Manuscript Details

El-Kamary, S. S., Higman, S. M., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. K. (2004). Hawaii’s Healthy Start home visiting program: Determinants and impact of rapid repeat birth. Pediatrics, 114(3), e317–e326.

High rating
Study reviewed under: Handbook of Procedures and Standards, Version 1
Study design characteristics contributing to rating
Design Attrition Baseline equivalence Confounding factors? Valid, reliable measures?
Randomized controlled trial Low

Established on race and SES. baseline equivalence on the outcome is not feasible. Partner violence had a statistically significant baseline difference but is included as a control.

None

Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1
Maternal Health
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Did not use birth control after index child’s birth One year postpartum High
0.08 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Maternal desire for RRB One year postpartum High
0.14 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
No family planning site One year postpartum High
0.05 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Rapid repeat birth (RRB) One year postpartum High
0.04 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Asian
28%
Native Hawaiian or Pacific Islander
34%
White
25%
Unknown
13%

Maternal Education

Data not available

Other Characteristics

Indigenous population
34%

This study included participants from the following locations:

  • Hawaii
Study Participants

Families were recruited to the study between November 1994 and December 1995. Hawaii Healthy Start Program staff screened the medical records of mothers from one of four Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Mothers found to be at risk, or those whose records did not contain sufficient information to screen out, were screened further using the Kempe Family Stress Checklist; eligible families were those in which either parent scored 25 or greater (Duggan, 2004a). Of the 897 families who were eligible to participate in the study, 730 (81%) agreed to participate and were randomly assigned to the program group (n = 395), the main comparison group (n = 290), or a testing comparison group (n = 45). 684 families completed a baseline interview (373 families in the program group, 270 families in the main comparison group, and 41 in the testing group comparison). On average, at baseline, mothers were 23.7 years of age (program group) and 23.3 years of age (comparison group). 63% (program group) and 67% (comparison group) of participating families lived below the poverty line. The racial composition of the program group was 34% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 10% Caucasian, and 27% of unknown primary ethnicity. The main comparison group consisted of 33% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 14% Caucasian, and 26% of unknown primary ethnicity. This study reports results from the three follow-ups of the Hawaii Healthy Start randomized controlled trial. In each follow-up year, interviews were completed for 88% of families. 81% of participating families completed all three follow-up interviews.

Setting

Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.

Intervention condition
Comparison Conditions

The main comparison group was tested annually to measure outcomes. A second “testing” comparison group was evaluated only at year 3 to ascertain the effect of repeated testing on observed outcomes (Duggan, McFarlane, Fuddy, Burrell, Higman, Windham, et al., 2004).

Subgroups examined

• Parity (primiparous)

Author Affiliation

None of the study authors are developers of this model.

Funding Sources

Maternal and Child Health Bureau (grant R40 MC 00029, formerly grant MCJ-240637, and grant R40 MC 00123, formerly grant MCJ-240838), the Robert Wood Johnson Foundation (grant 18303), the Annie E. Casey Foundation (grant 94–4041), the David and Lucile Packard Foundation (grants 93–6051, 94–7957, 97–8058, and 98–3448), and the Hawaii State Department of Health (grant 99-29-J).