Systematic review: Effects of sustained nurse home visiting programs for disadvantaged mothers and children

Abstract

Aims To systematically evaluate published experimental studies of sustained nurse home visiting (SNHV) programs. This review summarizes the evidence and identifies gaps in the literature to inform practice, policy, and future research. Design Restricted systematic review with narrative summary. Data Sources Databases searched were Medline, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials. Year of publication was originally restricted from 2008 to the date of search (13 February 2018, with supplementary searches conducted to identify more recent publications (up to 2019). Several reputable evidence clearinghouses were also searched. Review Methods Studies were included if they used a randomized or cluster‐randomized controlled trial to evaluate a home visiting program that: (a) targeted disadvantaged mothers; (b) commenced during pregnancy or prior to the child's first birthday; (c) had an intended duration of at least 12 months from the time of enrolment; and (d) was substantively delivered by nurses or midwives. Meta‐analyses and reviews of studies meeting these criteria were also included. A quality appraisal was conducted for all studies. Results Of 1,393 total articles, 30 met inclusion criteria. Seven specific SNHV programs were identified. Each demonstrated evidence of a positive statistical effect on at least one child or maternal outcome. Conclusion Sustained nurse home visiting programs benefit disadvantaged families, though effects vary across outcomes and subgroups. Further research is needed to discern the critical components of effective programs. Impact As SNHV programs have gained policy appeal, the need to evaluate the evidence‐base supporting such interventions has become imperative. The findings of this review will assist policy‐makers and practitioners in high‐income countries to make evidence‐informed decisions about which programs are best suited to addressing specific maternal and child outcomes for disadvantaged families. This should in turn ameliorate some of the inequalities in child development that have significant social and economic costs.

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

“…This investigation builds on a previously published systematic review of SNHV program effects on maternal and child outcomes (Molloy et al., 2020). It aims to identify the core components of effective SNHV programs, with a view to informing subsequent development of quality indicators for best‐practice implementation in SNHV programs, based on the highest levels of evidence.…”

“…Following best‐practice guidelines for systematic reviews (Kelly et al., 2016; Liberati et al., 2009; Pluddemann et al., 2018), the protocol for this study was established prior to its conduct and registered with PROSPERO (Molloy et al., 2020). In accordance with the PRISMA statement (Moher et al., 2009), a detailed account of the data sources, study selection, data abstraction, and quality assessment procedures has been published in a previous paper comparing SNHV effects on child and maternal outcomes (Molloy et al., 2020). The present study investigates the program componentry underpinning the SNHV programs included in that review.…”

“…Programs were excluded if they (a) did not specifically target disadvantaged mothers, (b) recruited only clinical subgroups (e.g., mothers with post‐natal depression) or specific populations other than mothers (e.g., fathers only, foster carers), (c) were designed for families with children who had specific developmental disabilities or chronic illnesses, (d) aimed to address one specific outcome only (e.g., smoking, breastfeeding), (e) had been trialled only in low‐ or middle‐income countries, (f) had not been compared with usual treatment, or (g) otherwise failed to meet our definition of SNHV. A list of excluded studies is published with the review of SNHV program effectiveness (Molloy et al., 2020).…”

“…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.…”

“…The effects of SNHV programs, relative to usual services, have been tested in randomized controlled trials (RCTs) since the 1970s across several countries and healthcare system contexts. Such evaluations have been conducted in the USA (Olds, 2008), UK (Robling et al., 2016), Australia (Goldfeld et al., 2018, 2019; Kemp et al., 2013), Germany (Jungmann et al., 2015), and the Netherlands (Mejdoubi et al., 2015), with all reporting positive effects across a range of maternal outcomes (Molloy et al., 2020).…”