https://orcid.org/0000-0002-3466-7407
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Abstract
Early years interventions, particularly those supporting parents in the first 1001 days of their infants life, support healthy development of infants and prevent adverse experiences that can have long term negative impacts. Volunteers are often used to deliver such interventions. This scoping review aimed to explore the roles and characteristics of volunteers across early years interventions and map the evaluation in this field to identify gaps in the literature. A scoping review was conducted according to the Arksey and O’Malley Framework. Academic databases and grey literature sources were searched to identify literature evaluating volunteer-based interventions for parents in the first 1001 days of their infant’s life (conception to aged two). Research conducted in the UK or comparable high-income countries since the year 2000 were identified and data relating to the volunteer role, intervention design and evaluation methods were mapped. Sixty-six articles were eligible for inclusion in the review. Volunteers were commonly involved in interventions to provide peer support for a range of parenting related matters, support breastfeeding and the mental and emotional wellbeing of parents. Volunteer roles were categorised based on their background (peers or non-peer volunteers), their responsibilities (provider of peer support, educator or providers of practical support) and the delivery style of their role (in person one to one support, group leader or remote support). Research most often involved exploring the experiences of those involved in receiving or delivering the interventions and measuring outcomes in relation to breastfeeding and parent mental wellbeing. Volunteers play a large role in the provision of early years interventions. Their varied contribution is presented through a typology that will allow comparisons of roles in future research. Further research exploring the impact on the volunteers and the organisation will support decision making around choosing a volunteer led model within early years services.
Citation: Padgett L, Blower SL, Henderson H, Bryant M (2024) Use of volunteers in early years interventions for parents: A scoping review of roles and the extent of evaluation research in this area. PLoS ONE 19(9): e0305551. https://doi.org/10.1371/journal.pone.0305551
Editor: Fatch Welcome Kalembo, Curtin University Bentley Campus: Curtin University, AUSTRALIA
Received: August 31, 2023; Accepted: June 2, 2024; Published: September 26, 2024
Copyright: © 2024 Padgett et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: Funding: this research was conducted as part of a PhD and is independent research funded by the National Institute for Health Research Yorkshire and Humber ARC and the University of York. SB and MB are also supported by the NIHR Yorkshire and Humber Applied Research Collaboration (ARC-YH; Ref: NIHR200166, see https://www.arc-yh.nihr.ac.uk,). The views in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript”. See cover letter for full updated funding statement.
Competing interests: The authors have declared that no competing interests exist.
Introduction
The early years, and more specifically the first 1001 days of life (from conception to aged 2 years), is a crucial period in a child’s development [1] with adverse experiences (i.e., neglect and poor attachment with caregivers [2, 3]) during this period having the potential to cause negative impacts on health and prospects that last through to adulthood [4]. Interventions to support development and prevent adverse experiences remain a priority within UK government [5].
A range of universally offered and targeted early years interventions are provided to support parents in the early years [6, 7]. Early years interventions are provided to parents and their families in the early stages of their child’s life to support healthy development, which can prevent problems with a child’s health and prospects in later life [8]. One early years intervention delivery approach is to include volunteer roles within the delivery of the service [9]. The inclusion of volunteers across the broad spectrum of Health and Social Care Services has been suggested to generate benefits to the intervention recipients (i.e., improved wellbeing and reduced social isolation [10, 11]), the organisation hosting the service (i.e., increased reach of services through larger workforces [12]), the volunteers themselves (i.e., improved health and wellbeing [13]) and the wider community (i.e., improved social cohesion [12]) [11, 13–15]. However, some evaluations of volunteer led services have found limitations in relation to volunteer burnout and reduced sustainability of services [16, 17]. In addition, there is broad variation in the types of volunteer roles taken on across the different health services [11] which likely influences the impact the intervention can have.
Volunteering rates are highest within high-income countries such as United States of America (USA), Canada, Australia and United Kingdom (UK) [18], with volunteers making a substantial contribution within health and social care settings [10, 19]. Specifically within the UK, the third sector provides an increasing contribution of the delivery of public services such as early years interventions [20]. The third sector predominantly includes charities and non-profit organisations, and is where approximately two thirds of volunteers provide their contribution [21]. Within the Government’s vision for the 1001 critical days, the important role of this sector and volunteers is clearly highlighted [5], and it is likely that volunteers will continue to play an important role in the provision of early years interventions. The potential for volunteers to be involved in the delivery of early years interventions which can have a large influence on the healthy development of children has generated the need for research to be conducted to evaluate and explore the impact of early years interventions that include volunteer roles.
Reviews of early years interventions involving volunteers have been previously carried out in relation to specific outcomes [9] or intervention settings [22, 23] with findings guiding the implementation of volunteer roles within specific contexts. Previous reviews have been rapid reviews conducted to support future intervention design within their specific settings (i.e. Better Start services and Children’s Centres) [9, 22] and have therefore focused their literature searches on their specific areas of interest rather than looking at all early years interventions more broadly. These reviews consolidated findings from research using varied methods (i.e., quantitative and qualitative methods) and exploring different outcomes with only a small number of studies exploring each outcome [9, 22, 23]. In addition, previous reviews had different aims [22, 23] and therefore many of the included studies would not be relevant within this review specifically exploring interventions delivered in the first 1001 days. It was therefore unclear what the available evidence base was for volunteer led interventions for parents in the infants first 1001 days highlighting a need for a scoping review to map the available evidence. Further, the most recently published review was in 2016 and a more up to date review was warranted.
The purpose of this scoping review was to map the available evidence base of early years interventions delivered by volunteers. Mapping the literature was intended to identify where and how most evaluation has been conducted to date, the outcomes of interest to researchers when evaluating interventions involving volunteers and identify where further research of volunteers within early years interventions for parents may be needed. This was intended to provide guidance to professionals and researchers in the field of the available evidence base that could be used to determine if including volunteer roles within a particular early years intervention would be appropriate.
This review was also conducted in order to provide an understanding of the roles of volunteers within interventions for parents of infants within their first 1001 days and to develop a typology of the roles that volunteers take on across different interventions and services. This scoping review explored the most up to date literature in order to map different types of volunteer roles, the characteristics of volunteers and the purpose and designs of the interventions volunteers are involved in.
Scoping review methodology was applied as it suited the review’s purpose (i.e. to determine the scope and coverage of a specific topic and identify gaps in the research) rather than determining the effectiveness of these interventions which would have been suited to a systematic review. Mapping the literature and creating a typology of volunteer roles was intended to provide an understanding of the contribution of volunteers within early years interventions and help to distinguish and compare different types of volunteer roles within future research. In addition, providing an understanding of the range of volunteer roles across the different early years interventions will highlight the potential value of volunteers to those involved in the commissioning, design and delivery of early years interventions.
Methods
A scoping review was conducted as this method enables the mapping of evidence in a particular field to understand more about a specific context (i.e. the role of volunteers in early years interventions) and identify where there are gaps in the literature [24]. The review was conducted according to the Arksey and O’Malley framework [25] which involved five key stages: identifying the research questions, identifying relevant studies, study selection, charting the data and collating, summarising, and reporting the results.
Results are reported according to the requirements of the PRISMA extension for scoping reviews (PRISMA-ScR) [26] (see S1 Checklist) and the protocol for the scoping review was pre-registered and published on the Open Science Framework (https://osf.io/yurj6).
Identifying the research question
The research question of the scoping review was: What are the roles of volunteers in interventions for parents of children in their first 1001 days and how are their roles evaluated? The review objectives were: 1) To identify and create a typology of the different roles that volunteers play in the delivery of interventions for parents of children within their first 1001 days. 2) To explore the characteristics of volunteers within interventions for parents of children within their first 1001 days. 3) To explore the methods used to evaluate interventions for parents of children within their first 1001 days that include a volunteer role or to evaluate the volunteer role itself. 4) To explore the outcomes of interest reported within evaluations of interventions for parents of children within their first 1001 days that include a volunteer role. Outcomes included those relating to the services, service users and/ or their children and volunteers themselves.
Identifying relevant studies
Search strategy. The search strategy was developed based on guidance from the Cochrane Collaboration [27] and Campbell Collaboration [28] and search strategies used within previous reviews relating to early years [9, 29] and volunteering [13, 30].
Search terms were based on the ‘Population’ in receipt of the intervention (i.e., parents and infants), the ‘Concept’ (i.e. volunteer roles), and the ‘Context’ (i.e., interventions and services) [31]. Additional terms relating to key outcomes and purposes of interventions were included to increase the specificity of search results. Search terms relating to each category of the strategy (i.e., population, concept, context and intervention outcome and purpose) were combined using the Boolean term OR and each category was then combined using the Boolean term AND (see S1 Text).
In order to identify the extent of the literature that could address the review objectives, both academic peer reviewed journals and grey literature sources were searched. The databases Medline, Psycinfo and Embase (Ovid), Applied Social Sciences Index & Abstracts (ASSIA), and Web of Science were searched using the prespecified search terms in May 2021 and updated in July 2023. The grey literature database HMIC (Health Management Information Consortium) was also searched. Search terms were identified within titles, abstracts, or key words. Mapping terms to subject headings (i.e. MeSH terms) was used within applicable databases to increase the efficiency and precision of the search [32]. Where possible, database searches were refined to documents published in English since the year 2000 and to exclude conference abstracts and student dissertations.
Web pages of organisations relevant to the review were hand searched for potentially eligible documents. Organisations included Early Intervention Foundation (EIF), National Institute for Health and Care Excellence (NICE), Department of Health, Nesta, Barnardo’s, Action for Children, Family Action and NSPCC. In addition, the internet search engine Google was searched using the same search terms through the advanced search functionality. The first five pages of results (based on 10 results per page) were screened as a minimum with an additional two pages being screened due to relevant searches continuing to be identified.
Reference lists of all eligible documents were screened to identify any eligible documents not identified through the search strategy.
Study selection
Eligibility criteria.
The eligibility criteria were developed based on the ‘Population’, ‘Concept’ and ‘Context’ of studies and criteria relating to the types of evidence source.
Population. The target population of interventions had to be parents and primary carers of infants within their first 1001 days (from pregnancy to two years of age). Interventions that also included parents of infants older than two years were eligible provided that the majority of children were aged under two (based on mean age or age range of sample). Interventions that also include the infants as intended beneficiaries along with the parent/ primary caregiver were eligible for inclusion.
Concept. Interventions had to include volunteer roles within some aspect of the delivery of the service. Volunteering was defined as “unpaid work conducted for the benefit of others beyond close relatives” [11] and therefore included any type of role (i.e., peer supporters and mentors) provided it was clearly stated they did not financially benefit from their role. Interventions where volunteers received expenses were eligible.
Context. Interventions conducted in the UK and comparable high income countries (based on the World Bank List 2020/ 2021 https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups) where volunteering rates are highest [18] and where healthcare systems are similar [33] were eligible. Eligible interventions were those that were designed to support parents during the transition to parenthood and up to an infant being aged two years, including those to support parenting (skills, confidence or satisfaction), parent wellbeing (emotional, mental or social), breastfeeding or to support the attachment and parent-child relationship.
Evidence source. Eligible evidence sources were required to provide details of the intervention purpose and delivery style, volunteer role and outline the purpose and methods used in evaluating the intervention or exploring the volunteer role. Studies using quantitative, qualitative and mixed methods were eligible for inclusion. Eligible documents were required to be available in the English language and published from the year 2000 onwards. Reviews, protocols, conference abstracts, dissertations and letters to editors were not eligible for inclusion to prioritise documents most likely to include all data necessary to address the review objectives. The decision to focus on documents published since the year 2000 was based on the rapid review conducted by McLeish, Baker [9] which explored early years interventions involving volunteer roles relating to the “A Better Start” programme outcomes which focused on studies published from 1990 to 2015. The reference list in this paper identified that few studies conducted in the 1990s were of relevance to this review and therefore this review focused on studies conducted from 2000. Due to differing objectives of this review compared to the review by McLeish, Baker [9] it was still deemed relevant to include eligible studies also identified by McLeish, Baker [9] from the year 2000.
Evidence selection.
Retrieved documents were exported into the reference management software, Endnote [34], where duplicates were removed. Documents were then screened according to the eligibility criteria, firstly based on the title and abstract and then those deemed potentially eligible screened against the full text. Eligibility screening was conducted using the software, Rayyan [35]. To ensure the eligibility criteria was being applied correctly and consistently, at both title and abstract and full text screening stages, two reviewers (LP and HH) independently reviewed the first 10% of documents. Inter-rater reliability was assessed using Cohens Kappa score and a strong agreement score of 0.8 or above [36] was required before the remaining documents were screened by the first reviewer (LP) only. At full text screening stage, an additional 10% of documents were reviewed due to a strong kappa score not being achieved after the first 10% of documents.
Charting the data
Data extraction.
Data relevant to the review objectives were extracted onto a piloted Google Form. The first 10% of documents were extracted independently by two reviewers (LP and HH) to ensure data was being extracted correctly and the remaining documents were then extracted by one reviewer (LP). Extracted data included author details, year and country of publication, intervention details such as target population, purpose, setting and delivery style of intervention, the role and characteristics of volunteers, methods used in evaluating the intervention or exploring the volunteer role and outcomes of interest within the evaluations.
Collating, summarising and reporting the results.
Characteristics (i.e. evidence source data and population characteristics) and data relating to the review objectives (i.e. volunteer characteristics, intervention and study design) of each eligible source of evidence were collated and presented in a table. A narrative summary was conducted to provide an overview of evidence identified. This involved identifying and quantifying the different research methods and outcomes explored to describe and summarise the evidence base, and identify gaps in the evidence of early years interventions involving volunteers. Similarly, data describing volunteer roles and characteristics were identified and quantified to identify commonalities to categorise roles and form a typology. The purpose and design of early years interventions was summarised and mapped against volunteer role typologies to gain an overview of how and where volunteers are contributing across different early years interventions.
Results
Search results
The searching of all databases resulted in a total of 15,046 documents being identified. Following the removal of duplicates, 7,883 documents were screened against the eligibility criteria based on their titles and abstracts. 334 documents were deemed potentially eligible and were then assessed for eligibility based on their full texts. An additional 62 documents were identified though searching the Google search engine and organisation web pages and through citation searches and were assessed for eligibility.
A total of 58 documents were deemed eligible for inclusion in the review, 51 of which were identified from databases and 7 from grey literature sources. Database and grey literature searches were updated in 2023 which resulted in an additional 8 eligible documents. Over half of publications were published since the year 2015 (n = 37) with most published in the UK (n = 24), Australia (n = 14), USA (n = 11) and Canada (n = 7). Fig 1 provides details of the flow of documents and reasons for exclusion of documents at the full text screening stage and Fig 2 presents the number of publications by year and by country.
The final 66 documents included evaluations of 55 different interventions. Six of the 55 interventions had multiple evaluations reported over multiple documents which accounts for there being more documents than individual interventions.
Characteristics of included articles and evidence base
Details of included study methods and outcomes can be seen in Table 1. Where intervention details and details of volunteer roles have been combined, this is to demonstrate that there have been multiple articles reporting different evaluations of the same intervention.
Of the 66 evaluations included in the review, 21 studies [37–57] used quantitative methods only, 25 studies [58–82] used qualitative methods only and 20 studies [76, 83–101] used mixed methods to evaluate the intervention or explore the roles of volunteers. The most common data collection methods were qualitative interviews or focus groups (n = 33) and collecting questionnaire or survey data (n = 29).
A total of 48 studies collected data from the mother, with a further four studies [56, 89, 93, 98] collecting data from both parents and one study collecting data from fathers only [88]. 25 studies collected data from the volunteers [39, 47, 59, 61, 63–66, 71–74, 77, 78, 80, 85, 88, 89, 91, 93, 96–98, 100, 101] and 12 studies collected data from stakeholders involved in the intervention or service such as project managers or coordinators [77, 78, 80, 85, 89, 96, 98], healthcare staff [61, 65, 67, 75, 77, 96] or partner agencies [85, 93].
The most common aims of the identified research were to explore experiences or perceptions of those involved in interventions. These studies included exploring the experiences of mothers receiving (n = 21) [41, 58, 60, 62, 65, 69–71, 73, 74, 77, 78, 82, 84, 89, 92, 93, 96, 99–101] or volunteers delivering an intervention (n = 14) [63, 64, 70–74, 77, 78, 85, 89, 93, 96, 97], the perceived impact of receiving the intervention on outcomes (n = 8) [62, 77, 79, 88, 95, 98, 100, 101] and the motivations, benefits and factors relating to the sustainability (n = 5) of volunteering within interventions or services [65–68, 88]. Additionally, studies explored perceptions of the mother-volunteer relationship (n = 4) [59, 62, 67, 76] and volunteer-healthcare professional relationship (n = 2) [75, 86].
Further quantitative research aimed to determine intervention effectiveness through randomised controlled trials (n = 12) with six of which included primary outcomes relating to mental health outcomes [38, 39, 56, 63, 83, 102], five RCTs relating to breastfeeding rates [44, 45, 54, 94] and the primary outcome of one RCT was mother infant interactions [51].
There were 13 studies that collected data post intervention to explore the impact that the intervention had on change in outcomes relating to the aims of the intervention. Outcomes of interest included breastfeeding intention [53, 95], incidence [46, 96] and satisfaction [48], mental wellbeing [87] and specifically anxiety and depression. Additional outcomes explored related to birthing type [46, 96], mother-child relationship and social support [49, 85] and improved knowledge, confidence or skills in parenting [87, 98]. Remaining studies explored the feasibility (n = 5) [50, 52, 55, 90, 91], satisfaction (n = 5) [47, 88, 92, 99, 103], acceptability (n = 3) [41, 55, 90] and cost effectiveness (n = 3) [92, 96, 102] of an intervention.
Intervention design.
The 54 interventions targeting parents or primary care givers of infants in their first 1001 days had a range of purposes and designs with some interventions including multiple components. The most common intervention purposes were providing support for the initiation or continuation of breastfeeding (n = 24) [43–46, 48, 52–55, 60, 61, 63, 67, 68, 70, 77, 79, 84, 88, 90, 94–96, 99], providing mental and emotional support to parents (n = 24)[39, 43, 46, 49, 51, 55, 56, 59, 60, 73, 75, 76, 83, 85–87, 89, 91, 93, 96, 98–100, 103] and signposting parents into services for further support (n = 15) [40, 43, 48, 49, 51, 70, 78, 82, 83, 89–91, 96, 98, 99]. The provision of peer support was commonly reported as an element, within 28 interventions [40, 41, 43–45, 48, 51, 52, 54, 56, 58, 61, 63, 65, 67, 70, 71, 76, 77, 79, 83, 84, 87, 88, 90, 94, 95, 103] predominantly in relation to breastfeeding support and supporting mothers with specific characteristics (i.e., first time mothers). Less common intervention components included teaching parent skills (n = 8) [38, 47, 49, 59, 68, 76, 83, 102], providing practical support (i.e., childcare) (n = 7) [38, 51, 68, 70, 78, 96, 100] and supporting parent-child attachment (n = 5) [51, 85, 89, 93, 98].
Interventions were most commonly delivered through home visiting (n = 29) [38, 45, 47, 49–51, 60, 64, 65, 68, 70–73, 76, 78, 79, 83, 85–87, 89, 90, 93, 94, 96, 100, 102], telephone support (n = 19) [39–41, 45, 47, 48, 54, 58, 63, 70–73, 77, 79, 94, 96, 99] and group sessions (n = 14) [46, 52, 65, 70, 76, 77, 79, 82, 84, 85, 88, 93, 95, 98] with some interventions using a combination of these approaches. Further delivery styles that were less commonly used included providing support in out of home settings such as clinical settings [53, 60, 61, 67, 75, 100] and via online or social media [44, 52, 56]. The duration and frequency of individual contacts or sessions within interventions were varied, ranging from a small number of interventions providing a one-off session only [88, 95, 99] to interventions that supported parents from pregnancy through to their infant being aged one or two years of age [70, 72, 82] (see Table 1 for individual intervention delivery approaches).
Mothers were the sole target of the majority of interventions (n = 47), with only one intervention targeting fathers only [88] and the remaining six interventions targeting both mothers and fathers [64, 65, 89, 93, 98]. Twenty-nine interventions were delivered to parents during their child’s infancy [39–41, 43, 44, 46–49, 51, 52, 54, 60, 61, 63, 64, 76–79, 84, 86, 90, 91, 94, 98, 99, 103], 21 interventions were delivered both during pregnancy and during their child’s infancy [38, 45, 50, 55, 56, 58, 65, 68, 70–73, 82, 83, 85, 87, 89, 93, 96, 100–102] and only four studies were delivered during pregnancy only [53, 59, 88, 95]. Of the interventions that targeted specific parents, common characteristics included those at risk of or living with a mental health condition [38–41, 51, 70, 76, 78, 85, 89], living in a deprived locality [45, 61, 93], being a young mother [59, 83, 102], having a migrant status [72, 73, 82, 86], being socially disadvantaged [45, 46, 49, 68, 96, 100] or socially isolated [73, 76, 78].
Volunteer characteristics.
The titles given for volunteer roles varied across the identified interventions. Volunteers were most commonly referred to as ‘peers’ including ‘peer supporters’ [44, 48, 58, 61, 67, 70, 79, 90, 94], ‘peer volunteers’ [39–41, 43, 50, 51, 56, 63, 65, 77, 88, 103] and ‘peer support counsellors’ [54, 55, 84]. Eight interventions included individuals who worked in a voluntary capacity as ‘Doulas’ [46, 60, 68, 70, 73, 75, 96, 100] and less common titles were ‘mentors’ [59, 71, 91] and ‘befrienders’ [85, 89, 93]. Within almost all interventions (n = 51) it was specified that volunteers were provided with training; however, there was a large range in the amount of training provided. The most commonly reported duration of training was 4 hours or under (n = 11) [39–41, 43, 44, 50, 53, 59, 63, 88, 91] with the majority of papers stating that volunteers received less than 40 hours of training. Interventions that provided more than 40 hours of training included volunteers with titles of peer support counsellors [84], befrienders [85, 89] and Doulas [73, 74].
Where information about the background of volunteers was provided (n = 44), volunteers were most commonly parents themselves (n = 35) with the majority including volunteers who were mothers only (n = 30). One intervention [88] included volunteers who were fathers only and four interventions included volunteers who were mothers and fathers [38, 58, 93, 98]. Some volunteers were specifically included in interventions due to their personal experience of breastfeeding (n = 13) [45, 48, 52, 55, 61, 63, 70, 77, 79, 90, 94, 95, 99] or personal experiences of a mental health condition (n = 4) [39, 51, 70, 103]. Where volunteers were not specifically parents themselves, volunteers were described to be individuals with specific training, members of the local community and students.
Studies relating to 17 of the 55 interventions provided some demographic information for the volunteers. Thirteen studies reported the age of volunteers, with volunteers most commonly being aged in their 30s (n = 7) [47, 50, 59, 64, 66, 68, 96]. The remaining six studies reporting details of volunteer ages ranged from 20 to 60 years of age [44, 46, 70, 73, 85, 89]. Fewer studies (n = 10) provided details of volunteer’s ethnicity. Of those that did, six were conducted in the UK. Volunteers in three UK studies were described to be mostly white British [73, 85, 104], two studies included volunteers where approximately half of volunteers were white British and half of volunteers identified as either Black, Asian or Mixed Race [70, 72] and one study included volunteers where the largest proportion identified as Black Caribbean [89]. Three studies conducted in the USA reported ethnicity of volunteers with the majority of volunteers in studies identifying as White [47], as either White or African-American [46] or mostly African-American [59].The only Australian study to report ethnicity included volunteers who mostly identified as Caucasian [50].
Volunteer typologies.
Volunteers were categorised into typologies based on available information on the roles they take on and their personal backgrounds. Fig 3 presents and describes the three typologies of volunteer roles within interventions to support parents of infants in their first 1001 days.
Firstly, volunteers were classified based on their personal characteristics. Therefore, volunteers are categorised based on whether they are ‘peers’ who are individuals with similar characteristics or experiences as the service users or as ‘non-peer volunteers’, who are those that do not necessarily have personal similar experiences. Secondly, volunteers can be classified based on their responsibilities they take on as part of their role and volunteers who are ‘peer supporters’, ‘educators’ and ‘providers of practical support’. Volunteers can also be grouped based on the method they deliver the intervention and therefore could be grouped as either ‘in person one to one supporters’, as ‘group leaders’ or as ‘remote supporters’.
Discussion
The evidence identified within this review has been explored to provide an understanding of the roles of volunteers in early years interventions, the characteristics of volunteers and the methods used to evaluate volunteer roles and the interventions they are involved in.
The review identified that individuals who take on volunteer roles within early years interventions are predominantly women and are often parents themselves. The use of peer-to-peer models has been identified to be a common approach within early years interventions, where parents are often paired with an individual with similar experiences. Peer support models are beneficial across interventions where trust and respect are required between recipients and those providing the support [105]. Peers have the ability to utilise their own personal experiences to reach out and engage with individuals through sharing their stories [106] with theoretical frameworks such as dynamic social impact theory and social cognitive theory explaining how shared experiences can encourage behaviour changes [107]. The high proportion of early years interventions designed to include volunteers who are peers of those receiving the intervention suggests there are perceived benefits to the mothers in having someone provide support who they can build trust with and learn from their similar personal experiences. Benefits to parents could include reduced stress, anxiety and depression and increased self-esteem and emotional wellbeing. These were identified as positive outcomes of peer support interventions in a previous review of early years interventions including volunteers by McLeish, Baker [9] which also identified peer support as a common role of volunteers.
As the majority of interventions targeted mothers, the use of peers likely explains why more women take on volunteer roles within early years interventions. However, due to many volunteers being parents of infants themselves, those volunteering within early years interventions are representing a younger demographic of volunteers than those often seen within other settings. Although volunteering roles are most likely to be taken up by women [15], the provision of volunteer roles within early years interventions could be an important setting for women who may have taken time out of work to care for their children to take up an active role in the community [108]. Further demographic data of volunteers was limited and therefore it was not possible to fully determine the ethnicity or socioeconomic status of individuals taking up volunteer roles within early years interventions. It is therefore unclear whether early years interventions are settings which attract and enable individuals of different ethnicities or socioeconomic status who often face more barriers to participating in volunteering to become involved [109]. Future research exploring the demographics of those volunteering within early years interventions would be beneficial to determine if the opportunity to volunteer and gain the potential benefits in this setting is available to all and, if not, could explore opportunities to make volunteering more accessible.
The evidence identified that volunteers are most commonly included within interventions to support the initiation and duration of breastfeeding and to support the mental and emotional wellbeing of mothers, reflecting two key public health priorities in the first 1001 days [1, 110, 111]. However, across the identified literature, volunteers were less likely to be involved in interventions to teach parenting skills, to provide practical support, or to support parent-child attachment despite being the focus of many interventions delivered by professionals or paid staff [6, 7, 112, 113]. This may suggest that volunteers are deemed more appropriate to be included in interventions where their previous experience (i.e., breastfeeding experience) or personal skills (i.e., ability empathise due to a peer experience) can be utilised compared to interventions such as those to teach parenting skills or support parent-child attachment where more specialist training may be required.
The review also highlighted that volunteers work within universally offered interventions as well as interventions targeting those deemed at higher risk (i.e. young mothers, individuals living in a deprived locality) with volunteers working within targeted interventions often having similar experiences (i.e. previous mental health condition) to those receiving the support. While volunteers are less commonly included in services that require specialist skills, the inclusion of volunteers within services for targeted groups suggest that volunteers could be well suited to working with ‘at risk’ groups either due to their peer experiences or due to their non statutory role.
In most interventions, volunteers were incorporated within a ‘Service Delivery Model’ in which volunteers delivered the intervention themselves as opposed to a ‘Support Role Model’ where volunteers would work alongside and support paid staff [114]. This suggests that, within early years interventions, volunteers are deemed appropriate to deliver a range of interventions themselves rather than providing additional support to paid staff or professionals. However, it has been previously highlighted that volunteer roles should not be seen as a cheaper replacement to a professional role and the qualities of volunteers as a non-professional role should be carefully considered during the decision to have the intervention delivered by volunteers in order for the intervention to be successful [9]. Given that volunteers are responsible for delivering important interventions with the potential to impact on the healthy development of children, there is justification for ongoing research into understanding if, how and why volunteer delivery models are suitable (or not) for all those involved, across the varied intervention designs.
Based on the information provided on how volunteers deliver their roles, a typology of delivery approaches was identified, including one to one in person support, group leader and remote support. This partly aligns with the model identified by McLeish, Baker [9] who also identified that volunteers were working both in a one on one capacity and as a group leader in interventions in the first four years of life. However, they also suggested a ‘Community champion’ approach, which was not evident in the identified literature, perhaps indicating it is a less common approach for interventions in the first 1001 days. Further, the evidence within this scoping review highlighted volunteers were often delivering part or all their support remotely. This typology can be considered within future research of volunteers within early years interventions to support the generation of more specific findings and recommendations for practice.
Mapping of the evidence
This review has identified that half of the included publications on the use of volunteers have been published since the year 2015, highlighting an increased interest in recent years. Research was predominantly conducted in the UK, USA, Australia and Canada despite all countries classified as high income being eligible for inclusion. Data collated by the United Nations Volunteers (UNV) programme highlights that these are some of the countries with the highest rates of volunteering globally [18] and therefore could explain the larger proportion of identified studies.
We found that the purpose of evaluations, methods used and the outcomes or phenomena of interest to researchers varied. Qualitative research methods were most common across included studies, with the majority of the literature focusing on outcomes or experiences related to the parents and infants involved in the interventions. However, the evidence provided in this review highlighted that fewer studies have been conducted that aim to determine the effectiveness of interventions including volunteer roles and the effectiveness of volunteers delivering the interventions. Further randomised controlled trials of the different early years interventions designed to be delivered by volunteers would contribute to the understanding of if the inclusion of volunteer roles is an effective approach in achieving desired outcome. In addition, determining the effectiveness of the range of early years interventions involving volunteers could enable the comparison to early years interventions delivered by professionals or paid staff and explore if volunteer led interventions are as effective. Recent systematic reviews of parenting [6, 7], breastfeeding [115] and postnatal depression interventions [116] provide mixed findings with combined results showing little or no effect on outcomes, highlighting challenges in providing a benchmark to determine if volunteer led interventions are as effective.
Within the literature, and particularly research published over the last six years, there has been some interest in how volunteers experience their role or how they are impacted by the intervention themselves. Other areas of the health and social care sector where volunteers are commonly included such as palliative care [117] or dementia care [118] have explored the experiences of volunteers to understanding how volunteers perceive their roles and the impact the roles have on themselves as well as the intervention recipients. Further, the potential of volunteering as a public health intervention in itself has previously been explored with direct benefits to mental and physical wellbeing of the volunteers reported [13]. The suggested increase in research of the volunteer experience could imply that there is interest in determining whether the inclusion of volunteer roles within early years interventions is an appropriate approach to intervention delivery from the perspective of the volunteer and how the inclusion of volunteer roles in early years interventions could be a beneficial approach for both intervention recipient and volunteer.
While there is limited but increasing interest in the perceived impact on and experiences of volunteers highlighted in the early years evidence, there is also limited evidence on how the inclusion of volunteer roles in interventions impacts on the organisation delivering the intervention or staff and professionals linked to the intervention. The inclusion of volunteer roles has been found to have wider benefits than to those directly receiving the intervention in terms of increasing the capacity of the organisation and building links with the local community [11, 15] but has also been found to have negative impacts such as volunteers experiencing burnout [119, 120] and high volunteer attrition increasing burden on paid staff in organisations [17]. This review has identified only a small number of studies that have explored the experience of paid staff who work alongside or support volunteers. Exploring the perceptions of individuals who work within the organisation could provide insight into if volunteers are generating wider benefits to the organisation and considerations for how they could be best included within the organisation.
This review has provided an up to date understanding of the contribution of volunteers within early years interventions. Volunteers make a significant contribution to the provision of these important services and the healthy development of children in the early years. This review has provided consideration for those designing early years interventions of the potential roles volunteers can play within these services, along with the presentation of available evidence that can support their decision making. The typology presenting the varied roles can enable future research to explore these differences when evaluating the impact of volunteer led early years interventions. This can provide more specific guidance and recommendations for the successful delivery of the different early years interventions. Gaps in the literature in relation to understanding the effectiveness of the different volunteer led early years interventions and the impact of a volunteer delivery model on the volunteer and organisation have also been highlighted. This can provide guidance for where future research should be prioritised to support the understanding of the roles and impact of volunteers delivering early years interventions.
Strengths and limitations
This review identified a large evidence base which has provided an understanding of the variety of volunteer roles within interventions delivered in the first 1001 days and has highlighted the characteristics of those taking up roles based on the most up to date literature. This information has supported the generation of a typology of volunteer roles which can be used to distinguish between the types of volunteer roles during future research. Additionally, the review has identified the extent of research previously conducted. An understanding of research previously conducted has identified where future research is needed based on gaps in the literature.
The findings presented in this review are predominantly from academic research sources and from service evaluations identified through searching grey literature sources. Therefore, the descriptions of volunteer roles and typologies created only reflects the contribution of volunteer roles from within the identified literature. It could therefore be beneficial to explore early years services currently being delivered to clarify that the findings of this review do reflect what is happening in practice. Secondly, this review can only provide a picture of the role of volunteers and extent of evaluation conducted within interventions for the first 1001 days of life rather than all early years interventions. In addition, all grey literature evidence sources searched during the review identified literature relating to interventions and services delivered in the UK. This could in part be due to the reviewer having more knowledge of UK organisations and therefore more UK websites searched and despite disabling location settings on Google, more UK webpages were displayed when using the search engine. Finally, while scoping review methods have allowed the mapping of the available evidence base, due to broad nature of the research question (and therefore evidence retrieved), it has not been possible to synthesise the findings of included studies and further systematic reviews would be beneficial in drawing conclusions of the findings of the current evidence base.
Conclusion
This scoping review explored the evidence and enabled a typology to be created to distinguish the different backgrounds of volunteers, their roles and how they deliver their roles within early years interventions which can provide guidance of the capabilities of volunteers to those considering including volunteers in future early years interventions. In addition, the development of a typology can support the description and classification of volunteer roles across a broad spectrum of early years interventions.
The literature to date has mostly focused on the experiences of those receiving the intervention and the impact the intervention had on health and wellbeing outcomes of the parent or their infant. The review has highlighted that less research has explored the implications of including volunteer roles on the organisation hosting, or the volunteers themselves. In addition, fewer studies have explored the effectiveness of early years interventions delivered by volunteers. Further research exploring the effectiveness of early years interventions that include volunteer roles and effectiveness of volunteers delivering interventions on different outcomes and research exploring the wider impact on the organisation would help provide a clearer picture of the impact of early years interventions being delivered by volunteers.
Acknowledgments
Thank you to Professor Kate Flemming, Professor Lorna Fraser and Dr Arabella Scantlebury for their input during the development of the protocol and support throughout the PhD.
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