English health visitors' perceptions of conducting indoor environmental assessments: barriers and facilitators.

Objectives: The aim of this qualitative research was to explore health visitors' perceptions of assessing their clients' homes and providing evidence-informed advice about environmental health.

Design And Sample: Between 2004 and 2007, an explorative study was conducted in Plymouth, England, during which interviews were held with health visitors trained to conduct environmental assessments in combination with routine visits.

Measures: Face-to-face, semi-structured interviews were conducted. Content analysis was used to explore emergent themes.

Results: The health visitors perceived that assessing the indoor environment was relevant to their role; however, conducting environmental measurements within routine visits was not feasible. The main barriers were the changing roles of health visitors (reducing time available), the time implications of being perceived as an environmental expert, and the impact on clients, such as raising expectations, imposing opinions on the state of clients' homes, and expecting clients to implement advice. Facilitators included the natural link to health visitors' roles, the ability to provide evidence of an environmental risk, and the satisfaction of observing clients implementing advice.

Conclusions: Health visitors lacked propositional knowledge on the indoor environment, highlighting a need for more training. Access to an environmental assessment system increased the health visitors' confidence in dealing with indoor environmental issues.