A Nurse Home Visiting Program for Pregnant Adolescents: A Randomized Controlled Trial

Abstract

Objective To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life.Methods We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse HVP for adolescent mothers living in a poor urban area of São Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Laços (intervention group, n = 40) or healthcare as usual (control group, n = 40) groups. Primeiros Laços is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child’s age of 24 months. Participants were assessed by blind interviewers at 8–16 weeks of pregnancy (baseline), 30 weeks of pregnancy, 3, 6, and 12 months of child’s age. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment (HOME). Generalized estimating equation (GEE) models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen’s d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818.Results Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient = 0.89, 95% CI [0.18, 1.61], p = 0.014), maternal emotional/verbal responsivity (coefficient = 0.97, 95% CI [0.37, 1.58], p = 0.002), and opportunities for variety in daily stimulation (coefficient = 0.37, 95% CI [0.09, 0.66], p = 0.009). Standardized effect sizes of the intervention were small to moderate.Conclusions Primeiros Laços is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers.

Effect of early childhood development interventions delivered by healthcare providers to improve cognitive outcomes in children at 0–36 months: a systematic review and meta-analysis

“…After assessing inclusion and exclusion criteria, 97 papers reporting on 42 trials were included in the narrative synthesis, of which 27 trials were included in the meta-analyses (online supplemental appendix 5). 15 35–130 Online supplemental appendix 3 displays the outcomes and scales reported by each study and those included in the meta-analyses. Online supplemental appendix 6 shows the ongoing studies.…”

“…Of the 42 trials, 38 were individual RCTs,37 38 44–49 54–77 79–122 124–129 and 4 were cluster RCTs15 35 36 39–43 50–53 78 123 130 (table 2). Thirty-three trials were conducted in HICs44–49 54–67 69–77 79–97 100 103 105–108 111–119 121 122 125 126 128 and eight were conducted in LMICs (Pakistan, Bangladesh, South Africa, Columbia, Jamaica, Brazil, India and Zambia) 15 35–38 41–43 50–53 68 78 96 98 99 101 102 104 109 110 120 123 124 127 129 130…”

Effectiveness of different health delivery agents of parenting stimulation interventions on child development outcomes among children aged 0 to 36 months: a systematic review protocol

“…In Brazil, a home visiting program delivered by nurses showed significant positive effects on child expressive language development. 13 However, two other nurse-delivered home visiting programs in Australia and Germany resulted in no significant differences in child development. 14,15 Despite the numerous systematic reviews confirming the effectiveness of parenting stimulation interventions on child development, 8,9,16,17 none have evaluated the effectiveness of parenting stimulation interventions on child development according to the delivery agent.…”