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Implementing Healthy Beginnings

Meets DHHS criteria for an evidenced based model

Implementation Experiences

Last Updated

June 2015

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Summary of Sources

Information in this section is based on studies included in the HomVEE review. For Healthy Beginnings, we reviewed two randomized controlled trials (RCTs) and one standalone implementation study. (Please see the study database for a list of the studies.)

The two RCTs and the implementation study we reviewed were about the same trial of Healthy Beginnings. Because of this overlap, we refer to these as one study. The implementation study focused on a subsample of participants, but we describe the characteristics of the full group of participants.

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Characteristics of Program Model Participants

Healthy Beginnings provided home visits to first-time mothers and their infants from socially and economically disadvantaged areas of Sydney, Australia.

The trial enrolled 337 mothers into the Healthy Beginnings program. Almost half (43 percent) of mothers were 24-years-old or younger, 33 percent were ages 25 to 29, and 24 percent were 30-years-old or older. The children in the program were equally split between boys and girls. The study did not include information about the race or ethnicity of participants.

Twenty percent of mothers had less than a high school certificate, 54 percent had a high school certificate or a technical and further education certificate or diploma, and 27 percent had a university degree. Slightly more than half (53 percent) of mothers were employed or on paid or unpaid maternity leave; 22 percent were unemployed; and 25 percent had home duties, were students, or had another employment status. Participants’ annual income was almost equally divided among those who earned $40,000 Australian dollars or less (32 percent), $40,000 to $80,000 (34 percent), or $80,000 or more (35 percent) (trial conducted from 2007 to 2010).

Most mothers (86 percent) were married or lived with a partner. Slightly more than a third (37 percent) of mothers were born outside of Australia, and 10 percent did not speak English at home.

Participation in Healthy Beginnings was voluntary.

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Location and Setting

The study was implemented in Southwest Sydney, Australia.

The study did not include information on the type of implementing agency.

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Staffing and Supervision

Specially trained community nurses conducted the home visits. The study did not include information on the education and characteristics of the home visitors or supervisors, or any training or supervision provided.

Four community nurses were recruited to provide Healthy Beginnings to 337 participants.

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Program Model Components

The program was designed to offer eight one- to two-hour home visits. The first visit was intended to occur during the mother’s third-trimester of pregnancy (30–36 weeks’ gestation), with the remaining seven after delivery (at 1, 3, 5, 9, 12, 18, and 24 months). The timing of the visits corresponded to milestones in early childhood development, particularly healthy feeding practices, nutrition and physical activity, and parent-child interactions.

Guided by a visit-specific checklist, nurses taught the mothers skills and initiated discussions in four areas: infant feeding practices, infant nutrition and active play, family physical activity and nutrition, and social support. The nurses also discussed any issues or concerns raised by the mothers.

The key intervention messages included “breast is best,” “no solids for me until 6 months,” “I eat a variety of fruits and vegetables every day,” “only water in my cup,” and “I am part of an active family.” Mothers received handouts supporting each key message.

The study did not include information on assessments used or whether program materials were available in languages other than English.

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Program Model Adaptations or Enhancements

The study did not include information on program model adaptations or enhancements.

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Dosage

Of the 268 mothers remaining in the study at 12 months, 35 percent received all six home visits intended for the first year of the intervention, including a prenatal visit; 35 percent received five postpartum home visits. No information was provided on the other 30 percent of mothers. The study also did not include information on the levels of service mothers received across the full two-year intervention.

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Fidelity Measurement

The study did not include information on fidelity measures.

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Costs

The study reported that the cost per child was $1,309 Australian dollars (AUD; all values in 2012 dollars), which included the following:

Labor costs ($794 AUD per child) for the eight home visits (approximately 70 minutes each) and nurse travel and administrative time (approximately 90 minutes per visit)

  • Nurse training ($70 AUD per child)
  • Program materials ($445 AUD per child), such as scales used to weigh the child, vehicle depreciation, and vehicle operating costs for the eight visits

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Lessons Learned

The study authors suggested initiating Healthy Beginnings prenatally to effectively support breastfeeding.

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