Goldfeld, S., Bryson, H., Mensah, F., Gold, L., Orsini, F., Perlen, S., Price, A., Hiscock, H., Grobler, A., Dakin, P., Bruce, T., Harris, D., & Kemp, L. (2021). Nurse home visiting and maternal mental health: 3-year follow-up of a randomized trial. Pediatrics, 147(2), 1–11.
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 2 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Not assessed for randomized controlled trials with low attrition |
No | No |
Yes |
Information to demonstrate equivalence of the intervention and comparison groups was based on correspondence with the author. Several findings received a low rating because they do not satisfy HomVEE’s baseline equivalence requirement: the Personal Wellbeing Index; the Depression Anxiety Stress Scales (DASS), Stress scale score; and the self-efficacy scale score. The authors present findings using multiple imputation as well as findings using complete case analysis. The complete case findings were used in HomVEE’s review because the findings using imputation did not meet all requirements under HomVEE standards.
| Study participants | Study participants were pregnant women recruited from prenatal clinics in public maternity hospitals across two states in Australia. To be eligible, women had to be at no more than 36 weeks of gestation, have sufficient knowledge of English to complete interviews, have 2 or more risk factors from a list of 10 identified at screening for poor child outcomes, and have home addresses within travel boundaries of the participating areas. A total of 722 pregnant women were randomly assigned to either the home visiting intervention (363 women) or the comparison condition (359 women); 528 women were included in the analyses in this manuscript (255 in the intervention group and 240 in the comparison group). Outcomes were measured when children were 3 years old. In the study, 24 percent of mothers did not complete high school, 65 percent completed high school or vocational training, and 11 percent had a university degree. |
|---|---|
| Setting | The study took place in Victoria and Tasmania in Australia. |
| Intervention services | The Maternal Early Childhood Sustained Home-Visiting (MECSH) intervention—as implemented in this study called Right@Home—consisted of about 25 home visits with a nurse that lasted 60 to 90 minutes each. The visits began before the child was born and lasted until the child reached 24 months. Mothers typically worked with the same trained nurse throughout the intervention. During visits, nurses focused on parent education around sleep routines, safety practices, nutrition, and emotional regulation, as well as the home learning environment. Nurses also provided guidance and instruction in bonding and the parent-child relationship, as well as maternal health and well-being. Nurses used video feedback and motivational interviewing strategies as primary modes of interaction. The intervention also included one or more visits by a program social care practitioner who assisted the nurse with delivering services and provided counseling and case management. |
| Comparison conditions | Mothers in the comparison group received six to nine consultations with a nurse until the child reached 24 months. The first consultation occurred in families’ homes and other occurred at local centers. The consultations focused on broad-ranging supports for child health and development as well as parental well-being. |
| 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). There were no subgroups reported in this manuscript. |
| Funding sources | This research was supported by the state governments of Victoria and Tasmania, the Ian Potter Foundation, Sabemo Trust, the Sidney Myer Fund, the Vincent Fairfax Family Foundation, and the National Health and Medical Research Council by Award Number 1079418. |
| Author affiliation | The authors are affiliated with Murdoch Children’s Research Institute, The Royal Children’s Hospital, the University of Melbourne, the Australian Research Alliance for Children and Youth, Western Sydney University, and Deakin University in Australia. Dr. Kemp, a study author, is a developer of the MECSH home visiting program. |
| Peer reviewed | Yes |
Clinicaltrials.gov Identifier: None found. SocialScienceRegistry.org Identifier: None found. Registry of Efficacy and Effectiveness Studies Identifier: None found. Study registration was assessed by HomVEE for Clinicaltrials.gov beginning with the 2014 review, and for other registries beginning with the 2021 review.
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 | Depression Anxiety Stress Scales (DASS): Anxiety Scale (dichotomized, reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
3 years old |
488 mothers | Adjusted proportion = 0.85 | Adjusted proportion = 0.78 | Odds ratio = 1.38 | Study reported = 0.20 | Not statistically significant, p= 0.12 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Depression Anxiety Stress Scales (DASS): Anxiety Scale (reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
3 years old |
488 mothers | Adjusted mean = 18.98 | Adjusted mean = 18.36 | Mean difference = 0.62 | Study reported = 0.17 | Statistically significant, p= 0.01 |
|
| High | Depression Anxiety Stress Scales (DASS): Depression Scale (dichotomized, reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
3 years old |
488 mothers | Adjusted proportion = 0.88 | Adjusted proportion = 0.83 | Odds ratio = 1.68 | Study reported = 0.31 | Statistically significant, p= 0.02 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Depression Anxiety Stress Scales (DASS): Depression Scale (reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
3 years old |
488 mothers | Adjusted mean = 18.52 | Adjusted mean = 17.88 | Mean difference = 0.64 | Study reported = 0.20 | Statistically significant, p= <.01 |
|
| High | Depression Anxiety Stress Scales (DASS): Total Score (reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
3 years old |
487 mothers | Adjusted mean = 54.15 | Adjusted mean = 51.77 | Mean difference = 2.38 | Study reported = 0.25 | Statistically significant, p= <.01 |