Aims: To assess outcomes in families who received the First Parent Health Visitor Scheme (FPHVS), in comparison with families who received conventional ("generic") health visiting. Methods: Retrospective data on 2113 families were collected during 1986-92 as part of National Health Service (NHS) service provision. Prospective data were collected during 1993-98 on 459 mothers and their children, with outcomes assessed at one year (93% follow up) and two years (80% follow up). Results: There were no differences between the groups of mothers in self esteem, locus of control, or depression rates. The women who received the FPHVS were more likely to have changed partners, but they also had a wider support network than comparison women, and consulted their general practitioner (GP) less often. Breast feeding rates were higher in the FPHVS mothers, who also gave their infants more fruit juice drinks than the comparison group. No differences were apparent in developmental outcome using the Bayley Scales at 1 and 2 years of age. Both height and weight Z scores at 2 years of age were lower in the FPHVS children than the comparison children. Receipt of the FPHVS was associated with increased use of electric socket covers and lower accident rates in the second year of life. No differences were seen in immunisation rates, uptake of child health surveillance, or use of hospital services. A higher proportion of families who received the FPHVS were registered on the local child protection register compared with comparison families. Conclusion: Clustering effects dominated the analysis, but overall this evaluation could not show a clear advantage for the FPHVS over conventional health visiting.T he Child Development Programme (CDP) 1 aims to improve the health and development of young children from deprived backgrounds by offering a programme of parental support, based on the principles of empowerment. The CDP was initiated in 1979 by Dr Walter Barker at the School of Applied Social Studies, University of Bristol, and by the time this evaluation commenced in 1993 the programme had been adopted by 18 NHS (National Health Service) provider units across the UK. One of the most important interventions in the CDP is the First Parent Health Visitor Scheme (FPHVS), in which first time parents from deprived areas are offered a programme of regular home visits by a specially trained health visitor who aims to help, support, and advise the mother during the first phase of parenting. The FPHVS contrasts with the usual pattern of health visiting in targeting first time mothers, emphasising empowerment, and using appropriate written materials, including cartoons.The FPHVS was implemented in three areas of socioeconomic deprivation (two inner city areas and one suburban estate) in the city of Bristol in February 1989. Families receiving the FPHVS in Bristol are visited at home antenatally (in the third trimester), at the statutory primary birth visit, at three weeks postnatally, and then every five weeks until the infant is 8 months old. For ...

This article presents the feasibility and acceptability of using mobile health technology by community health workers (CHWs) in San Juan Province, Dominican Republic, to improve identification of pregnancy complications and access to care for pregnant women. Although most women in the Dominican Republic receive four antenatal care visits, poor women and adolescents in remote areas are more likely to have only one initial prenatal visit to verify the pregnancy. This community-based research began when community leaders raised concern about the numbers of their mothers who died in childbirth annually; San Juan's maternal mortality rate is 144/100,000 compared to the Caribbean rate of 85/100,000. Eight CHWs in three communities were taught to provide third-trimester antenatal assessment, upload the data on a mobile phone application, send the data to the local physician who monitored data for "red flags," and call directly if a mother had an urgent problem. Fifty-two pregnant women enrolled, 38 were followed to delivery, 95 antenatal care postintake were provided, 2 urgent complications required CHW home management of mothers, and there were 0 deaths. Stakeholders endorsed acceptability of intervention. Preliminary data suggest CHWs using mobile health technology is feasible, linking underserved and formal health care systems with provision of primary care in mothers' homes.

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