Black or African American
52%
Source
Peer reviewed?
Yes
McConnell, M. A., Rokicki, S., Ayers, S., Allouch, F., Perreault, N., Gourevitch, R. A., Martin, M. W., Zhou, R., A., Zera, C., Hacker, M. R., Chien, A., Bates, M. A., & Baicker, K. (2022). Effect of an intensive nurse home visiting program on adverse birth outcomes in a Medicaid-eligible population: A randomized clinical trial. JAMA, 328(1), 27–37. https://doi.org/10.1001/jama.2022.9703
Model(s) Reviewed
Study Registration
Funding Sources
This research was supported by the Children’s Trust of South Carolina, Arnold Ventures, The Duke Endowment, BlueCross BlueShield Foundation of South Carolina, and the Abdul Latif Jameel Poverty Action Lab North America Health Care Delivery Initiative.
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 on sample sizes and adjusted means for the study’s findings is based on correspondence with the authors.
Study Participants
Participants could refer themselves to the program or be referred through clinicians, schools, or Medicaid. Eligible participants had to be pregnant (< 28 weeks’ gestation) with no previous live births, income-eligible for Medicaid during pregnancy, and residing in a program-served county in South Carolina. Participants were ineligible if they were age 14 or younger or were incarcerated or in a lockdown facility. They were randomized to either the Nurse-Family Partnership intervention (3,806 participants) or the comparison condition (1,864 participants). Four thousand nine hundred and sixty-six mothers were included in the analyses in this manuscript (3,319 in the intervention group and 1,647 in the comparison group). Participants were in the study from the time of enrollment at pregnancy until the child was 24 months old. Outcomes presented in this manuscript were measured at the child’s birth. In the study, 55 percent of the participants were Black and 35 percent were White, and at enrollment, 82 percent were age 19 or older. Thirty-five percent had a high school diploma or equivalent, whereas 42 percent had some college, a college degree, or postgraduate training.
Setting
The study took place in South Carolina.
Home Visiting Services
As described in this manuscript, the Nurse-Family Partnership intervention consisted of prenatal and infancy home visits until the focal child was 24 months old. All participants in the intervention received four weekly visits at the beginning of the intervention to establish a relationship with the nurse. Nurses tailored the content of the visit to clients’ strengths, risks, and preferences; and used motivational interviews, educational tools, health assessments, and goal-setting related to prenatal health, child health and development, and maternal life course. They encouraged the mothers to use available health care and made referrals to health and social services. The first four home visits after enrollment were conducted every week, and follow-up visits were scheduled every other week until delivery. Visits lasted between 60 to 90 minutes, and nurses were trained to flexibly support their clients if additional or fewer visits were necessary. Intervention services were provided in English and Spanish if bilingual nurses were available, and translation services were available for clients who spoke other languages.
Comparison Conditions
Participants assigned to the comparison condition were not eligible to receive home visits through Nurse-Family Partnership. They received usual care, including access to all other community and medical services. They were provided with a list of available community resources.
Were any subgroups examined?
No
Subgroups examined
• Mother has vulnerability (yes or no) • Race/ethnicity (Black or non-Black)
Study Participants
Participants could refer themselves to the program or be referred through clinicians, schools, or Medicaid. Eligible participants had to be pregnant (< 28 weeks’ gestation) with no previous live births, income-eligible for Medicaid during pregnancy, and residing in a program-served county in South Carolina. Participants were ineligible if they were age 14 or younger or were incarcerated or in a lockdown facility. They were randomized to either the Nurse-Family Partnership intervention (3,806 participants) or the comparison condition (1,864 participants). Four thousand nine hundred and sixty-six mothers were included in the analyses in this manuscript (3,319 in the intervention group and 1,647 in the comparison group). Participants were in the study from the time of enrollment at pregnancy until the child was 24 months old. Outcomes presented in this manuscript were measured at the child’s birth. In the study, 55 percent of the participants were Black and 35 percent were White, and at enrollment, 82 percent were age 19 or older. Thirty-five percent had a high school diploma or equivalent, whereas 42 percent had some college, a college degree, or postgraduate training.
Setting
The study took place in South Carolina.
Home Visiting Services
As described in this manuscript, the Nurse-Family Partnership intervention consisted of prenatal and infancy home visits until the focal child was 24 months old. All participants in the intervention received four weekly visits at the beginning of the intervention to establish a relationship with the nurse. Nurses tailored the content of the visit to clients’ strengths, risks, and preferences; and used motivational interviews, educational tools, health assessments, and goal-setting related to prenatal health, child health and development, and maternal life course. They encouraged the mothers to use available health care and made referrals to health and social services. The first four home visits after enrollment were conducted every week, and follow-up visits were scheduled every other week until delivery. Visits lasted between 60 to 90 minutes, and nurses were trained to flexibly support their clients if additional or fewer visits were necessary. Intervention services were provided in English and Spanish if bilingual nurses were available, and translation services were available for clients who spoke other languages.
Comparison Conditions
Participants assigned to the comparison condition were not eligible to receive home visits through Nurse-Family Partnership. They received usual care, including access to all other community and medical services. They were provided with a list of available community resources.
Were any subgroups examined?
No
Subgroups examined
• Mother has vulnerability (yes or no) • Race/ethnicity (Black or non-Black)
Findings that rate moderate or high in this manuscript
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Adverse birth outcome composite |
Child's birth |
High | 0.02 | Not statistically significant, p= ≥0.05 |
4966 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
||
Very low birth weight |
Child's birth |
High | 0.17 | Not statistically significant, p= ≥0.05 |
4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
||
Extremely preterm birth |
Child's birth |
High | 0.00 | Not statistically significant, p= ≥0.05 |
4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
||
Neonatal morbidity |
Child's birth |
High | 0.09 | Not statistically significant, p= ≥0.05 |
4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
||
Overnight NICU stay |
Child's birth |
High | 0.06 | Not statistically significant, p= ≥0.05 |
4543 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
||
Large for gestational age |
Child's birth |
High | 0.11 | Not statistically significant, p= ≥0.05 |
4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
||
Mean birth weight (in grams) |
Child's birth |
High | 0.01 | Not statistically significant, p = 0.67 |
4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
||
Mean gestational age (in weeks) |
Child's birth |
High | 0.04 | Not statistically significant, p = 0.15 |
4932 children | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Cesarean delivery |
Child's birth |
High | 0.06 | Not statistically significant, p= ≥0.05 |
4932 mothers | NFP vs. usual care RCT, South Carolina 2016-2021, full sample |
||
Severe maternal morbidity |
Child's birth |
High | 0.13 | Not statistically significant, p= ≥0.05 |
5158 mothers | NFP vs. usual care RCT, South Carolina 2016-2021, 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:
- South Carolina