Manuscript Detail | Home Visiting Evidence of Effectiveness

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

Manuscript screening details
Screening decision	Screening conclusion	HomVEE procedures and standards version
Passes screens	Eligible for review	Version 2

Study design details
Rating	Design	Attrition	Baseline equivalence	Compromised randomization	Confounding factors	Valid, reliable measure(s)
High	Randomized controlled trial	Low	Not assessed for randomized controlled trials with low attrition	No	No	Yes, details reported below for findings on valid, reliable outcomes that otherwise rate at least moderate

Notes:

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.

Study characteristics
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 services	The MIHOW intervention sends health outreach workers to provide one-on-one services to pregnant women. The health outreach workers form relationships with the expectant parents and provide support, parenting education, and referrals through monthly hourlong home visits and group activities. Health outreach workers worked with parents to demonstrate positive parenting practices, and provided information about children's development, health, and nutrition. The program services typically last until the child is 36 months old, but services in this study ended when the child reached the age of 6 months due to funding constraints. Despite the reduced length of service, there were no adaptations to the content or intensity of the intervention. Intervention participants also received the educational materials sent to those in the comparison group.
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	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). There were no subgroups reported in this manuscript.
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.
Author affiliation	Three of the four authors are affiliated with the Vanderbilt School of Nursing, which developed the MIHOW intervention and supports its implementation.
Peer reviewed	Yes

Study Registration:

Clinicaltrials.gov Identifier: None found. SocialScienceRegistry.org Identifier: None found. Registry of Efficacy and Effectiveness Studies Identifier: None found. Study registration was assessed by HomVEE for Clinicaltrials.gov beginning with the 2014 review, and for other registries beginning with the 2021 review.

Findings that rate moderate or high

Child health
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Breastfeeding at 6 months postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	175 mothers	Unadjusted proportion = 0.50	Unadjusted proportion = 0.49	Difference = 0.01	HomVEE calculated = 0.01	Not statistically significant, p = 0.94	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Ever breastfed the child	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 weeks postpartum	177 mothers	Unadjusted proportion = 0.86	Unadjusted proportion = 0.83	Difference = 0.03	Study reported = 0.13	Not statistically significant, p= 0.57	Author-reported effect size was calculated with Cohen’s D.
High	Median number of weeks of exclusive breastfeeding	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	175 mothers	Unadjusted median = 1.40	Unadjusted median = 0.30	Median difference = 1.10	Study reported = 0.04	Statistically significant, p= 0.01	Author-reported effect size was calculated with Cohen’s D.
High	Never breastfed exclusively	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	176 mothers	Unadjusted proportion = 0.56	Unadjusted proportion = 0.79	Difference = -0.24	HomVEE calculated = -0.67	Statistically significant, p < .05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Never breastfed the child	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	175 mothers	Unadjusted proportion = 0.14	Unadjusted proportion = 0.18	Difference = -0.03	HomVEE calculated = -0.14	Not statistically significant, p = 0.56	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Still exclusive breastfeeding 6 months postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	176 mothers	Unadjusted proportion = 0.02	Unadjusted proportion = 0.01	Difference = 0.01	HomVEE calculated = 0.40	Not statistically significant, p >= .05
High	Stopped breastfeeding by 2 months postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 months postpartum	175 mothers	Unadjusted proportion = 0.16	Unadjusted proportion = 0.09	Difference = 0.06	HomVEE calculated = 0.35	Not statistically significant, p = 0.23	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Stopped breastfeeding by 2 weeks postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 weeks postpartum	175 mothers	Unadjusted proportion = 0.02	Unadjusted proportion = 0.02	Difference = 0.00	HomVEE calculated = -0.04	Not statistically significant, p = 0.95	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Stopped breastfeeding by 6 months postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	175 mothers	Unadjusted proportion = 0.18	Unadjusted proportion = 0.21	Difference = -0.03	HomVEE calculated = -0.13	Not statistically significant, p = 0.57	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Stopped breastfeeding exclusively by 2 months postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 months postpartum	176 mothers	Unadjusted proportion = 0.19	Unadjusted proportion = 0.08	Difference = 0.11	HomVEE calculated = 0.59	Statistically significant, p < .05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Stopped breastfeeding exclusively by 2 weeks postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 weeks postpartum	176 mothers	Unadjusted proportion = 0.23	Unadjusted proportion = 0.12	Difference = 0.12	HomVEE calculated = 0.51	Statistically significant, p < .05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.

Linkages and referrals
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Referred to resources at 6 months postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	178 mothers	Unadjusted proportion = 1.00	Unadjusted proportion = 0.28	Difference = 0.72	HomVEE calculated = 4.77	Statistically significant, p = 0.02	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.

Maternal health
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Edinburgh Postpartum Depression Scale (EPDS)	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 months postpartum	176 mothers	Unadjusted median = 0.00	Unadjusted median = 3.00	Median difference = -3.00	Study reported = -1.08	Statistically significant, p <.01	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Author-reported effect size was calculated with Cohen’s D.
High	Edinburgh Postpartum Depression Scale (EPDS)	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	178 mothers	Unadjusted median = 0.00	Unadjusted median = 0.00	Median difference = 0.00	Study reported = -0.76	Statistically significant, p <.01	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Author-reported effect size was calculated with Cohen’s D.
High	Edinburgh Postpartum Depression Scale (EPDS)	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 weeks postpartum	177 mothers	Unadjusted median = 0.00	Unadjusted median = 5.00	Median difference = -5.00	Study reported = -1.41	Statistically significant, p <.01	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Author-reported effect size was calculated with Cohen’s D.
High	Parenting Stress Index 4 (PSI): Total stress score	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 weeks postpartum	177 mothers	Unadjusted median = 74.00	Unadjusted median = 76.00	Median difference = -2.00	Study reported = -0.45	Statistically significant, p= 0.00	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Author-reported effect size was calculated with Cohen’s D.
High	Parenting Stress Index 4 (PSI): Total stress score	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 months postpartum	176 mothers	Unadjusted median = 74.00	Unadjusted median = 76.00	Median difference = -2.00	Study reported = -0.46	Statistically significant, p= 0.00	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Author-reported effect size was calculated with Cohen’s D.
High	Parenting Stress Index 4 (PSI): Total stress score	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	178 mothers	Unadjusted median = 74.00	Unadjusted median = 77.00	Median difference = -3.00	Study reported = -0.72	Statistically significant, p <.01	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Author-reported effect size was calculated with Cohen’s D.

Positive parenting practices
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Child sleeps on back at 2 months postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 months postpartum	176 mothers	Unadjusted proportion = 0.98	Unadjusted proportion = 0.66	Difference = 0.31	HomVEE calculated = 1.88	Statistically significant, p = 0.00	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Child sleeps on back at 2 weeks postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 weeks postpartum	177 mothers	Unadjusted proportion = 0.99	Unadjusted proportion = 0.66	Difference = 0.33	HomVEE calculated = 2.32	Statistically significant, p = 0.00	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Child sleeps on back at 6 months postpartum	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	178 mothers	Unadjusted proportion = 0.98	Unadjusted proportion = 0.75	Difference = 0.23	HomVEE calculated = 1.64	Statistically significant, p = 0.00	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Median Home Observation for Measurement of the Environment (HOME) Inventory Score	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	178 mothers	Unadjusted median = 40.00	Unadjusted median = 33.00	Median difference = 7.00	Not reported	Statistically significant, p <.001
High	Median Home Observation for Measurement of the Environment (HOME) Inventory Score	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 weeks postpartum	177 mothers	Unadjusted median = 21.00	Unadjusted median = 15.00	Median difference = 6.00	Not reported	Statistically significant, p <.001
High	Median Home Observation for Measurement of the Environment (HOME) Inventory Score	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 months postpartum	175 mothers	Unadjusted median = 27.00	Unadjusted median = 19.00	Median difference = 8.00	Not reported	Statistically significant, p <.001
High	Median number of days during prior week reading to child	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 weeks postpartum	176 mothers	Unadjusted median = 5.00	Unadjusted median = 0.00	Median difference = 5.00	Not reported	Statistically significant, p <.001
High	Median number of days during prior week singing or telling stories to child	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 weeks postpartum	176 mothers	Unadjusted median = 6.00	Unadjusted median = 5.00	Median difference = 1.00	Not reported	Statistically significant, p <.001
High	Reads stories at least three times per week	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	2 months postpartum	176 mothers	Unadjusted proportion = 0.92	Unadjusted proportion = 0.37	Difference = 0.55	HomVEE calculated = 1.82	Statistically significant, p = 0.00	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Reads stories at least three times per week	FavorableUnfavorable or ambiguousNo Effect	MIHOW vs. MEI, Davidson County, Tennessee, 2014-2016, full sample	6 months postpartum	176 mothers	Unadjusted proportion = 0.97	Unadjusted proportion = 0.26	Difference = 0.71	HomVEE calculated = 2.69	Statistically significant, p = 0.00	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.