Abstract / Summary
Abstract Background As part of community-based, health promotion intervention to reduce inequity in child health (BISB), a proactive and telephone-based infant feeding counselling intervention was implemented in three Danish municipalities. Integrated into standard care provided by health visitors, the intervention consisted of six proactive calls delivered between home visits during the postpartum period. The intervention targeted families receiving additional maternity care services due to medical and/psychosocial risk factors. Objective To evaluate the delivery and implementation of a proactive and telephone-based infant feeding counselling intervention, delivered by health visitors in three Danish municipalities, including dose, reach, fidelity, adaptations, context, and provider acceptability. Methods The study is designed as a process evaluation, following the Medical Research Council’s guidance. It is based on routine monitoring data collected from three municipalities and 15 individual or group interviews with health visitors ( n = 13), health visiting managers ( n = 3), and project manager (= 1). Results The intervention was delivered with low fidelity in all three municipalities, with considerable variation in the number, timing, and content of calls. Four themes explained the implementation patterns: (1) challenges with identifying and recruiting the intended target group, which raised questions about who should be included; (2) competing priorities and time constraints in a complex work environment, which limited consistent delivery; (3) the tension between a standardised protocol and the relational, needs-based logic of health visiting, which led to adaptations in practice; and (4) instances where the proactive calls were experienced as meaningful and supportive, particularly when adapted and embedded in existing relationships. Conclusion This study highlights the difficulty of implementing a structured, proactive service within a dynamic and relational practice context. While the intervention was not delivered as intended, health visitors kept core functions through flexible and relational adaptations. These adaptations enabled a form of delivery that aligned with professional values and supported families in meaningful ways. Future interventions should allow for adaptive implementation, support professional judgement, and strengthen the theorisation of mechanisms to enhance feasibility, acceptability, and impact on health equity. Clinical trial number Not applicable.