‘Making the most of together time’: development of a Health Visitor–led intervention to support children’s early language and communication development at the 2–2½-year-old review

Background: Early interventions to support young children’s language development through responsive parent–child interaction have proven efficacy but are not currently delivered universally. A potential universal delivery platform is the Health Visitor (HV)–led 2–2½-year-old review in England’s Healthy Child Programme. It is unclear if it is feasible to offer such interventions through this platform. We report an intervention development process, including extensive stakeholder consultation and co-design which aimed to develop an acceptable, feasible and equitable early language intervention for delivery in this context. Methods: The study involved five phases including 13 stakeholder co-design workshops with 7 parents and 39 practitioners (HVs, early years practitioners and speech and language therapists): (1) Identification of existing intervention evidence, (2) qualitative review of intervention studies extracting candidate target behaviours for intervention and intervention techniques, (3) co-design workshops with parents and practitioners examining acceptability, barriers and enablers to those behaviours and techniques (particular attention was paid to diverse family circumstances and the range of barriers which might exist), (4) findings were analysed using COM-B and theoretical domains frameworks and a prototype intervention model designed, and (5) co-design workshops iteratively refined the proposed model. Results: Practitioners were committed to offering language intervention at the 2–2½-year-old review but were not sure precisely how to do so. Parents/caregivers wanted to be proactive and to have agency in supporting their own children and to do this as soon as possible. For equitable intervention, it must be proportionate, with higher ‘intensity’ for higher levels of disadvantage, and tailored, offering differing approaches considering the specific barriers and enablers, assets and challenges in each family. The importance and potential fragility of alliances between parent/caregiver and practitioner were identified as key, and so, strategies to engender successful collaborative partnership are also embedded in intervention design. Conclusion: It is possible to develop a universal intervention which parents and practitioners judge would be acceptable, feasible and equitable for use at the 2–2½-year review to promote children’s language development. The result is one of the most explicitly developed universal interventions to promote children’s language development. Further development and piloting is required to develop materials to support successful widespread implementation.