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Lutenbacher, M., Elkins, T., & Dietrich, M. S. (unpublished manuscript). Using community health workers to improve health outcomes in a sample of Hispanic women and their infants: Findings from a randomized clinical trial.

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:

Several findings receive a moderate rating because they have high attrition but establish baseline equivalence. Findings on some outcomes—including Edinburgh Postnatal Depression Scale (EPDS) scores at 2, 6, 12, and 15 months postpartum—receive a low rating because attrition is high, and baseline equivalence is not established. Measures of social and emotional support receive a low rating due to insufficient reliability. Information on baseline equivalence, measures of findings at specific time points, reliability of measures, and other details about the study is based on correspondence with the authors. One outcome, "prior breastfeeding", is not a post-intervention outcome, and therefore was ineligible for review.

Study characteristics
Study participants Research staff visited community businesses and agencies to recruit pregnant Hispanic women for the study. There were also referrals from other study participants through word of mouth. Participants were randomly assigned to the Maternal Infant Health Outreach Worker (MIHOW) intervention (66 women) or the comparison group (66 women). The average age was 30, and the highest percentage of participants were from Mexico (49 percent). When the study began, 8 percent were employed full time, and 12 percent were employed part time. Most (66 percent) did not have a high school diploma, and more than half (53 percent) had never been married.
Setting The study took place in six counties in central 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. Visits were conducted virtually between March 2020 and November 2020 due to COVID restrictions. Over the course of the study, however, most home visits were delivered in-person rather than virtually. MIHOW services typically last until the child is 36 months old, but services in this study ended when the child reached 15 months old 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).

• Mothers with children at baseline

Funding sources This research was supported by Award Numbers 1X10MC31171-01-00 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 The authors are affiliated with the Vanderbilt School of Nursing, which developed the MIHOW intervention and supports its implementation.
Peer reviewed No
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

Child given solid food by 9 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

9 months postpartum

109 mothers Unadjusted proportion = 1.00 Unadjusted proportion = 0.98 Difference = 0.02 HomVEE calculated = 1.80

Not statistically significant, p= 0.23

High

Currently breastfeeding at 9 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

9 months postpartum

109 mothers Unadjusted proportion = 0.43 Unadjusted proportion = 0.25 Difference = 0.18 Study reported = 0.46

Statistically significant, p= 0.04

Author-reported effect size was calculated with Cohen's D.

Moderate

Breastfeeding initiated (ever breastfed the child)

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 weeks postpartum

113 mothers Unadjusted proportion = 0.97 Unadjusted proportion = 0.89 Difference = 0.08 Study reported = 0.30

Not statistically significant, p= 0.11

Author-reported effect size was calculated with Cohen's D.

Moderate

Child given solid food by 2 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 months postpartum

112 mothers Unadjusted proportion = 0.02 Unadjusted proportion = 0.08 Difference = -0.06 Study reported = -0.85

Not statistically significant, p= 0.12

Author-reported effect size was calculated with Cohen's D.

Moderate

Child given solid food by 6 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

6 months postpartum

111 mothers Unadjusted proportion = 0.95 Unadjusted proportion = 0.93 Difference = 0.02 Study reported = 0.22

Not statistically significant, p= 0.61

Author-reported effect size was calculated with Cohen's D.

Moderate

Currently breastfeeding at 12 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

12 months postpartum

110 mothers Unadjusted proportion = 0.37 Unadjusted proportion = 0.13 Difference = 0.24 Study reported = 0.74

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Currently breastfeeding at 15 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

15 months postpartum

110 mothers Unadjusted proportion = 0.11 Unadjusted proportion = 0.02 Difference = 0.09 HomVEE calculated = 1.09

Not statistically significant, p= 0.05

Moderate

Currently breastfeeding at 2 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 months postpartum

113 mothers Unadjusted proportion = 0.71 Unadjusted proportion = 0.61 Difference = 0.10 Study reported = 0.25

Not statistically significant, p= 0.26

Author-reported effect size was calculated with Cohen's D.

Moderate

Currently breastfeeding at 2 weeks postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 weeks postpartum

106 mothers Unadjusted proportion = 0.84 Unadjusted proportion = 0.82 Difference = 0.03 Study reported = 0.10

Not statistically significant, p= 0.73

Author-reported effect size was calculated with Cohen's D.

Moderate

Currently breastfeeding at 6 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

6 months postpartum

111 mothers Unadjusted proportion = 0.52 Unadjusted proportion = 0.34 Difference = 0.18 Study reported = 0.40

Not statistically significant, p= 0.06

Author-reported effect size was calculated with Cohen's D.

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 (prenatal)

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

35 weeks gestation

105 mothers Unadjusted proportion = 0.70 Unadjusted proportion = 0.14 Difference = 0.56 Study reported = 1.49

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Referred to resources (postpartum)

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

15 months postpartum

110 mothers Unadjusted proportion = 0.95 Unadjusted proportion = 0.25 Difference = 0.70 HomVEE calculated = 2.43

Statistically significant, p <.01

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 Postnatal Depression Scale (EPDS)

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

9 months postpartum

109 mothers Unadjusted mean = 1.20 Unadjusted mean = 1.43 Mean difference = -0.23 Study reported = -0.56

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

High

Edinburgh Postnatal Depression Scale (EPDS)

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

35 weeks gestation

102 mothers Unadjusted mean = 1.44 Unadjusted mean = 1.47 Mean difference = -0.02 Study reported = -0.06

Not statistically significant, p= 0.75

Author-reported effect size was calculated with Cohen's D.

High

Edinburgh Postnatal Depression Scale (EPDS)

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 weeks postpartum

109 mothers Unadjusted mean = 1.26 Unadjusted mean = 1.26 Mean difference = 0.00 Study reported = -0.01

Not statistically significant, p= 0.95

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, Tennessee, 2018-2020, full sample

9 months postpartum

108 mothers Unadjusted mean = 72.20 Unadjusted mean = 78.50 Mean difference = -6.30 Study reported = -0.35

Statistically significant, p = 0.04

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, Tennessee, 2018-2020, full sample

2 weeks postpartum

109 mothers Unadjusted mean = 75.70 Unadjusted mean = 77.70 Mean difference = -2.00 HomVEE calculated = -0.09

Not statistically significant, p= 0.64

High

Parenting Stress Index 4 (PSI): Total stress score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

12 months postpartum

109 mothers Unadjusted mean = 67.00 Unadjusted mean = 79.40 Mean difference = -12.40 Study reported = -0.77

Statistically significant, p <.01

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, Tennessee, 2018-2020, full sample

2 months postpartum

109 mothers Unadjusted mean = 79.80 Unadjusted mean = 76.90 Mean difference = 2.90 Study reported = 0.14

Not statistically significant, p = 0.43

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, Tennessee, 2018-2020, full sample

15 months postpartum

109 mothers Unadjusted mean = 59.10 Unadjusted mean = 77.10 Mean difference = -18.00 Study reported = -1.19

Statistically significant, p <.01

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, Tennessee, 2018-2020, full sample

6 months postpartum

109 mothers Unadjusted mean = 75.30 Unadjusted mean = 75.30 Mean difference = 0.00 Study reported = 0.00

Not statistically significant, p = 1.00

Author-reported effect size was calculated with Cohen's D.

Moderate

Had a postpartum checkup

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 months postpartum

110 mothers Unadjusted proportion = 0.91 Unadjusted proportion = 0.94 Difference = -0.03 Study reported = 0.23

Not statistically significant, p= 0.56

Author-reported effect size was calculated with Cohen's D.

Moderate

Had a postpartum checkup

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

6 months postpartum

110 mothers Unadjusted proportion = 1.00 Unadjusted proportion = 0.96 Difference = 0.04 Study reported = 0.41

Not statistically significant, p= 0.09

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 9 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

9 months postpartum

109 mothers Unadjusted proportion = 0.80 Unadjusted proportion = 0.60 Difference = 0.20 Study reported = 0.54

Statistically significant, p= 0.02

Author-reported effect size was calculated with Cohen's D.

High

Median Home Observation for Measurement of the Environment (HOME) Inventory Score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

9 months postpartum

108 mothers Unadjusted median = 43.00 Unadjusted median = 40.00 Median difference = 3.00 Study reported = 1.53

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

High

Median number of days during prior week reading to child

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

9 months postpartum

109 mothers Unadjusted median = 4.50 Unadjusted median = 1.00 Median difference = 3.50 Study reported = 1.29

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

High

Parenting Sense of Competence (PSOC) score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 months postpartum

107 mothers Unadjusted mean = 67.10 Unadjusted mean = 64.70 Mean difference = 2.40 Study reported = 0.41

Statistically significant, p = 0.03

Author-reported effect size was calculated with Cohen's D.

High

Parenting Sense of Competence (PSOC) score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

6 months postpartum

107 mothers Unadjusted mean = 68.80 Unadjusted mean = 65.80 Mean difference = 3.00 Study reported = 0.47

Statistically significant, p = 0.02

Author-reported effect size was calculated with Cohen's D.

High

Parenting Sense of Competence (PSOC) score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

9 months postpartum

107 mothers Unadjusted mean = 73.20 Unadjusted mean = 65.30 Mean difference = 7.90 Study reported = 0.98

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

High

Reads stories at least three times per week

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

9 months postpartum

109 mothers Unadjusted proportion = 0.93 Unadjusted proportion = 0.43 Difference = 0.50 Study reported = 1.56

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Child sleeps on back at 2 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 months postpartum

113 mothers Unadjusted proportion = 0.98 Unadjusted proportion = 0.85 Difference = 0.13 Study reported = 1.27

Statistically significant, p= 0.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Child sleeps on back at 2 weeks postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 weeks postpartum

113 mothers Unadjusted proportion = 0.93 Unadjusted proportion = 0.93 Difference = 0.01 Study reported = 0.19

Not statistically significant, p= 0.63

Author-reported effect size was calculated with Cohen's D.

Moderate

Child sleeps on back at 6 months postpartum

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

6 months postpartum

111 mothers Unadjusted proportion = 0.83 Unadjusted proportion = 0.72 Difference = 0.11 Study reported = 0.35

Not statistically significant, p= 0.16

Author-reported effect size was calculated with Cohen's D.

Moderate

Median Home Observation for Measurement of the Environment (HOME) Inventory Score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

12 months postpartum

108 mothers Unadjusted median = 43.00 Unadjusted median = 38.00 Median difference = 5.00 Study reported = 1.74

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Median Home Observation for Measurement of the Environment (HOME) Inventory Score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

15 months postpartum

108 mothers Unadjusted median = 44.00 Unadjusted median = 35.00 Median difference = 9.00 Study reported = 1.78

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Median Home Observation for Measurement of the Environment (HOME) Inventory Score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 weeks postpartum

105 mothers Unadjusted median = 23.00 Unadjusted median = 23.00 Median difference = 0.00 Study reported = 0.11

Not statistically significant, p= 0.52

Author-reported effect size was calculated with Cohen's D.

Moderate

Median Home Observation for Measurement of the Environment (HOME) Inventory Score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 months postpartum

109 mothers Unadjusted median = 30.00 Unadjusted median = 29.00 Median difference = 1.00 Study reported = 0.47

Statistically significant, p= 0.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Median Home Observation for Measurement of the Environment (HOME) Inventory Score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

6 months postpartum

108 mothers Unadjusted median = 43.00 Unadjusted median = 40.00 Median difference = 3.00 Study reported = 1.44

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Median number of days during prior week reading to child

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

12 months postpartum

110 mothers Unadjusted median = 6.00 Unadjusted median = 3.00 Median difference = 3.00 Study reported = 1.85

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Median number of days during prior week reading to child

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

15 months postpartum

110 mothers Unadjusted median = 7.00 Unadjusted median = 3.00 Median difference = 4.00 Study reported = 1.79

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Median number of days during prior week reading to child

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 months postpartum

113 mothers Unadjusted median = 1.00 Unadjusted median = 0.00 Median difference = 1.00 Study reported = 0.30

Not statistically significant, p= 0.09

Author-reported effect size was calculated with Cohen's D.

Moderate

Median number of days during prior week reading to child

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

6 months postpartum

111 mothers Unadjusted median = 4.00 Unadjusted median = 1.00 Median difference = 3.00 Study reported = 0.66

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Median number of days during prior week singing or telling stories to child

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 months postpartum

113 mothers Unadjusted median = 5.00 Unadjusted median = 5.00 Median difference = 0.00 Study reported = 0.08

Not statistically significant, p= 0.67

Author-reported effect size was calculated with Cohen's D.

Moderate

Median number of days during prior week singing or telling stories to child

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

6 months postpartum

111 mothers Unadjusted median = 5.00 Unadjusted median = 5.00 Median difference = 0.00 Study reported = 0.18

Not statistically significant, p= 0.33

Author-reported effect size was calculated with Cohen's D.

Moderate

Parenting Sense of Competence (PSOC) score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

15 months postpartum

108 mothers Unadjusted mean = 77.00 Unadjusted mean = 63.40 Mean difference = 13.60 Study reported = 2.02

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Parenting Sense of Competence (PSOC) score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 weeks postpartum

108 mothers Unadjusted mean = 65.60 Unadjusted mean = 65.00 Mean difference = 0.60 HomVEE calculated = 0.11

Not statistically significant, p= 0.55

Moderate

Parenting Sense of Competence (PSOC) score

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

12 months postpartum

108 mothers Unadjusted mean = 74.80 Unadjusted mean = 63.80 Mean difference = 11.00 Study reported = 1.51

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Reads stories at least three times per week

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

12 months postpartum

109 mothers Unadjusted proportion = 0.98 Unadjusted proportion = 0.54 Difference = 0.44 Study reported = 2.13

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Reads stories at least three times per week

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

15 months postpartum

109 mothers Unadjusted proportion = 0.98 Unadjusted proportion = 0.70 Difference = 0.28 Study reported = 1.75

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.

Moderate

Reads stories at least three times per week

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

2 months postpartum

112 mothers Unadjusted proportion = 0.41 Unadjusted proportion = 0.21 Difference = 0.20 Study reported = 0.53

Statistically significant, p= 0.02

Author-reported effect size was calculated with Cohen's D.

Moderate

Reads stories at least three times per week

FavorableUnfavorable or ambiguousNo Effect

MIHOW vs. MEI, Tennessee, 2018-2020, full sample

6 months postpartum

108 mothers Unadjusted proportion = 0.83 Unadjusted proportion = 0.35 Difference = 0.47 Study reported = 1.18

Statistically significant, p <.01

Author-reported effect size was calculated with Cohen's D.