Manuscript Details

Source

Peer reviewed?
Yes

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).

Rating
High
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.

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.

Study Design

Design Attrition Baseline equivalence Confounding factors Valid, reliable measures?
Randomized controlled trial Low

Not assessed for randomized controlled trials with low attrition

No

Yes

Notes

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 668 women were included in the analyses at 24 months (339 in the intervention group and 329 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.

Home Visiting 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.

Were any subgroups examined?
No
Subgroups examined

• 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)

Findings that rate moderate or high in this manuscript

Positive parenting practices
Outcome measure Timing of follow-up Rating Effect size Stastical significance Sample size Sample description

Warm parenting (items drawn from Longitudinal Study of Australian Children)

24 months old

High 0.20

Statistically significant, p= 0.01

582 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Hostile parenting (items drawn from Longitudinal Study of Australian Children; reverse coded)

24 months old

High 0.24

Statistically significant, p= <.001

588 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Home Observation for Measurement of the Environment (HOME), Parental Responsivity

24 months old

High 0.02

Not statistically significant, p= 0.74

546 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Parenting Self-Efficacy Scale (items drawn from Longitudinal Study of Australian Children)

24 months old

High 0.14

Statistically significant, p= 0.04

587 mothers

MECSH vs. comparison, Australia, 2013-2017, 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 Effect size Stastical significance Sample size Sample description

Mother - High self-efficacy (item drawn from Longitudinal Study of Australian Children)

24 months old

High 0.08

Not statistically significant, p= 0.25

568 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Mother - Does not smoke

12 months old

High -0.02

Not statistically significant, p= 0.86

635 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Mother - Does not smoke

24 months old

High -0.12

Not statistically significant, p= 0.14

587 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Depression, Anxiety, and Stress Scale‍ (DASS), Depression (reverse coded)

24 months old

High -0.04

Not statistically significant, p= 0.55

573 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Depression, Anxiety, and Stress Scale‍ (DASS), Anxiety (reverse coded)

24 months old

High 0.07

Not statistically significant, p= 0.34

574 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Depression, Anxiety, and Stress Scale‍ (DASS), Stress (reverse coded)

24 months old

High 0.10

Not statistically significant, p= 0.26

573 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Depression, Anxiety, and Stress Scale‍ (DASS), Overall (reverse coded)

24 months old

High 0.05

Not statistically significant, p= 0.52

571 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Assessment of Quality of Life (AQoL)

24 months old

High -0.03

Not statistically significant, p= 0.78

571 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Maternal stress (hair cortisol, pg/mg; logtransformed)

24 months old

High -0.08

Not statistically significant, p= 0.25

438 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Personal Wellbeing Index (PWI)

24 months old

High 0.04

Not statistically significant, p= 0.46

559 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Child health
Outcome measure Timing of follow-up Rating Effect size Stastical significance Sample size Sample description

Mother - Breastfed until age 6 months

24 months old

High -0.17

Not statistically significant, p= 0.16

566 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Mother - Ever breastfed

24 months old

High -0.05

Not statistically significant, p= 0.64

668 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Child - Began solid foods at ages 4–6 months

24 months old

High -0.15

Not statistically significant, p= 0.33

635 children

MECSH vs. comparison, Australia, 2013-2017, full sample

Child - Only given water, milk, formula to drink

12 months old

High -0.04

Not statistically significant, p= 0.93

633 children

MECSH vs. comparison, Australia, 2013-2017, full sample

Child - Ate breakfast today

24 months old

High -0.50

Statistically significant, p= 0.01

589 children

MECSH vs. comparison, Australia, 2013-2017, full sample

Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Family economic self-sufficiency
Outcome measure Timing of follow-up Rating Effect size Stastical significance Sample size Sample description

Mother - Employed

24 months old

High -0.13

Not statistically significant, p= 0.13

581 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Mother - Currently studying

24 months old

High -0.06

Not statistically significant, p= 0.65

582 mothers

MECSH vs. comparison, Australia, 2013-2017, full sample

Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Child development and school readiness
Outcome measure Timing of follow-up Rating Effect size Stastical significance Sample size Sample description

Child - Engages in pretend play

24 months old

High 0.31

Not statistically significant, p= 0.05

589 children

MECSH vs. comparison, Australia, 2013-2017, full sample

Child - Puts 2 words together

24 months old

High 0.23

Not statistically significant, p= 0.14

587 children

MECSH vs. comparison, Australia, 2013-2017, full sample

Child - Nods to indicate yes

24 months old

High 0.12

Not statistically significant, p= 0.25

581 children

MECSH vs. comparison, Australia, 2013-2017, full sample

Child - Waves to greet people

24 months old

High 0.08

Not statistically significant, p= 0.64

584 children

MECSH vs. comparison, Australia, 2013-2017, full sample

Child - Gets mother to notice things

24 months old

High 0.46

Not statistically significant, p= 0.08

590 children

MECSH vs. comparison, Australia, 2013-2017, full sample

Child - Does things to get mother to laugh

24 months old

High 0.63

Statistically significant, p= 0.01

586 children

MECSH vs. comparison, Australia, 2013-2017, full sample

Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant