Black or African American
92%
Source
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
Note: Navigate to model page for more information about the home visiting model. See the study manuscript for more information about how the model was implemented in this study.
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.
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Difference in SES, but controlled in analysis. |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
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
Home Visiting 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.
Model(s) Reviewed
Note: Navigate to model page for more information about the home visiting model. See the study manuscript for more information about how the model was implemented in this study.
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.
Findings that rate moderate or high in this manuscript
Maternal health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Gestational weight gain |
36th week of pregnancy |
High | Not statistically significant, p ≥ 0.05 |
916 mothers | Full (Memphis) |
|||
Systolic blood pressure |
36th week of pregnancy |
High | Not statistically significant, p ≥ 0.05 |
916 mothers | Full (Memphis) |
|||
Diastolic blood pressure |
36th week of pregnancy |
High | Not statistically significant, p ≥ 0.05 |
916 mothers | Full (Memphis) |
|||
Standard prenatal care visits (total) |
36th week of pregnancy |
High | Not statistically significant, p ≥ 0.05 |
916 mothers | Full (Memphis) |
|||
Obstetrical evaluation visits (total) |
36th week of pregnancy |
High | Not statistically significant, p ≥ 0.05 |
916 mothers | Full (Memphis) |
|||
Number of hospitalizations during pregnancy |
36th week of pregnancy |
High | Not statistically significant, p ≥ 0.05 |
916 mothers | Full (Memphis) |
|||
Number of Gardnerella infections |
36th week of pregnancy |
High | Not statistically significant, p ≥ 0.05 |
916 mothers | Full (Memphis) |
|||
Number of yeast infections |
36th week of pregnancy |
High | Statistically significant, |
916 mothers | Full (Memphis) |
|||
Number of sexually transmitted diseases |
36th week of pregnancy |
High | Not statistically significant, p ≥ 0.05 |
916 mothers | Full (Memphis) |
|||
Pregnancy-induced hypertension (percentage) |
36th week of pregnancy |
High | 0.31 | Statistically significant, |
916 mothers | Full (Memphis) |
||
Subsequent pregnancy, 0-24 months postpartum (percentage) |
2 years postpartum |
High | 0.28 | Statistically significant, |
671 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
||
Spontaneous abortion, 0–24 months postpartum (percentage) |
2 years postpartum |
High | 0.32 | Not statistically significant, p ≥ 0.05 |
671 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
||
Therapeutic abortion, 0–24 months postpartum (percentage) |
2 years postpartum |
High | 0.43 | Not statistically significant, p ≥ 0.05 |
671 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
||
Subsequent live birth, 0–24 months postpartum (percentage) |
2 years postpartum |
High | 0.28 | Statistically significant, |
671 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
||
Anxiety (MHI), 24 months postpartum, standardized |
2 years postpartum |
High | Not statistically significant, p ≥ 0.05 |
671 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Depression (MHI), 24 months postpartum, standardized |
2 years postpartum |
High | Not statistically significant, p ≥ 0.05 |
671 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Pearlin Mastery, 24 months postpartum, standardized |
2 years postpartum |
High | Statistically significant, |
671 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
Child health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Birth weight, grams |
Birth |
High | Not statistically significant, |
1082 children | Full (Memphis) |
|||
Gestational age, weeks |
Birth |
High | Not statistically significant, |
1082 children | Full, (Memphis) |
|||
5-minute Apgar |
Birth |
High | Not statistically significant, |
1082 children | Full, (Memphis) |
|||
Low birth weight (percentage < 2500 g) |
Birth |
High | 0.05 | Not statistically significant, |
1082 children | Full, (Memphis) |
||
Intrauterine growth restriction (percentage) |
Birth |
High | 0.00 | Not statistically significant, |
1082 children | Full, (Memphis) |
||
Preterm (less than 37 weeks, percentage) |
Birth |
High | 0.12 | Not statistically significant, |
1082 children | Full, (Memphis) |
||
Indicated preterm delivery (percentage) |
Birth |
High | 0.00 | Not statistically significant, |
1082 children | Full, (Memphis) |
||
Spontaneous preterm delivery, percentage |
Birth |
High | 0.08 | Not statistically significant, |
1082 children | Full, (Memphis) |
||
Breastfeeding attempted, percentage |
2 years postnatal |
High | 0.37 | Statistically significant, |
671 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
||
Immunizations up to date, percentage |
2 years postnatal |
High | 0.06 | Not statistically significant, |
671 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
||
Number of well-child visits |
2 years postnatal |
High | Not statistically significant, |
671 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
Positive parenting practices
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
NCAST Child Responsiveness (total score) |
2 years postnatal |
High | Not statistically significant, |
1082 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Beliefs associated with child abuse (AAPI total score) |
2 years postpartum |
High | Statistically significant, |
672 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
HOME (emotional/ cognitive stimulation) |
2 years postpartum |
High | Statistically significant, |
675 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
NCAST Maternal Teaching (total score) |
2 years postpartum |
High | Not statistically significant, |
675 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
Child development and school readiness
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
BSID (total score) |
2 years postnatal |
High | Not statistically significant, |
1082 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
CBCL (total score) |
2 years postnatal |
High | Not statistically significant, |
1082 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
Reductions in child maltreatment
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Total number of health care encounters–injuries/ingestions |
2 years postnatal |
High | Statistically significant, |
671 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Number of outpatient visits–injuries/ingestions |
2 years postnatal |
High | Statistically significant, |
671 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Number of emergency department visits–injuries/ingestions |
2 years postnatal |
High | Not statistically significant, |
671 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Number of hospitalizations–injuries/ingestions |
2 years postnatal |
High | Not statistically significant, |
671 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Number of days hospitalized–injuries/ingestions |
2 years postnatal |
High | Statistically significant, |
671 children | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
Family economic self-sufficiency
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Used other community services |
36th week of pregnancy |
High | 0.30 | Statistically significant, |
916 mothers | Full (Memphis) |
||
In school during pregnancy |
36th week of pregnancy |
High | 0.07 | Not statistically significant, |
916 mothers | Full (Memphis) |
||
Employed during pregnancy |
36th week of pregnancy |
High | 0.44 | Not statistically significant, |
916 mothers | Full (Memphis) |
||
Months worked, 0–12 months postpartum |
2 years postpartum |
High | Not statistically significant, |
681 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Months worked, 13–24 months postpartum |
2 years postpartum |
High | Not statistically significant, |
671 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Months on AFDC , 0–12 months postpartum |
2 years postpartum |
High | Not statistically significant, |
681 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
|||
Months on AFDC , 13–24 months postpartum |
2 years postpartum |
High | Not statistically significant, |
671 mothers | Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- Tennessee