Marketing the service : basic social process in health visiting.
The present study was undertaken to provide an understanding of the
processes underlying health visiting practice. The research strategy selected
was grounded theory (Glaser and Strauss 1967, Strauss 1987, Strauss and
Corbin 1990). A total of 21 female health visitors from a District Health
Authority in the North West of England participated in the study. Data was
collected by means of 20 formal interviews and 41 days of participant
observation in four different health centres.
To recognize the basic social process in any interaction is one of the major
aspects of grounded theory. This requires the identification of the
"Phenomenon" which motivates the development of a process and the
conditions under which it operates. The basic problem or phenomenon in
health visiting uncovered in the data was "Securing Life Trajectories". This
forms the core of the health visitor's work. The general set of conditions
that influence health visiting work was identified as "Working Between Two
Worlds". This is used to describe the health visitor's position between the
policy agenda and the client's agenda. The process revealed in the data that
health visitors use to respond to this overall problem was "Marketing Health
Visiting". This refers to the different tactics that they use to introduce the
policy agenda into the client's domain. During this process the policy
agenda is adjusted to fit the client's circumstances. Three major strategies are identified in this process: 1) Promoting the service, 2) Adjusting delivery
and 3) Tailoring the content.
This study found that "Marketing Health Visiting" is a gradual process in
which the health visitor wins grounds as time passes. As marketing
strategies are implemented the conditions influencing the interaction change.
Hence it moves from taking place in what is labelled in this study as
"Dissociated Context", to a "Convergent Context" and finally to a "Shared
Context". The final consequence of implementing marketing strategies is
that of constructing "A Common Agenda" with clients. This agenda is
basically the personalisation and contextualization of health visiting services.
To build this common agenda it is of crucial importance that the client
should see and feel the need for the health visiting service as well as the
development of trust between the professional and the client. Hence the
relationship that is developed between them acts as an enabling factor for
reaching mutual collaboration.
The discussion of the study focuses on its significance within the actual
debate on health visiting about introducing new ways of practice. The health
visitor's overall role is examined and the importance of developing
relationships with clients is also highlighted.