Manuscript Details

Lutenbacher, M., Elkins, T., Dietrich, M. S., & Riggs, A. (2018). The efficacy of using peer mentors to improve maternal and infant health outcomes in Hispanic families: Findings from a randomized clinical trial. Maternal & Child Health Journal, 22(1), 92-104. https://doi.org/10.1007/s10995-018-2532-z

Peer Reviewed

Model(s): Maternal Infant Health Outreach Worker (MIHOW)®
High rating
Study reviewed under: Handbook of Procedures and Standards, Version 2
Study design characteristics contributing to rating
Design Attrition Baseline equivalence Confounding factors? Valid, reliable measures?
Randomized controlled trial Low

Not assessed for randomized controlled trials with low attrition

No

Yes, details reported below for findings on valid, reliable outcomes that otherwise rate at least moderate
Notes from the review of this manuscript

Findings with high attrition ("receiving prenatal care," Edinburgh Postnatal Depression Scale (EPDS) prenatal scores, and "referred to resources" at 35 weeks prenatal) are assigned a low rating because baseline equivalence was not demonstrated on a socioeconomic status indicator for these specific analytic samples. Furthermore, findings on child co-sleeping and whether mother receiving social and emotional support receive a low rating because reliability statistics could not be obtained for the measures. Information on baseline equivalence, reliability of measures, and other details about the study is based on correspondence with the authors and information reported in Lutenbacher et al. (2016). HomVEE determined that one finding, "time to first prenatal visit (weeks)," is ineligible for review because it may not reflect post-intervention impacts.

Child Health
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Breastfeeding at 6 months postpartum 6 months postpartum High
0.01 Not statistically significant, p = 0.94 175 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Ever breastfed the child 2 weeks postpartum High
0.13 Not statistically significant, p= 0.57 177 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Median number of weeks of exclusive breastfeeding 6 months postpartum High
0.04 Statistically significant, p= 0.01 175 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Never breastfed exclusively 6 months postpartum High
0.67 Statistically significant, p < .05 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Never breastfed the child 6 months postpartum High
0.14 Not statistically significant, p = 0.56 175 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Still exclusive breastfeeding 6 months postpartum 6 months postpartum High
0.40 Not statistically significant, p >= .05 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Stopped breastfeeding by 2 months postpartum 2 months postpartum High
0.35 Not statistically significant, p = 0.23 175 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Stopped breastfeeding by 2 weeks postpartum 2 weeks postpartum High
0.04 Not statistically significant, p = 0.95 175 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Stopped breastfeeding by 6 months postpartum 6 months postpartum High
0.13 Not statistically significant, p = 0.57 175 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Stopped breastfeeding exclusively by 2 months postpartum 2 months postpartum High
0.59 Statistically significant, p < .05 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Stopped breastfeeding exclusively by 2 weeks postpartum 2 weeks postpartum High
0.51 Statistically significant, p < .05 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Linkages and Referrals
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Referred to resources at 6 months postpartum 6 months postpartum High
4.77 Statistically significant, p = 0.02 178 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Maternal Health
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Edinburgh Postpartum Depression Scale (EPDS) 2 weeks postpartum High
1.41 Statistically significant, p <.01 177 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Edinburgh Postpartum Depression Scale (EPDS) 2 months postpartum High
1.08 Statistically significant, p <.01 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Edinburgh Postpartum Depression Scale (EPDS) 6 months postpartum High
0.76 Statistically significant, p <.01 178 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Parenting Stress Index 4 (PSI): Total stress score 2 weeks postpartum High
0.45 Statistically significant, p= 0.00 177 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Parenting Stress Index 4 (PSI): Total stress score 2 months postpartum High
0.46 Statistically significant, p= 0.00 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Parenting Stress Index 4 (PSI): Total stress score 6 months postpartum High
0.72 Statistically significant, p <.01 178 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Positive Parenting Practices
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Child sleeps on back at 2 months postpartum 2 months postpartum High
1.88 Statistically significant, p = 0.00 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Child sleeps on back at 2 weeks postpartum 2 weeks postpartum High
2.32 Statistically significant, p = 0.00 177 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Child sleeps on back at 6 months postpartum 6 months postpartum High
1.64 Statistically significant, p = 0.00 178 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Median Home Observation for Measurement of the Environment (HOME) Inventory Score 2 weeks postpartum High
Statistically significant, p <.001 177 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Median Home Observation for Measurement of the Environment (HOME) Inventory Score 2 months postpartum High
Statistically significant, p <.001 175 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Median Home Observation for Measurement of the Environment (HOME) Inventory Score 6 months postpartum High
Statistically significant, p <.001 178 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Median number of days during prior week reading to child 2 weeks postpartum High
Statistically significant, p <.001 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Median number of days during prior week singing or telling stories to child 2 weeks postpartum High
Statistically significant, p <.001 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Reads stories at least three times per week 2 months postpartum High
1.82 Statistically significant, p = 0.00 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Reads stories at least three times per week 6 months postpartum High
2.69 Statistically significant, p = 0.00 176 mothers MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

Note: Tables do not include findings that HomVEE rated low or indeterminate, or found to be ineligible for review.

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.

Hispanic or Latino
100%

Maternal Education

Less than a high school diploma
79%
High school diploma or GED
20%
Some college or Associate's degree
1%
Unknown
1%

Other Characteristics

Enrollment in means-tested programs
45%

This study included participants from the following locations:

  • Tennessee
Study Participants

Pregnant Hispanic women older than 18 were recruited to participate in the study through word of mouth, agency referrals, and distributing flyers in locations with a high concentration of Hispanic individuals. A total of 188 participants were randomly assigned to either the Maternal Infant Health Outreach Worker (MIHOW) intervention (94 women) or the comparison group (94 women). The average age of the study participants was 30, and about two-thirds of the participants were from Mexico. When the study began, 10 percent were employed full time, and 16 percent were employed part time. Most (about 80 percent) did not have a high school diploma, and more than half (about 56 percent) had never been married.

Setting

The study was conducted in Davidson County, an urban area of Tennessee.

Intervention condition
Maternal Infant Health Outreach Worker (MIHOW)®

Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.

Comparison Conditions

Pregnant women assigned to the comparison group were given educational materials about maternal and child health and development during the 35th week of pregnancy and when the infant was 2 weeks, 2 months, and 6 months old. These materials were also provided to the intervention group.

Subgroups examined

There were no subgroups reported in this manuscript.

Author Affiliation

Three of the four authors are affiliated with the Vanderbilt School of Nursing, which developed the MIHOW intervention and supports its implementation.

Funding Sources

This research was supported by Award Numbers D89MC23542 and UL1TR000445 from the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program and the National Center for Advancing Translational Sciences of the National Institutes of Health.