The British Columbia Healthy Connections Project: findings on socioeconomic disadvantage in early pregnancy

Abstract

Background Maternal exposure to socioeconomic disadvantage increases the risk of child injuries and subsequent child developmental and mental health problems — particularly for young mothers. To inform early intervention planning, this research therefore aimed to describe the health and social adversities experienced by a cohort of girls and young women in early pregnancy in British Columbia (BC), Canada. Methods Participants were recruited for the BC Healthy Connections Project (BCHCP), a randomized controlled trial examining the effectiveness of Nurse-Family Partnership, a home visitation program, in improving child and maternal outcomes. Baseline data were collected from 739 participants on trial entry. Participants were selected on the basis of preparing to parent for the first time and experiencing socioeconomic disadvantage. Analyses involved descriptive statistics and age-group comparisons. Results Most participants reported having low income (84%), having limited education (52%) and being single (91%) at trial entry. Beyond these eligibility criteria, other health and social adversities included: housing instability (52%); severe anxiety or depression (47%); other diagnosed mental disorders (22%); prenatal nicotine and cannabis use (27 and 21%); physical health problems (20%); child maltreatment when younger (56%); and intimate partner violence recently (50%). As well, few (29%) had received income assistance entitlements. More than two thirds (70%) were experiencing four or more forms of adversity. Age-group differences were observed for cognitive functioning, being single, low income, limited education, psychological distress and service use ( p -value ≤0.05). Conclusions This cohort was selected on the basis of socioeconomic disadvantage. Yet all participants were experiencing substantial added adversities — at higher rates than other Canadians. Furthermore, despite Canada’s public programs, these pregnant girls and young women were not being adequately reached by social services. Our study adds new data to inform early intervention planning, suggesting that unacceptably high levels of socioeconomic disadvantage exist for some young British Columbians. Therefore greater health and social supports and services are warranted for these young mothers and their children. Trial registration Registered August 24, 2012 with ClinicalTrials.gov Identifier: NCT01672060 . Active not recruiting.

Retaining participants in community-based health research: a case example on standardized planning and reporting

“…The BC Healthy Connections Project (BCHCP) involves an RCT examining the effectiveness of the Nurse-Family Partnership (NFP) program compared with existing services in improving child development and mental health, as well as maternal outcomes [28,29].…”

“…The NFP involves intensive home visitation starting prenatally and continuing until children reach age 2 years. The program focuses on the children of young, first-time mothers who are experiencing socioeconomic disadvantage [29]. An adjunctive mixed-methods process evaluation has also examined how this public health intervention was implemented and delivered across BC [30].…”

“…The BCHCP also focuses on participants experiencing socioeconomic disadvantage, who are often described as "hard-to-reach" with respect to engaging in health services and research [6,29]. Most participants at trial entry were facing challenges such as living on low income (84% earning less than CAD$20,000 per year) or experiencing housing instability (52% had had to move three or more times in the past year).…”

“…Most participants at trial entry were facing challenges such as living on low income (84% earning less than CAD$20,000 per year) or experiencing housing instability (52% had had to move three or more times in the past year). More than two-thirds (70%) were also experiencing cumulative disadvantage (defined as four or more forms of adversity) [29]. A brief summary of the data-collection schedule is described in the following.…”

“…A brief summary of the data-collection schedule is described in the following. Details on the RCT, including the eligibility criteria, main outcome indicators and participant characteristics at study entry, are available elsewhere [28,29].…”