NHS Health Scotland



In this section:


The work on the Outcomes Framework for Pregnancy and Parenthood in Young People (PPYP) was undertaken as part of the development of the Pregnancy and Parenthood in Young People Strategy . The outcomes framework comprises a strategic logic model and four detailed logic models corresponding to each of the strategic model’s four strands.

The background to this work and the components of the outcomes framework, including the evidence and plausible theory to support the detailed models, are presented here. This is a working framework and additional sources of highly processed evidence and any changes in our understanding of pregnancy in young people will be taken into account in further developments.


Setting the context
The Scottish Government has worked with Health Boards, Local Authorities, the Third Sector and young people to develop a National PPYP Strategy following on from the recommendations of the Scottish Parliament’s Health and Sport Committee inquiry into teenage pregnancy in 2013(1). The Strategy emphasises the need for a holistic approach to tackling pregnancy in young people by considering those wider determinants that are key, not just for pregnancy but also for supporting young people more widely in relationships, education, attainment, training and employment.

The PPYP Outcomes Framework was designed to help with the development of the Strategy. It runs alongside other supporting papers such as a policy mapping, young people engagement report, an evaluability assessment, children’s rights and wellbeing, impact assessment and an equality impact assessment. The aim of supporting policy development in this way is to help make it more systematic, explicit and targeted. The outcomes framework has also been created to support and inform policy makers, planners, evaluators and researchers whose work involves, or is linked to, pregnancy and parenthood in young people. It may also help community planning partners (and others) develop an outcomes-focused approach to planning and performance management in this area.


Outcomes Framework for Pregnancy and Parenthood in Young People Strategy

The purpose of the Pregnancy and Parenthood in Young People (PPYP) Strategy Outcomes  Framework is to highlight key outcomes and identify activities, informed by both evidence and plausible theory, which can contribute to these outcomes. The actions aim to decrease the cycle of deprivation associated with pregnancy and support young parents with both health and care needs. They also aim to contribute to a more supportive and less stigmatising environment for young people, a reduction in pregnancy, and improved health and social wellbeing of young parents.

The framework does not try to explain all of the interactions between activities and outcomes and therefore does not depict the full complexity of pregnancy in young people. Rather it attempts to clarify some of the key pathways to achieving the short-term, medium-term and longer-term outcomes. Ultimately the framework is a resource for policy makers and planners to help them clarify what outcomes they want to achieve and what can be done to achieve those outcomes.

The framework covers a broad range of activities and evidence, some of which go beyond that described in the PPYP Strategy but are linked with other policy areas. They are included here for completeness. The outcomes framework presents a snapshot of what is currently known about pregnancy and parenthood in young people. This should be reviewed and updated to reflect changes in the evidence and our understanding. This is particularly important since external factors such as a deteriorating economic environment may have an impact on the population and it would be important to be sensitive to any changes that take place.

Summary of the development process

A collaborative approach was adopted while developing the framework. Key stakeholders were invited to a ‘brain storming’ session in June 2014 to capture initial ideas for outcomes for the framework and actions which might contribute to those outcomes. The process was overseen by the PPYP Steering Group, which comprised individuals involved in or with links to pregnancy in young people and young parents, from the Scottish Government, Local Authorities, Health Boards and the Third Sector. Highly processed evidence was reviewed in relation to the key pathways. A draft logic model with supporting evidence was then sent out for wider consultation and to experts for peer review and was revised in light of ongoing discussion and consultation.

The strategic logic model defines four areas of focus. These are:
Strand 1 – Leadership and accountability
Strand 2 – Giving young people more control
Strand 3 – Pregnancy in young people
Strand 4 – Parenthood in young people

More detailed logic models for each of these strands illustrate the actions outlined in the PPYP Strategy. These also include the short-, medium- and long-term outcomes they are likely to contribute to and the key pathways through which this would logically be achieved. These pathways are referred to as ‘links’ and are numbered in the models and described in the text. An overview of the available highly processed evidence and plausible theory which informed these actions, as well as broader actions which would contribute to these outcomes, is provided. The evidence largely focuses on the effectiveness of interventions and initiatives which are likely to contribute to the outcomes in the pathways. Where the evidence draws on research looking at the views of or interventions for vulnerable or disadvantaged young people this is included as a Health Inequalities Impact Assessment (HIIA) note.

What are our evidence sources?
The evidence and/or evidence-informed recommendations used to inform the logic models has been drawn primarily from a number of key health-related sources and was collated between August 2014 and July 2015. It does not represent a comprehensive critical review of all the available evidence. These sources are:

  • National Institute for Health and Care Excellence (NICE) public health guidance (and relevant NHS Health Scotland Commentaries / Scottish Perspectives)
  • NICE Clinical Guidelines
  • NICE and Health Development Agency (HDA) public health briefings
  • Publications from the World Health Organization (WHO)
  • Key systematic reviews identified largely through the Cochrane Collaboration, the Evidence for Policy and Practice Information and Coordinating Centre (EPPI) and the Campbell Collaboration
  • Key reviews and evaluation reports commissioned by the Scottish Government, the UK Government and national organisations and collaborators.

We have called this information ‘highly processed evidence’. Highly processed evidence summarises high-quality international research (including from Scotland and the rest of the UK where this is available) that has been quality assured. As such it is less subject to bias and therefore we can be more confident that the findings are reliable. However, limitations and caveats in the evidence base remain. For details of the limitations of the research examined in reviews please consult the original sources. As a consequence of the international nature of the research and limited highly processed evidence based on UK studies, much of the evidence is drawn from evaluations of studies in North America and other countries where the health,social care and education systems are different to those in Scotland. Where theevidence is largely from outside Scotland the applicability of the evidence to the Scottish context should be considered carefully as results may not replicate in a different context.

For a variety of reasons we do not always have ‘good evidence’ from these sources. This lack of highly processed evidence, however, does not necessarily mean there is no link between two components in a logic model, nor that evidence of effectiveness does not exist. The research may not have been done or findings may not have been reported or reviewed alongside other similar studies. Lack of highly processed evidence should not necessarily prevent us from acting if there is plausible theory or emerging practice to explain the links in the models. However, we may proceed with more caution than where there is good highly processed evidence in place.

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  1. The Scottish Parliament, Health and Sport Committee inquiry into teenage pregnancy (2013). Available from (external link ): http://www.parliament.scot/parliamentarybusiness/CurrentCommittees/58031.aspx