Less than a high school diploma
24.40%
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).
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.
Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
---|---|---|---|---|
Randomized controlled trial | Low | Not assessed for randomized controlled trials with low attrition |
No |
Yes |
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 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.
The study took place in Victoria and Tasmania in Australia.
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.
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.
• 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)
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 |
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 |
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 |
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 |
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 |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations: