Organisational barriers and enablers to infant abuse prevention programme ICON

How healthcare managers and frontline staff influence the delivery and sustainability of a key infant abuse prevention initiative across the NHS has been revealed in a new study. The ARC West-led evaluation of ICON, a UK-wide programme designed to reduce the risk of abusive head trauma (AHT) in infants, is published in BMC Public Health.

ICON has been widely adopted in hospitals and primary care. While most evaluations of AHT prevention focus on parents and carers, this research examined the perspectives of those responsible for implementing ICON in practice.

Researchers conducted interviews and focus groups with 53 managers and healthcare professionals across 6 regions of England between October 2022 and April 2023.

The analysis identified 4 enablers and associated challenges affecting ICON’s reach and long-term impact:

• Fidelity and consistency: Ensuring ICON’s messages were delivered at the recommended touchpoints in a consistent way was central to its effectiveness, but variable delivery reduced reach
• Tailoring to the family: Families were more receptive when staff tailored their approach, but this required time and flexibility
• Staff buy-in: Engagement was influenced by workload pressures and past exposure to AHT cases
• Leadership oversight: Strategic leadership and governance support were critical for adoption, sustained implementation and embedding ICON in routine care

The researchers conclude that staff are motivated to deliver ICON and adapt messages to family circumstances, provided adequate training and manageable workloads are in place. Leadership prioritisation emerged as pivotal for mainstreaming the programme.

Researchers suggest that recognising these organisational barriers and facilitators will be key to ensuring ICON can be scaled, sustained, and adapted to meet the needs of local families – ultimately strengthening policy efforts to prevent infant harm.