Black or African American
92%
Source
Olds, D. L., Kitzman, H., Knudtson, M. D., Anson, E., Smith, J. A., & Cole, R. (2014). Effect of home visiting by nurses on maternal and child mortality: Results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatrics, 168(9), 800-806.
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.
Study Registration
Funding Sources
National Institute of Drug Abuse (grant 1R01DA021624)
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Not established on race or SES; outcome measures not assessable at baseline |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
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, 1,138 women were randomly assigned to one of four intervention groups (two treatment and two control conditions) after providing informed consent. Of the 1,138 women randomized into the four conditions, all 1,138 were included in the analytic sample to assess maternal mortality. Approximately 89 to 96 percent of women in this sample were African American and 1 to 3 percent were married. The average age was 18 years and the average education level was 10 years. On average, women lived in census tracts with 35 to 39 percent of the population living below the poverty level. This study measures maternal and child mortality outcomes 21 years after randomization.
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 before discharge and another 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.
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.
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 | |
|---|---|---|---|---|---|---|---|---|
21 year maternal mortality rate - all causes (Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison) |
21 years |
Moderate | 0.69 | Statistically significant, p = 0.01 |
1138 mother/child dyads | Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison (Memphis) |
||
21 year maternal mortality rate - external cause (Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison) |
21 years |
Moderate | 1.22 | Statistically significant, p = 0.02 |
1138 mother/child dyads | Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison (Memphis) |
||
21 year maternal mortality rate - all causes (Nurse home visits during pregnancy plus 2 postpartum visits vs. transport to prenatal appointment comparison) |
21 years |
Moderate | 1.41 | Statistically significant, p = 0.01 |
910 mother/child dyads | Nurse home visits during pregnancy plus 2 postpartum visits vs. transport to prenatal appointment comparison (Memphis) |
||
21 year maternal mortality rate - external cause (Nurse home visits during pregnancy plus 2 postpartum visits vs. transport to prenatal appointment comparison) |
21 years |
Moderate | Not statistically significant, p = 0.05 |
910 mother/child dyads | Nurse home visits during pregnancy plus 2 postpartum visits vs. transport to prenatal appointment comparison (Memphis) |
|||
21 year maternal mortality rate - all causes (Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison) |
21 years |
Moderate | 0.69 | Statistically significant, p = 0.01 |
1138 mother/child dyads | Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison (Memphis) |
||
21 year maternal mortality rate - external cause (Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison) |
21 years |
Moderate | 1.22 | Statistically significant, p = 0.02 |
1138 mother/child dyads | Nurse home visits during pregnancy and infancy vs. transport to prenatal appointment comparison (Memphis) |
Child health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
20 year child mortality rate - all causes (Nurse home visits during pregnancy and infancy vs. developmental screening comparison) |
20 years |
Moderate | 0.68 | Not statistically significant, p = 0.11 |
708 mother/child dyads | Nurse home visits during pregnancy and infancy vs. developmental screening comparison (Memphis) |
||
20 year child mortality rate - preventable cause (Nurse home visits during pregnancy and infancy vs. developmental screening comparison) |
20 years |
Moderate | Statistically significant, p = 0.04 |
708 mother/child dyads | Nurse home visits during pregnancy and infancy vs. 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