Health impacts of the Sure Start programme on disadvantaged children in the UK: a systematic review

Abstract

Objectives: With rising poverty and widening health inequity among children in the UK, the objective of this study is to evaluate the impact of the Sure Start programme on child health outcomes in disadvantaged children.

Design: Systematic review.

Data sources: We conducted a comprehensive search of three databases: Embase, Medline and Social Policy and Practice, with grey literature searched using Open Grey, Social Care Online and Google Scholar. The search was conducted in January 2024.

Eligibility criteria for selecting studies: All primary studies investigating health outcomes in children as a result of Sure Start intervention were eligible for inclusion, without limitations on study design.

Data extraction and synthesis: Full-text articles in English were independently screened according to the eligibility criteria by two researchers. Results were synthesised and presented in both a quantitative and narrative format. We assessed the risk of bias in each included study.

Results: Our initial search identified 585 records, of which 9 met our inclusion criteria with a further 3 grey literature reports included. Three themes were identified: physical health, social functioning and neurodevelopmental disorders. In terms of physical health, our findings indicate significant reductions in hospitalisations in older children, accidental injury and obesity prevalence. Furthermore, Sure Start increased the prevalence of breastfeeding and improved dental hygiene in children. In the social functioning domain, the Sure Start programme produced mixed findings: with children from certain backgrounds observing adverse effects as a result of the intervention. Yet, Sure Start demonstrated significant improvement in education attainment, with a maximal improvement of grade improvement in children from low socio-economic and ethnic minority backgrounds. For neurodevelopmental disorders, Sure Start was able to significantly improve conduct disorder and attention-deficit hyperactivity disorder symptomatology with long-term clinical stabilisation, as well as improving screening rates for developmental disorders.

Conclusion: This study examines the evidence of the Sure Start programme, as an example of an early-years community-based intervention, to mitigate health inequity among disadvantaged children. The findings suggest the Sure Start programme to be effective in health generation across the domains of physical health and neurodevelopmental disorders for disadvantaged children, but with mixed findings for social development that can only partially be explained by methodological flaws.

Trial registration number: PROSPERO CRD42024503234.

Keywords: Adolescent; Community child health; Health; Health Equity; PUBLIC HEALTH; SOCIAL MEDICINE.

Figure 1. A summary of the Core Sure Start Services and Integrated Interventions, highlighting the essential programmes delivered through Sure Start centres to promote child health and development.

Figure 2. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram, illustrating the selection process of studies included in the systematic review, detailing the number of records identified, screened and included, along with reasons for exclusions.

Figure 3. ROBINS-I risk-of-bias summary, displaying the overall risk-of-bias assessment across various domains for each included study, based on the ROBINS-I tool for non-randomised studies.

Figure 4. ROBINS-I weighted risk of bias, showing the distribution of weighted bias across the included studies, illustrating how bias influences the overall assessment of evidence in the review.