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Practitioner reported barriers to parental engagement with Child Health Hubs in North West London disadvantaged neighbourhoods: a COM-B framework analysis

Year: 2026
Type: article
Abstract: Background Families from underserved communities face disproportionate barriers to accessing early years support. In response, Early Years GP Child Health Hub Pilots were set up in three North West London boroughs (Brent, Ealing, Harrow) between 2023 and 2025 to improve access to integrated services, reflecting the NHS 10-Year Plan’s ambition for neighbourhood-based care. The hubs have been funded to continue supporting local communities. However, there is limited understanding of how parents from underserved communities experience these services and the challenges they encounter in engaging with them. This study explored practitioner-reported barriers parents face in accessing and engaging with integrated child health services.Methods We used qualitative multiple practitioner-generated case study data specifically for families with children aged 0–5 years from the three pilot sites. We applied the Capability, Opportunity, Motivation-Behaviour (COM-B) framework to analyse the data thematically, guided deductively by the framework and inductively allowing for emergent themes.Results Twenty-one case studies, collected between September 2024 and January 2025, were generated by practitioners using information they recorded from contact with each family. Barriers were identified across all COM-B domains and multiple barriers overlapping domains. Capability barriers were reported to be the most common (eg, poor parental mental health, low parenting confidence and limited health literacy). Opportunity barriers included financial hardship, competing priorities, social isolation and family interference. Motivational barriers included fear of judgement, emotional stress and previous negative experiences with services. The case studies also identified several enablers including trusted practitioner relationships, culturally sensitive care, proactive follow-up and multidisciplinary collaboration.Conclusion Families living in disadvantaged areas face multiple, intersecting barriers to engaging with integrated services. Child Health Hubs should adopt co-produced, community-informed approaches with parents that integrate health and social support to improve equitable access and sustained engagement for families experiencing adversity.
DOI: 10.1136/bmjpo-2026-005272
Language: English
Open Access status: diamond
OpenAlex ID: W7221837649
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