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

Abstract

Aims To identify the core components or potential ‘active ingredients’ of sustained nurse home visiting (SNHV) programs that have demonstrated positive effects on maternal or child health, psychosocial development, or self‐sufficiency outcomes among disadvantaged families in high‐income countries. Design Systematic review with narrative summary. Data sources Programs were identified from searches of several reputable evidence clearing houses and the following bibliographic databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Cochrane Central Register of Controlled Trials. Year of publication was originally restricted from 2008 ‐2018, with additional searches conducted up to 2019. Review methods This review of SNHV program componentry builds on a previous evaluation of program effectiveness. Programs were selected for inclusion if they had been tested in a randomized or cluster‐randomized controlled trial (RCT/CRCT). Componentry characteristics related to program delivery, nurse provider, and outcome‐specific intervention content were then extracted. Results Comparison of the seven eligible programs showed seven common core components: antenatal commencement, support to child age 2 years, at least 19 scheduled visits and experienced or highly qualified nurses with program‐specific training, caseloads of approximately 25 families, regular supervision, and multidisciplinary supports. Outcome‐specific program content was generally not well reported. Conclusion The findings from this review have utility in guiding the development of minimum standard benchmarks and best‐practice recommendations for SNHV programs and call for more detailed publication of core content componentry in the SNHV literature. Impact Identification of the core componentry underpinning program effectiveness should inform policy decisions on program selection, adaptation for specific populations, and quality control. Such evidence‐based decision‐making should in turn lead to better maternal and child outcomes among disadvantaged families in high‐income countries, reducing societal and economic burdens of inequity.

Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden

“…The programme theory that resulted from the analysis contains five core components which are composed of contents, delivery aspects and characteristics of the home visiting professionals, in line with Beatson et al’s definition [ 34 ]. However, the analysis did not reach the point of producing clear indications of all mechanisms of change between specific components and outcomes as proposed by Weiss [ 43 ] or investigating the programme theory’s assumptions of specific Mechanisms of Action that would drive changes or development of expected parenting behaviour [ 44 – 46 ].…”

“…This effort is not all that straight forward due to the large diversity of home visiting programmes in terms of aims, structure and contexts. However, a recent systematic review of home visiting programmes, presented in two articles by Molloy et al [ 11 ] and Beatson et al [ 34 ], focused on programmes lasting at least 12 months, with content predominantly delivered by nurses or midwives, characteristics that correspond well to the structure of the Rinkeby extended home visiting programme. A number of common process and provider components were found for the seven successful programmes reviewed: antenatal initiation, duration until child is aged 2 years, with approximately 25 visits, carried out by highly qualified or experienced nurses with programme-specific training, receiving regular supervision, recommended caseload of 25 families, continuity of care, and families have access to multidisciplinary support (incl.…”

“…Central in the efforts to improve interventions in early childhood is to gain detailed understanding of what they contain, how they are delivered and by whom, areas where there are still knowledge gaps in the ECD literature [ 10 , 34 ]. In order to understand an intervention’s capacity to achieve its stated aims it is essential to develop a programme theory that spells out expected programme effects and the reasoning of how the intervention is supposed to generate these effects for the specific target audience [ 35 , 36 ].…”

“…In order to understand an intervention’s capacity to achieve its stated aims it is essential to develop a programme theory that spells out expected programme effects and the reasoning of how the intervention is supposed to generate these effects for the specific target audience [ 35 , 36 ]. Involved in this effort is also to identify the core components, or active ingredients, of the intervention that are essential for producing the expected effects [ 21 , 34 ]. Core components may include programme contents, delivery aspects or characteristics of the home visiting professionals [ 34 ].…”

“…Involved in this effort is also to identify the core components, or active ingredients, of the intervention that are essential for producing the expected effects [ 21 , 34 ]. Core components may include programme contents, delivery aspects or characteristics of the home visiting professionals [ 34 ]. In addition, it is also important to establish core components and mechanisms of the implementation process of an intervention to ensure improvements and successful scaling-up of ECD and home visiting programmes, an area where research is also still needed [ 35 , 37 – 39 ].…”