these compare to referral rates in areas that do not use the guidance.
3. WP3 will generate recommendations for future policy and practice based on findings from WP1 and 2.

An online national stakeholder workshop in April 2026 will use a world cafe approach to discuss findings and co-produce recommendations with stakeholders for integrating the guidance equitably into practice.

The research is funded by the National Institute for Health Research (NIHR) and led by Dr Sarah Blower, in collaboration with researchers at the University of Huddersfield, and Humber Teaching NHS Foundation Trust. 

We are also supported by an Expert Advisory Board, including people with expertise in parent-infant relationships and supporting families, and a Lived Experience Group of parents and caregivers who have their own experience of worrying about their connection with their baby.

To contact us about the project, please email spire-project@york.ac.uk, or follow us on BlueSky at @familywellbeinguoy.bsky.social

The research is funded by the National Institute for Health Research (NIHR) (NIHR207680). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.