Goldfeld, S., Price, A., Smith, C., Bruce, T., Bryson, H., Mensah, F., Orsini, F., Gold, L., Hiscock, H., Bishop, L., Smith, A., Perlen, S., & Kemp, L. (2019). Nurse home visiting for families experiencing adversity: A randomized trial. Pediatrics, 143(1).
| 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 the measures did not meet HomVEE’s reliability standards or reliability was not calculated. These included several subscales of the Home Observation for Measurement of the Environment (HOME) scale, measures of child’s mealtimes and food choices, bedtime routines, mother and child health, and language behaviors. In addition, several findings at 24 months old received an indeterminate rating—measures of mother’s planning future study, child stress, and sibling mental health—because the findings were high attrition and HomVEE could not assess whether the findings satisfied the baseline equivalence requirement based on the available information. Two outcomes were not eligible for review: Patient Satisfaction Index and Parent Enablement Index. These are measures of implementation of the home visiting evaluation, which are not eligible for review in one of HomVEE’s outcome domains.
| 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 two or more risk factors identified at screening from a list of 10 for poor child outcomes, and their home addresses had to be 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). Outcomes were measured when children were 12 and 24 months. Up to 596 women were included in the analyses at 24 months (306 in the intervention group and 290 in the comparison group). 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). • Parity (primiparous or multiparous) • Antenatal risk factors (2 or fewer risk factors or 3 or more risk factors) • Overall mental health (higher than the 85th percentile for mental health or less than the 85th percentile) • Maternal self-efficacy (high or low) |
| 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 | Child - Does things to get mother to laugh |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
586 children | Unadjusted proportion = 0.97 | Unadjusted proportion = 0.95 | Odds ratio = 2.85 | Study reported = 0.63 | Statistically significant, p= 0.01 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Child - Engages in pretend play |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
589 children | Unadjusted proportion = 0.93 | Unadjusted proportion = 0.87 | Odds ratio = 1.67 | Study reported = 0.31 | Not statistically significant, p= 0.05 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Child - Gets mother to notice things |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
590 children | Unadjusted proportion = 0.98 | Unadjusted proportion = 0.95 | Odds ratio = 2.12 | Study reported = 0.46 | Not statistically significant, p= 0.08 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Child - Nods to indicate yes |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
581 children | Unadjusted proportion = 0.86 | Unadjusted proportion = 0.81 | Odds ratio = 1.22 | Study reported = 0.12 | Not statistically significant, p= 0.25 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Child - Puts 2 words together |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
587 children | Unadjusted proportion = 0.91 | Unadjusted proportion = 0.86 | Odds ratio = 1.45 | Study reported = 0.23 | Not statistically significant, p= 0.14 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Child - Waves to greet people |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
584 children | Unadjusted proportion = 0.88 | Unadjusted proportion = 0.85 | Odds ratio = 1.15 | Study reported = 0.08 | Not statistically significant, p= 0.64 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Child - Ate breakfast today |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
589 children | Unadjusted proportion = 0.90 | Unadjusted proportion = 0.94 | Odds ratio = 0.44 | Study reported = -0.50 | Statistically significant, p= 0.01 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Child - Began solid foods at ages 4–6 months |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
635 children | Unadjusted proportion = 0.86 | Unadjusted proportion = 0.86 | Odds ratio = 0.78 | HomVEE calculated = -0.15 | Not statistically significant, p= 0.33 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Child - Only given water, milk, formula to drink |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
12 months old |
633 children | Unadjusted proportion = 0.60 | Unadjusted proportion = 0.60 | Odds ratio = 0.93 | HomVEE calculated = -0.04 | Not statistically significant, p= 0.93 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Mother - Breastfed until age 6 months |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
566 mothers | Unadjusted proportion = 0.40 | Unadjusted proportion = 0.43 | Odds ratio = 0.76 | HomVEE calculated = -0.17 | Not statistically significant, p= 0.16 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Mother - Ever breastfed |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
668 mothers | Unadjusted proportion = 0.83 | Unadjusted proportion = 0.83 | Odds ratio = 0.92 | Study reported = -0.05 | Not statistically significant, p= 0.64 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Mother - Currently studying |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
582 mothers | Unadjusted proportion = 0.17 | Unadjusted proportion = 0.18 | Odds ratio = 0.91 | Study reported = -0.06 | Not statistically significant, p= 0.65 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Mother - Employed |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
581 mothers | Unadjusted proportion = 0.32 | Unadjusted proportion = 0.34 | Odds ratio = 0.81 | Study reported = -0.13 | Not statistically significant, p= 0.13 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Assessment of Quality of Life (AQoL) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
571 mothers | Unadjusted mean = 0.73 | Unadjusted mean = 0.73 | Mean difference = 0.00 | Study reported = -0.03 | Not statistically significant, p= 0.78 |
|
| High | Depression, Anxiety, and Stress Scale (DASS), Anxiety (reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
574 mothers | Unadjusted mean = 19.10 | Unadjusted mean = 18.92 | Mean difference = 0.18 | Study reported = 0.07 | Not statistically significant, p= 0.34 |
|
| High | Depression, Anxiety, and Stress Scale (DASS), Depression (reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
573 mothers | Unadjusted mean = 18.71 | Unadjusted mean = 18.86 | Mean difference = -0.15 | Study reported = -0.04 | Not statistically significant, p= 0.55 |
|
| High | Depression, Anxiety, and Stress Scale (DASS), Overall (reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
571 mothers | Unadjusted mean = 54.53 | Unadjusted mean = 54.20 | Mean difference = 0.33 | Study reported = 0.05 | Not statistically significant, p= 0.52 |
|
| High | Depression, Anxiety, and Stress Scale (DASS), Stress (reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
573 mothers | Unadjusted mean = 16.74 | Unadjusted mean = 16.44 | Mean difference = 0.30 | Study reported = 0.10 | Not statistically significant, p= 0.26 |
|
| High | Maternal stress (hair cortisol, pg/mg; logtransformed) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
438 mothers | Unadjusted mean = 1.46 | Unadjusted mean = 1.42 | Mean difference = 0.04 | Study reported = -0.08 | Not statistically significant, p= 0.25 |
Negative effect is favorable to the intervention. |
| High | Mother - Does not smoke |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
12 months old |
635 mothers | Unadjusted proportion = 0.62 | Unadjusted proportion = 0.61 | Odds ratio = 0.97 | Study reported = -0.02 | Not statistically significant, p= 0.86 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Mother - Does not smoke |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
587 mothers | Unadjusted proportion = 0.63 | Unadjusted proportion = 0.66 | Odds ratio = 0.82 | Study reported = -0.12 | Not statistically significant, p= 0.14 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Mother - High self-efficacy (item drawn from Longitudinal Study of Australian Children) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
568 mothers | Unadjusted proportion = 0.75 | Unadjusted proportion = 0.76 | Odds ratio = 1.15 | Study reported = 0.08 | Not statistically significant, p= 0.25 |
HomVEE calculated the effect size based on the study-reported odds ratio. |
| High | Personal Wellbeing Index (PWI) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
559 mothers | Unadjusted mean = 60.01 | Unadjusted mean = 58.85 | Mean difference = 1.16 | Study reported = 0.04 | Not statistically significant, p= 0.46 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Home Observation for Measurement of the Environment (HOME), Parental Responsivity |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
546 mothers | Unadjusted mean = 10.33 | Unadjusted mean = 10.27 | Mean difference = 0.06 | Study reported = 0.02 | Not statistically significant, p= 0.74 |
|
| High | Hostile parenting (items drawn from Longitudinal Study of Australian Children; reverse coded) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
588 mothers | Unadjusted mean = 8.55 | Unadjusted mean = 8.25 | Mean difference = 0.30 | Study reported = 0.24 | Statistically significant, p= <.001 |
|
| High | Parenting Self-Efficacy Scale (items drawn from Longitudinal Study of Australian Children) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
587 mothers | Unadjusted mean = 8.21 | Unadjusted mean = 8.01 | Mean difference = 0.20 | Study reported = 0.14 | Statistically significant, p= 0.04 |
|
| High | Warm parenting (items drawn from Longitudinal Study of Australian Children) |
FavorableUnfavorable or ambiguousNo Effect |
MECSH vs. comparison, Australia, 2013-2017, full sample |
24 months old |
582 mothers | Unadjusted mean = 4.61 | Unadjusted mean = 4.54 | Mean difference = 0.07 | Study reported = 0.20 | Statistically significant, p= 0.01 |