Authors' objectives: The COVID-19 pandemic interrupted and, in some cases, transformed the way health visiting teams work, the way they interact with families and children and with the wider community and other service providers. Health visiting services are organised, delivered and experienced differently in different places, with little evidence to suggest what works best, for whom and in what contexts. To synthesise the evidence on changes during the pandemic to identify the potential for improving health visiting services and their delivery in the United Kingdom.

Authors' results and conclusions: One hundred and eighteen documents informed this review; most focused on health visiting in England (56%) or the United Kingdom (34%), with relatively few from Wales (6%), Scotland (3%) and Northern Ireland (1%). Documents highlighted the widespread, uneven and lasting impact of the COVID-19 pandemic on babies and families. Findings revealed significant concerns expressed by both families and practitioners and corresponding actions taken by health visiting services. These concerns and responses emphasised the flexibility and resourcefulness of health visitors, the vital role of trusting relationships between health visitors and families and the importance of holistic assessments for early intervention. Changes in service delivery were varied and were not always evaluated or sustainable. While the data illuminated some of the hidden complexities of health visiting practice, limited evidence was found on decision-making at organisational and managerial levels during the pandemic response. The COVID-19 pandemic highlighted the essential role of health visitors in safeguarding child and family well-being in the United Kingdom. While digital adaptations provide necessary continuity, face-to-face interactions remain essential for effective health visiting. The crisis exposed pre-existing workforce pressures and inconsistencies in service provision, emphasising the need for adequate support and funding. Policy-makers must recognise the complexity of health visiting and ensure sustained investment in universal home visiting services. Future resilience requires a realistic understanding of health visitors’ work, integration into broader child health policies and enhanced interagency collaboration to address inequalities and improve long-term public health outcomes.

Authors' methods: This realist review engaged professional stakeholders (N = 28) and those caring for babies during the pandemic (N = 6) throughout the process. We searched five electronic databases for publications on health visiting during the COVID-19 pandemic from October 2022 to April 2023. This was followed by citation searching and review of organisational websites. Programme theory was iteratively refined through discussions with the team, professional stakeholders and people with lived experience and was translated into key findings and recommendations.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR136053

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/published-articles/GJEG0402

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GJEG0402

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk