From leadership research to district action: Healthcare leaders and professionals’ perspectives of the ICON programme to prevent abusive head trauma in infants: a qualitative study

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Background Abusive head trauma (AHT) in infants is the most common abusive injury in young children, and increased awareness has resulted in the development of prevention programmes. Most research evaluating AHT prevention programmes report parental and carer perspectives. Little is known about barriers and facilitators to adopting, implementing, and maintaining educational programmes from the perspectives of managers and staff delivering the education. ICON is an AHT prevention programme currently being delivered in National Health Service hospital and primary care settings in the United Kingdom. Methods This study evaluated the ICON programme from the perspective of managers and healthcare professionals through the RE-AIM framework using qualitative methods. Fifty-three managers and healthcare professionals across six geographical areas in England participated in individual interviews and focus groups between October 2022 and April 2023. Data collection and analysis were concurrent, systematic, and iterative, using framework analysis as a guide to explore factors impacting ICON’s reach and the key enablers and obstacles to its effectiveness, adoption, implementation, and maintenance. Results Four primary enablers and related challenges to the ICON programme’s impact were identified. Fidelity to the programme’s recommended touchpoints and message impacted ICON’s reach to new parents and carers. Parental receptiveness to the programme was affected by staff individualising their approach. Staff buy-in was related to staff workload and previous experiences with AHT. Managers with strategic leadership responsibility for reducing infant mortality and able to provide governance oversight fostered successful adoption, implementation, and maintenance of the programme. Conclusions Staff are willing and able to deliver the ICON programme, including, where necessary, delivering the key messages in a format acceptable to families varying situations, if given the workload and training to do so. Those in leadership positions influence the likelihood of successful adoption, delivery and longer-term mainstreaming, if they are able to prioritise the programme. Understanding the barriers and facilitators to ICON’s delivery has the potential to inform policy by facilitating the uptake of the programme by settings, enabling delivery of ICON to reach the needs of local families, and ensuring sustainability of the ICON programme. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-025-24682-0. Keywords: Abusive head trauma, Prevention programme, Shaken baby syndrome, Programme evaluation, Infants

Study methods

We used qualitative methods and the RE-AIM Framework to identify key barriers and facilitators to the ICON programme in practice [16, 17]. The RE-AIM Framework’s emphasis on programme evaluation assisted with identifying barriers and facilitators to behavioural interventions, such as ICON’s message of coping strategies to assist new parents in caring for a crying infant. The research question for this qualitative component of the larger mixed-methods study was as follows: Amongst managers and HCPs, what factors determine the reach of the ICON programme, the ability to be effective, and the key enablers and obstacles to its adoption, implementation, and maintenance?

Limitations

A primary strength of this study was the large number of participants including various professions and grades, enabling capture of a broad range of views. Recognising the importance of input from multiple staff groups during the initial recruitment phase, we exceeded the anticipated sample size to include commissioners, managers, safeguarding leads, midwives, nurses, health visitors, GPs, and infant feeding teams. This approach garnered a comprehensive picture of the context of ICON roll-out in the regions studied. Another study strength was obtaining perspectives on an educational intervention across multiple regions in England, including from the north, central and south of England and communities with varied cultural backgrounds and supporting clients experiencing different levels of advantage. Online interviews and focus groups facilitated data collection across England, booked at times convenient to healthcare teams. Following data analysis, we ran a stakeholder event to discuss findings with managers and HCPs involved in the study; themes were positively validated, and no participants expressed contradictory views. There was unanimity in affirming the importance of a national strategy addressing AHT. One potential limitation relates to the challenge of recruiting midwives and GPs, which may be due to lower use of ICON in practice and limited capacity to participate; only three GPs and four midwives were interviewed. In addition, there was limited cultural and gender diversity of participants in the study, reflecting limited diversity in the workforce (e.g., less than 0.3% of midwives are male) [29]. Limited ethnic and gender diversity of the workforce is a concern, as recognising issues specific to families from diverse ethnic groups and men may not have been noted.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one recurring leadership practice described in the source. Map its participants, incentives and constraints to a district setting, then design a small reversible staff pilot with an accountable owner. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Record implementation fidelity, staff review time, task quality and unintended burdens against a baseline. Use a comparison team where feasible and document alternative explanations before expanding. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Julie M Brose; Julie Mytton; Mark D Lyttle; Maria Theresa Redaniel; Jelena Savović; Hugh McLeod; Carlos Sillero Rejon; Joni Jackson; Maria Barnes. Healthcare leaders and professionals’ perspectives of the ICON programme to prevent abusive head trauma in infants: a qualitative study. BMC Public Health (2025-10-21). https://doi.org/10.1186/s12889-025-24682-0

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.