Quality of delivery of “right@home”: Implementation evaluation of an Australian sustained nurse home visiting intervention to improve parenting and the home learning environment

Abstract

Background Home visiting programs are implemented in high income countries to improve outcomes for families with young children. Significant resources are invested in such programs and high quality evaluations are important. In the context of research trials, implementation quality is often poorly reported and, when reported, is variable. This paper presents the quality of implementation of the right@home program, a sustained nurse home visiting intervention trialled in Australia, and delivered in a ‘real world’ context through usual child and family health services. right@home is structured around the core Maternal Early Childhood Sustained Home-visiting (MECSH) program, which is a salutogenic, child focused prevention model. Method At each visit right@home practitioners completed a checklist detailing the client unique identifier, date of contact and activities undertaken. These checklists were collated to provide data on intervention dose, retention to program completion at child age 2 years, and visit content, which were compared with the program schedule. Quality of family-provider relationship was measured using the Session Rating Scale. Exploratory factor analysis was conducted to identify clusters of activities and allow qualitative assessment of concordance between program aims and program delivery. Results Of 363 intervention families offered the program, 352 (97·0%) commenced the program and 304 (87·3%) completed the program to child age 2 years. 253 of 352 (71·9%) families who commenced the program received more than 75 percent of scheduled visits including at least one antenatal visit. Families rated the participant-practitioner relationship highly (mean 39.4/40). The factor analysis identified six antenatal and six postnatal components which were concordant with the program aims. Conclusions The right@home program was delivered with higher adherence to program dose, schedule and content, and retention than usually reported in other home visiting research. Program compliance may have resulted from program design (visit schedule, dose, content and delivery flexibility) that was consistent with family aims.

Systematic review: An exploration of core componentry characterizing effective sustained nurse home visiting programs

“…Thirty‐one publications including two reviews met inclusion criteria. These studies identified seven SNHV programs: the Family Nurse Partnership (FNP; Corbacho et al., 2017; Owen‐Jones et al., 2013; Robling et al., 2016); Maternal Early Childhood Sustained Home visiting program (MECSH; Kemp et al., 2007, 2008, 2011, 2013); Minding the Baby (MtB; Ordway et al., 2014, 2018; Sadler et al., 2013; Slade et al., 2005, 2019); Pro Kind (Brand & Jungmann, 2012, 2014; Jungmann et al., 2009, 2015; Sandner et al., 2018; Sandner & Jungmann, 2017; Sierau et al., 2016); right@home (Goldfeld et al., 2017, 2018, 2019; Kemp et al., 2019); VoorZorg (Mejdoubi et al., 2011, 2013, 2014, 2015); and Nurse Family Partnership (NFP; Kitzman et al., 1997; Miller, 2015; Olds, 2008; Olds et al., 1986, 2002). Note that journal articles published prior to 2008 were selected only in cases where these were cited by studies meeting the inclusion criteria and considered necessary for ascertaining program componentry.…”

“…All programs appear to offer at least three prenatal visits and most include weekly visits in the first 4–6 weeks following birth, with frequency of visits tapering out at different rates thereafter. It is worth noting that the right@home trial reported very high rates of uptake (97% commencement), completion (87% to child age 2 years), and engagement (72% received 75% of scheduled visits; Kemp et al., 2019).…”

“…Yet, in the interests of progressing the science of SNHV, it is important to overcome the barriers each presents and document exactly what is delivered within SNHV programs. Only a handful of SNHV publications describing experimentally tested programs have focused explicitly on providing critical details of the specific interventions (Kemp, 2016; Kemp et al., 2007, 2019), although even these lack important information.…”

“…As described elsewhere (Molloy et al., 2020), the database searches identified 1,933 unique publications. A total of 30 publications met inclusion criteria and an additional paper (Kemp et al., 2019) was identified following completion of the outcomes review, bringing the total to 31 publications.…”

“…Internationally, government investment in home visiting programs is high (Avellar & Supplee, 2013; Corbacho et al., 2017; Sandstrom, 2019; Stamuli et al., 2015) and implementation of SNHV programs is a popular policy option (Kemp et al., 2019). For example, the Maternal and Early Childhood Sustained Home‐visiting (MECSH) program has been rolled out in several parts of Australia, the UK, and South Korea (Kemp et al, 2005, 2017).…”