Olds, D. L., Henderson Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1986). Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation. Pediatrics, 77(1), 16.
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Established on race and SES. | None | None | Not assessed in manuscripts reviewed before 2021 |
Olds, Henderson, Tatelbaum and Chamberlin (1986) analyzed other outcomes in the maternal health domain, including participation in childbirth education and number of cigarettes per day, but these are not reported in the HomVEE table because the sample size used for these outcomes is substantially smaller than the sample on which baseline equivalence was established.
The Elmira sample included two deviations from the randomization procedure. First, six housemates of women already randomly assigned and enrolled in the study were assigned to the same treatment as the women already enrolled. Second, the probability of being assigned to one of the treatment groups was increased in the last 6 months of the 30 month enrollment period. The first issue suggests a mismatch between the unit of assignment (adult in the household) and the unit of analysis, which may lead to overstating the precision of the standard errors. The second issue should lead to a weighting strategy in the analysis, so that those who were enrolled later receive less weight in the analysis. Weighting, however, was not used in these studies.
| Study participants | The sample included pregnant, first-time mothers who were less than 30 weeks pregnant. Women were recruited through health and human services agencies, including health clinics, Planned Parenthood, and public schools. In these locations, pregnant women who were less than 19 years old, were single parents, or had low socioeconomic status were actively recruited for the study. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. For this study, 46 nonwhite women were excluded from the sample. At enrollment, on average, the women were about 19 years old, 17 weeks pregnant, and had approximately 11 years of education. Roughly 42 percent of the sample was married. This study measured the sample in the 32nd week of pregnancy and the time of birth. The study sample included 354 women, 189 in the program group and 165 in the comparison group. |
|---|---|
| Setting | The study was conducted in Elmira, a metropolitan area within a semi-rural county in the Appalachian region of New York that has approximately 100,000 residents. |
| Intervention services | The study included two treatment groups, which were combined for the analyses. The first treatment group received home visits from a nurse during pregnancy. The nurse visited the family every other week and made nine visits, on average, which lasted one hour and 15 minutes. This 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. Home visits were weekly for the first month after delivery, decreasing over time to once every 6 weeks when the child was 18-24 months. Home visits focused on parent education, enhancing the women’s support systems, and linkages to community services. |
| Comparison conditions | The study included two comparison groups, which were combined for the analyses. The first comparison group did not receive any services during pregnancy. When the children were 12 and 24 months old, they were screened for sensory and developmental problems and referred to other specialists, as appropriate. The second treatment group received free transportation (through a contract with a local taxi company) for prenatal and well-child care at local clinics and doctors’ offices. The second comparison group also received the 12- and 24-month developmental screening. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). • Maternal age (ages 18–22 years) • Smoking status (current smoker) • Subgroups defined by combinations of maternal characteristics (White and uncomplicated pregnancy) |
| Funding sources | Bureau of Community Health Services (HHS-MCR-360403-06), the Robert Wood Johnson Foundation (grant 5263), and the W. T. Grant Foundation (grant 0723-80). The serum cotinine assays were carried out in the laboratories of Dr. Helen Van Vunakis at Brandeis University and were partially supported by grant DA 2407 from the Department of Health and Human Services. |
| Author affiliation | David L. Olds, a study author, is a developer of this model. |
| Peer reviewed | Peer reviewed status is not listed for manuscripts reviewed before 2021. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Child birth weight (grams) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Birth | 308 children | Adjusted mean = 3285.00 | Adjusted mean = 3262.00 | Mean difference = 23.00 | Not available | Not statistically significant, p > 0.05 |
|
| High | Length of gestation | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Birth | 308 children | Adjusted mean = 39.57 | Adjusted mean = 39.71 | Mean difference = -0.14 | Not available | Not statistically significant, p > 0.05 |
|
| High | Percentage low birth rate, (≤ 2,500 grams) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Birth | 308 children | % (adjusted) = 5.78 | Adjusted mean % = 2.61 | Mean difference = 3.17 | HomVEE calculated = 0.50 | Not statistically significant, p > 0.05 |
|
| High | Percentage preterm delivery (< 37 weeks) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Birth | 308 children | % (adjusted) = 6.90 | Adjusted mean % = 7.27 | Mean difference = -0.37 | HomVEE calculated = -0.03 | Not statistically significant, p > 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Number of nutritional supplementation vouchers | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | 32 weeks | 288 mothers | Mean = 2.18 | Mean = 1.56 | Mean difference = 0.62 | Not available | Statistically significant, p ≤ 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Number of services known | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | 32 weeks postpartum | 294 mothers | Mean = 4.91 | Mean = 5.47 | Mean difference = -0.56 | Not available | Statistically significant, p ≤ 0.01 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Average weight gain (pounds) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Prepregnancy to last prenatal visit | 289 mothers | Mean = 35.71 | Mean = 32.78 | Mean difference = 2.93 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Bladder infection (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Enrollment to delivery | 306 mothers | Mean % = 10.00 | Mean % = 6.00 | Mean difference = 4.00 | HomVEE calculated = 0.34 | Not statistically significant, p ≥ 0.05 | |
| High | Change in average adequacy of diet (percentage RDA) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Enrollment to week 32 | 253 mothers | Mean = 4.14 | Mean = -0.33 | Mean difference = 3.81 | Not available | Statistically significant, p ≤ 0.05 |
|
| High | Change in blood pressure | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Enrollment to last prenatal visit | 295 mothers | Mean = 7.60 | Mean = 7.13 | Mean difference = -0.47 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Change in percentage experienced bleeding | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | First to third trimester | 295 mothers | = 0.00 | = 0.05 | Mean difference = 5.00 | Not available | Not statistically significant, p ≥ 0.05 | footnote150High score equals unfavorable. |
| High | Change in percentage experienced spotting | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | First to third trimester | 308 mothers | = -0.03 | = -0.06 | Mean difference = -3.00 | HomVEE calculated = -0.40 | Not statistically significant, p ≥ 0.05 | |
| High | Edema (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Enrollment to delivery | 308 mothers | Mean % = 62.00 | Mean % = 58.00 | Mean difference = 0.04 | HomVEE calculated = 0.10 | Not statistically significant, p ≥ 0.05 | |
| High | Hematocrit (percentage, last before delivery) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Enrollment to delivery | 308 mothers | Mean % = 36.76 | Mean % = 36.67 | Mean difference = 0.09 | HomVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | |
| High | Hypertensive disorder of pregnancy (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Enrollment to delivery | 308 mothers | Mean % = 4.00 | Mean % = 7.00 | Mean difference = -3.00 | HomVEE calculated = -0.36 | Not statistically significant, p ≥ 0.05 | |
| High | Kidney infection (percentage) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Enrollment to delivery | 306 mothers | Mean % = 0.00 | Mean % = 3.00 | Mean difference = -3.00 | Not available | Statistically significant, p ≤ 0.01 |
|
| High | Number alcoholic drinks per week (average change) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Enrollment to week 32 | 293 mothers | Mean = -0.04 | Mean = -0.06 | Mean difference = -0.02 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Number of antepartum visits | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | 32 weeks | 292 mothers | Mean = 10.49 | Mean = 10.50 | Mean difference = -0.01 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Number of calls to physician/clinic | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | 32 weeks | 292 mothers | Mean = 1.43 | Mean = 1.72 | Mean difference = -0.29 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Proteinuria (≥ 2+, percentage) | FavorableUnfavorable or ambiguousNo Effect |
Full (Elmira) | Enrollment to delivery | 308 mothers | Mean % = 5.00 | Mean % = 3.00 | Mean difference = 2.00 | HomVEE calculated = 0.32 | Not statistically significant, p ≥ 0.05 |
