Effectiveness of nurse home-visiting for disadvantaged families: results of a natural experiment

Abstract

ObjectiveTo evaluate the effects of a postnatal home-visiting programme delivered by community health nurses to socially disadvantaged mothers in South Australia.DesignThe intervention group of 428 mothers lived in metropolitan Adelaide and the comparison group of 239 mothers lived in regional towns where the programme was not yet available. All participating mothers met health service eligibility criteria for enrolment in the home-visiting programme. Participants in both groups were assessed at baseline (mean child age=14.4 weeks SD=2.3), prior to programme enrolment, and again when the children were aged 9, 18 and 24 months.SettingState-wide community child health service.Participants667 socially disadvantaged mothers enrolled consecutively. 487 mothers (73%) completed the 24-month assessment.InterventionTwo-year postnatal home-visiting programme based on the Family Partnership Model.Primary outcome measuresParent Stress Index (PSI), Kessler Psychological Distress Scale and the Ages and Stages Questionnaire.ResultsMixed models adjusting for baseline differences were used to compare outcomes in the two groups. The mothers in the home-visiting group reported greater improvement on the PSI subscales assessing a mother's perceptions on the quality of their relationship with their child (1.10, 95% CI 0.06 to 2.14) and satisfaction with their role as parents (0.46, 95% CI −0.15 to 1.07) than mothers in the comparison group. With the exception of childhood sleeping problems, there were no other significant differences in the outcomes across the two groups.ConclusionsThe findings suggest that home-visiting programmes delivered by community health nurses as part of routine clinical practice have the potential to improve maternal–child relationships and help mothers adjust to their role as parents.Clinical Trial RegistrationAustralian and New Zealand Clinical Trials Registry ACTRN12608000275369.

Effectiveness of nurse home visiting for families in rural South Australia

“…Approximately 65% of families maintained their enrolment for the full 2 years of the programme. This was similar to the retention rate found for families who received the SA‐FHV programme in the metropolitan region (68%) . It also exceeded the programme objective (60%) identified for the Family Nurse Partnership programme in England .…”

“…The evaluation did not identify a statistically significant effect of the SA‐FHV programme on maternal and child outcomes in rural South Australia. This contrasts with results from the evaluation of the SA‐FHV programme in the Adelaide metropolitan area where there was some evidence of improved maternal attachment, role restriction and child sleeping problems that were attributed to the SA‐FHV programme …”

“…These include greater concerns about confidentiality and the extensive travel needed to provide home visits across large geographical areas . The latter may have been reflected in the lower percentage of mothers who completed >65% of planned visits in rural (35%) versus metropolitan (53%) areas …”

“…In South Australia, a State‐wide nurse home‐visiting service (South Australian Family Home Visiting (SA‐FHV)) was found to have some benefits for maternal–child relationships and parental role satisfaction among mothers living in metropolitan Adelaide . In the present study, we have extended the evaluation to families living in rural areas.…”

Home Visit: Benefits for Early Child Development

“…In this field, different studies bring the benefits of home visiting by nurses for vulnerable families [7], young mothers [8], teen mothers [9], and to prevent birth outcomes -preterm and low birth weight [10].…”