Kitzman, H., Olds, D. L., Henderson, C. R., Hanks, C., Cole, R., Tatelbaum, R., et al. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA: The Journal of the American Medical Association, 278(8), 644–652.
Model(s) Reviewed:
Nurse-Family Partnership (NFP)®
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Difference in SES, but controlled in analysis. | None | None | Not assessed in manuscripts reviewed before 2021 |
Notes:
In 2020, HomVEE updated this review to move the NCAST Child Responsiveness (total score) from the Child Development and School Readiness domain to the Positive Parenting Practices domain because ACF determined that outcomes assessed with the NCAST, including the NCAST total score, most appropriately belong in the Positive Parenting Practices domain.
| Study participants | The sample included pregnant, first-time mothers who were less than 29 weeks pregnant. Women were recruited through an obstetrical clinic if they had no previous live births, no chronic illnesses linked to fetal growth retardation or preterm delivery, and at least two of the following sociodemographic characteristics: unmarried, less than 12 years of education, and unemployed. From June 1990 through August 1991, 1,290 women were invited to participate and 1,139 consented and were randomly assigned. At enrollment, 92 percent of the women enrolled were African American, 98 percent were unmarried, and 64 percent were age 18 or younger. This study measured the sample up through the child’s 24th month. At the 24-month follow-up, the sample included 675 women, 208 in the program group and 467 in the comparison group. |
|---|---|
| Setting | Memphis, Tennessee |
| Intervention services | The study included two treatment groups. The first treatment group received home visits from a nurse during pregnancy and two postpartum visits (one in the hospital prior to discharge and one in the home). The treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. On average, the nurses completed 7 home visits during pregnancy and 26 home visits postpartum. Nurses used a detailed protocol for each visit, which focused on health-related behaviors, parenting, education, and employment. The two treatment groups were combined for the prenatal analysis. Only the second treatment group was followed for postnatal outcomes. |
| Comparison conditions | The study included two comparison groups. The first comparison group received taxicab transportation for prenatal care appointments. The second comparison group received the transportation plus developmental screening and referral to services when the children were 6, 12, and 24 months old. The two comparison groups were combined for the prenatal analysis. Only the second group was followed for postnatal outcomes. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). Subgroups are not listed for manuscripts reviewed before 2021. |
| Funding sources | Five federal agencies: the National Institute of Nursing Research (grant NR01-01691-05); the Bureau of Maternal and Child Health (grant MCJ 360579); the Administration for Children and Families (grant 90PJ0003); the Office of the Assistant Secretary for Planning and Evaluation; and the National Center for Child Abuse and Neglect, through a transfer of funds to the National Institute of Nursing Research. Four private foundations: the Robert Wood Johnson Foundation, Princeton, NJ (grants 017934 and 11084); the Carnegie Corporation of New York, New York, NY (grant 5492); the Pew Charitable Trusts, Philadelphia, Pa (grants 88-0211-000 and 93-02363-000); and the William T. Grant Foundation, New York, NY (grants 88-1246-88 and 91-1246-88), including a William T. Grant Faculty Scholars Award 86108086) and a Senior Research Scientist Award (1-K05-MH01382-01) to Dr. Olds. |
| Author affiliation | David L. Olds, a study author, is a developer of this model. |
| Peer reviewed | Peer reviewed status is not listed for manuscripts reviewed before 2021. |
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | CBCL (total score) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 1,082 children | Adjusted mean = 46.00 | Adjusted mean = 49.20 | Mean difference = -3.20 | Not available | Not statistically significant, p > 0.05 |
|
| High | BSID (total score) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 1,082 children | Adjusted mean = 94.50 | Adjusted mean = 94.30 | Mean difference = 0.20 | Not available | Not statistically significant, p > 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Birth weight, grams | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | Birth | 1,082 children | Adjusted mean = 3032.20 | Adjusted mean = 3050.40 | Mean difference = -18.20 | Not available | Not statistically significant, p > 0.05 |
|
| High | 5-minute Apgar | FavorableUnfavorable or ambiguousNo Effect |
Full, (Memphis) | Birth | 1,082 children | Adjusted mean = 8.60 | Adjusted mean = 8.70 | Mean difference = -0.10 | Not available | Not statistically significant, p > 0.05 |
|
| High | Gestational age, weeks | FavorableUnfavorable or ambiguousNo Effect |
Full, (Memphis) | Birth | 1,082 children | Adjusted mean = 39.00 | Adjusted mean = 39.00 | Mean difference = 0.00 | Not available | Not statistically significant, p > 0.05 |
|
| High | Indicated preterm delivery (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Full, (Memphis) | Birth | 1,082 children | % (adjusted) = 3.00 | Adjusted mean % = 3.00 | OR = 1.00 | HomVEE calculated = 0.00 | Not statistically significant, p > 0.05 |
Statistical significance reported on authors’ calculations of the odds ratio.
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Intrauterine growth restriction (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Full, (Memphis) | Birth | 1,082 children | % (adjusted) = 9.00 | Adjusted mean % = 9.00 | OR = 1.00 | HomVEE calculated = 0.00 | Not statistically significant, p > 0.05 |
Statistical significance reported on authors’ calculations of the odds ratio.
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Low birth weight (percentage < 2500 g) | FavorableUnfavorable or ambiguousNo Effect |
Full, (Memphis) | Birth | 1,082 children | % (adjusted) = 15.00 | Adjusted mean % = 14.00 | OR = 1.10 | HomVEE calculated = 0.05 | Not statistically significant, p > 0.05 |
Statistical significance reported on authors’ calculations of the odds ratio.
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Preterm (less than 37 weeks, percentage) | FavorableUnfavorable or ambiguousNo Effect |
Full, (Memphis) | Birth | 1,082 children | % (adjusted) = 11.00 | Adjusted mean % = 13.00 | OR = 0.80 | HomVEE calculated = -0.12 | Not statistically significant, p > 0.05 |
Statistical significance reported on authors’ calculations of the odds ratio.
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Spontaneous preterm delivery, percentage | FavorableUnfavorable or ambiguousNo Effect |
Full, (Memphis) | Birth | 1,082 children | % (adjusted) = 8.00 | Adjusted mean % = 9.00 | OR = 0.80 | HomVEE calculated = -0.08 | Not statistically significant, p > 0.05 |
Statistical significance reported on authors’ calculations of the odds ratio.
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Breastfeeding attempted, percentage | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 671 children | % (adjusted) = 26.00 | Adjusted mean % = 16.00 | OR = 1.90 | HomVEE calculated = 0.37 | Statistically significant, p < 0.01 |
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Immunizations up to date, percentage | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 671 children | % (adjusted) = 70.00 | Adjusted mean % = 68.00 | OR = 1.10 | HomVEE calculated = 0.06 | Not statistically significant, p > 0.05 |
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Number of well-child visits | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 671 children | Adjusted mean = 4.60 | Adjusted mean = 4.80 | Mean difference = -0.20 | Not available | Not statistically significant, p > 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Employed during pregnancy | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | % (adjusted) = 6.00 | Adjusted mean % = 3.00 | OR = 2.00 | HomVEE calculated = 0.44 | Not statistically significant, p > 0.05 |
Authors report the difference in this outcome to be statistically significant, p < 0.10, which is greater than the acceptable alpha for this review (α = 0.05).
|
| High | In school during pregnancy | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | % (adjusted) = 44.00 | Adjusted mean % = 41.00 | OR = 1.20 | HomVEE calculated = 0.07 | Not statistically significant, p > 0.05 |
Statistical significance reported on authors’ calculations of the odds ratio.
|
| High | Used other community services | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | % (adjusted) = 29.00 | Adjusted mean % = 20.00 | OR = 1.80 | HomVEE calculated = 0.30 | Statistically significant, p ≤ 0.01 |
Statistical significance reported on authors’ calculations of the odds ratio.
|
| High | Months worked, 0–12 months postpartum | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 681 mothers | Adjusted mean = 2.20 | Adjusted mean = 1.70 | Mean difference = 0.50 | Not available | Not statistically significant, p > 0.05 |
|
| High | Months on AFDC , 13–24 months postpartum | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 671 mothers | Adjusted mean = 7.80 | Adjusted mean = 8.40 | Mean difference = -0.60 | Not available | Not statistically significant, p > 0.05 |
Authors report the difference in this outcome to be statistically significant, p < 0.10, which is greater than the acceptable alpha for this review (α = 0.05).
|
| High | Months on AFDC , 0–12 months postpartum | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 681 mothers | Adjusted mean = 7.30 | Adjusted mean = 7.60 | Mean difference = -0.30 | Not available | Not statistically significant, p > 0.05 |
|
| High | Months worked, 13–24 months postpartum | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 671 mothers | Adjusted mean = 3.40 | Adjusted mean = 3.40 | Mean difference = 0.00 | Not available | Not statistically significant, p > 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Diastolic blood pressure | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | Adjusted mean = 66.80 | Adjusted mean = 67.50 | Mean difference = -0.70 | Not available | Not statistically significant, p ≥ 0.05 | This mean difference, calculated by HomVEE, is within |0.01| of the difference reported by the authors, with the discrepancy likely due to rounding error.
|
| High | Gestational weight gain | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | Adjusted mean = 14.60 | Adjusted mean = 14.90 | Mean difference = -0.30 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Number of Gardnerella infections | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | Adjusted mean = 0.06 | Adjusted mean = 0.07 | Mean difference = -0.01 | Not available | Not statistically significant, p ≥ 0.05 | Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Number of hospitalizations during pregnancy | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | Adjusted mean = 0.15 | Adjusted mean = 0.13 | Mean difference = 0.02 | Not available | Not statistically significant, p ≥ 0.05 | Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Number of sexually transmitted diseases | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | Adjusted mean = 0.22 | Adjusted mean = 0.21 | Mean difference = 0.01 | Not available | Not statistically significant, p ≥ 0.05 | Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Number of yeast infections | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | Adjusted mean = 0.14 | Adjusted mean = 0.19 | Mean difference = -0.05 | Not available | Statistically significant, p ≤ 0.05 |
Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Obstetrical evaluation visits (total) | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | Adjusted mean = 2.80 | Adjusted mean = 2.80 | Mean difference = 0.00 | Not available | Not statistically significant, p ≥ 0.05 | This mean difference, calculated by HomVEE, is within |0.01| of the difference reported by the authors, with the discrepancy likely due to rounding error.
|
| High | Pregnancy-induced hypertension (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | % (adjusted) = 13.00 | Adjusted mean % = 20.00 | OR = 0.60 | HomVEE calculated = -0.31 | Statistically significant, p ≤ 0.01 |
Statistical significance reported on authors’ calculations of the odds ratio.
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Standard prenatal care visits (total) | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | Adjusted mean = 6.20 | Adjusted mean = 6.50 | Mean difference = -0.30 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Systolic blood pressure | FavorableUnfavorable or ambiguousNo Effect |
Full (Memphis) | 36th week of pregnancy | 916 mothers | Adjusted mean = 111.70 | Adjusted mean = 112.60 | Mean difference = -0.90 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Anxiety (MHI), 24 months postpartum, standardized | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 671 mothers | Adjusted mean = 99.10 | Adjusted mean = 100.30 | Mean difference = -1.20 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Depression (MHI), 24 months postpartum, standardized | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 671 mothers | Adjusted mean = 99.50 | Adjusted mean = 100.10 | Mean difference = -0.06 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Pearlin Mastery, 24 months postpartum, standardized | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 671 mothers | Adjusted mean = 101.60 | Adjusted mean = 99.40 | Mean difference = 2.20 | Not available | Statistically significant, p < 0.01 |
|
| High | Spontaneous abortion, 0–24 months postpartum (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 671 mothers | % (adjusted) = 5.00 | Adjusted mean % = 3.00 | OR = 1.50 | HomVEE calculated = 0.32 | Not statistically significant, p ≥ 0.05 | The odds ratio compares the nurse-visited group to the comparison.
|
| High | Subsequent live birth, 0–24 months postpartum (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 671 mothers | % (adjusted) = 22.00 | Adjusted mean % = 31.00 | OR = 0.60 | HomVEE calculated = -0.28 | Statistically significant, p < 0.01 |
Statistical significance reported on authors’ calculations of the odds ratio.
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Subsequent pregnancy, 0-24 months postpartum (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 671 mothers | % (adjusted) = 36.00 | Adjusted mean % = 47.00 | OR = 0.60 | HomVEE calculated = -0.28 | Statistically significant, p < 0.01 |
Statistical significance reported on authors’ calculations of the odds ratio.
The odds ratio compares the nurse-visited group to the comparison.
|
| High | Therapeutic abortion, 0–24 months postpartum (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 671 mothers | % (adjusted) = 2.00 | Adjusted mean % = 4.00 | OR = 0.50 | HomVEE calculated = -0.43 | Not statistically significant, p ≥ 0.05 | The odds ratio compares the nurse-visited group to the comparison.
|
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | HOME (emotional/ cognitive stimulation) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 675 mothers | Adjusted mean = 32.30 | Adjusted mean = 30.90 | Mean difference = 1.40 | Not available | Statistically significant, p < 0.01 |
|
| High | NCAST Child Responsiveness (total score) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 1,082 children | Adjusted mean = 17.70 | Adjusted mean = 17.40 | Mean difference = 0.30 | Not available | Not statistically significant, p > 0.05 |
|
| High | NCAST Maternal Teaching (total score) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 675 mothers | Adjusted mean = 36.70 | Adjusted mean = 36.50 | Mean difference = 0.20 | Not available | Not statistically significant, p > 0.05 |
|
| High | Beliefs associated with child abuse (AAPI total score) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postpartum | 672 mothers | Adjusted mean = 98.70 | Adjusted mean = 100.50 | Mean difference = -1.80 | Not available | Statistically significant, p < 0.01 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Number of days hospitalized–injuries/ingestions | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 671 children | Adjusted mean = 0.04 | Adjusted mean = 0.18 | Mean difference = -0.14 | Not available | Statistically significant, p < 0.01 |
Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Number of emergency department visits–injuries/ingestions | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 671 children | Adjusted mean = 0.33 | Adjusted mean = 0.34 | Mean difference = -0.01 | Not available | Not statistically significant, p > 0.05 |
Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Number of hospitalizations–injuries/ingestions | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 671 children | Adjusted mean = 0.01 | Adjusted mean = 0.03 | Mean difference = -0.02 | Not available | Not statistically significant, p > 0.05 |
Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Number of outpatient visits–injuries/ingestions | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 671 children | Adjusted mean = 0.11 | Adjusted mean = 0.20 | Mean difference = -0.09 | Not available | Statistically significant, p ≤ 0.05 |
Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Total number of health care encounters–injuries/ingestions | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) | 2 years postnatal | 671 children | Adjusted mean = 0.43 | Adjusted mean = 0.56 | Mean difference = -0.13 | Not available | Statistically significant, p ≤ 0.05 |
Statistical significance reported on authors’ calculations of the log-incidence difference.
|