Evaluation protocol to assess maternal and child health outcomes using administrative data: a community health worker home visiting programme

Abstract

IntroductionEmerging evidence suggests community health workers (CHWs) delivering preventive maternal and child health (MCH) interventions through home visiting improve several important health outcomes, including initiation of prenatal care, healthy birth weight and uptake of childhood immunisations.Methods and analysisThe Arizona Health Start Program is a behavioral-based home visiting intervention, which uses CHWs to improve MCH outcomes through health education, referral support, and advocacy services for at-risk pregnant and postpartum women with children up to 2 years of age. We aim to test our central hypothesis that mothers and children exposed to this intervention will experience positive health outcomes in the areas of (1) newborn health; (2) maternal health and healthcare utilisation; and (3) child health and development. This paper outlines our protocol to retrospectively evaluate Health Start Program administrative data from 2006 to 2015, equaling 15 576 enrollees. We will use propensity score matching to generate a statistically similar control group. Our analytic sample size is sufficient to detect meaningful programme effects from low-frequency events, including preterm births, low and very low birth weights, maternal morbidity, and differences in immunisation and hospitalisation rates.Ethics and disseminationThis work is supported through an inter-agency contract from the Arizona Department of Health Services and is approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802, approved 25 January 2017). Evaluation of the three proposed outcome areas will be completed by June 2020.

The Family as Recipient and Provider of Home Care: A Primary Care Perspective

“…Efforts are targeted towards early prenatal care, breastfeeding, reduction of maternal morbidity and perinatal mortality and appropriate childhood immunizations. Home visiting interventions lead to a decreased incidence of preterm birth and low birthweight [66]. By having a common language, a similar socioeconomic status and understanding life experiences of their clients, CHWs are accepted by vulnerable and disenfranchised groups.…”

“…By having a common language, a similar socioeconomic status and understanding life experiences of their clients, CHWs are accepted by vulnerable and disenfranchised groups. Being integral contributors in collaborative health-based and community-based teams, CHWs improve comprehensive care and contribute to health improvements and cost savings [66].…”

Addressing maternal and child health equity through a community health worker home visiting intervention to reduce low birth weight: retrospective quasi-experimental study of the Arizona Health Start Programme

“…28 We conducted a quasi-experimental evaluation of a long-standing state health department-operated programme administered within county, clinic and community-based organisations in 14 rural and urban counties across Arizona to assess whether Health Start Programme participation is associated with improved birth and birth-related outcomes. 29 Our study aims to contribute to the gap in literature for rigorous evaluations of CHW-led home visiting programmes targeting MCH equity.…”

“… 30 31 MCH home visiting services are delivered by trained CHWs who, through CHW core competency and specialised MCH training, connect clients to prenatal care and increase continuity of care during and after pregnancy. 29 Broadly, CHWs identify, screen and enrol eligible women; provide perinatal and postpartum education and social support; provide referral and advocacy services; and emphasise timely immunisations and developmental assessments for children. 29 31 32 During pregnancy, CHWs provide education (eg, perinatal nutrition, physical symptoms and changes, labour and delivery, and breastfeeding); assist with access and enrolment to continuous perinatal care; screen, educate and follow-up for maternal behavioural health disorders, alcohol, tobacco and drug cessation; and intimate partner violence.…”

“… 29 Broadly, CHWs identify, screen and enrol eligible women; provide perinatal and postpartum education and social support; provide referral and advocacy services; and emphasise timely immunisations and developmental assessments for children. 29 31 32 During pregnancy, CHWs provide education (eg, perinatal nutrition, physical symptoms and changes, labour and delivery, and breastfeeding); assist with access and enrolment to continuous perinatal care; screen, educate and follow-up for maternal behavioural health disorders, alcohol, tobacco and drug cessation; and intimate partner violence. The Health Start Programme’s CHWs are trained to motivate and support their clients through behaviour change activities that promote personal agency and self-efficacy, and achieve Health Start Programmatic goals, including reducing LBW outcomes.…”