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Study Detail

Olds, D. L., Henderson, C. R., & Kitzman, H. (1994). Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? Pediatrics, 93(1), 89–98.

Program(s) Reviewed: Nurse Family Partnership (NFP)®

Study Screening Details

Screening DecisionScreening Conclusion
Study Passes ScreensEligible for Review

Study Design Details

RatingDesignSampleAttritionBaseline EquivalenceReassignmentConfounding Factors
HighRandomized controlled trial Elmira, New York SampleLowEstablished on race and SES.NoneNone

The cases of abuse and neglect outcomes had high attrition and therefore rate moderate.

The Elmira sample included two deviations from the randomization procedure. First, six housemates of women already randomly assigned and enrolled in the study were assigned to the same treatment as the women already enrolled. Second, the probability of being assigned to one of the treatment groups was increased in the last 6 months of the 30 month enrollment period. The first issue suggests a mismatch between the unit of assignment (adult in the household) and the unit of analysis, which may lead to overstating the precision of the standard errors. The second issue should lead to a weighting strategy in the analysis, so that those who were enrolled later receive less weight in the analysis. Weighting, however, was not used in these studies.

Study Characteristics

Study Participants The sample included pregnant, first-time mothers who were less than 30 weeks pregnant. Women were recruited through health and human services agencies, including health clinics, Planned Parenthood, and public schools. In these locations, pregnant women who were less than 19 years old, were single parents, or had low socioeconomic status were actively recruited for the study. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. For this study, 46 nonwhite women were excluded from the sample. At enrollment, on average, the women were about 19 years old, 17 weeks pregnant, and had approximately 11 years of education. This study measured the sample at registration and at the 34th, 36th, 46th, and 48th months of the child’s life. For the data collection ant 48 months postpartum, the study sample included 343 women, 183 in the program group and 160 in the comparison group. (Information on sample size for this follow-up was received through communication with the author.)
Setting The study was conducted in Elmira, a metropolitan area within a semi-rural county in the Appalachian region of New York that has approximately 100,000 residents.
Home Visiting Services The study included two treatment groups, which were combined for the analyses. The first treatment group received home visits from a nurse during pregnancy. The nurse visited the family every other week and made nine visits, on average, which lasted one hour and 15 minutes. This treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. Home visits were weekly for the first month after delivery, decreasing over time to once every 6 weeks when the child was 18-24 months. Home visits focused on parent education, enhancing the women’s support systems, and linkages to community services. After the child’s second birthday, home visitors provided any appropriate social service referrals to families and children with special needs. Nurses worked in two-person teams (one primary and one backup home visitor).
Comparison Condition The study included two comparison groups, which were combined for the analyses. The first comparison group did not receive any services during pregnancy. When the children were 12 and 24 months old, they were screened for sensory and developmental problems and referred to other specialists, as appropriate. The second treatment group received free transportation (through a contract with a local taxi company) for prenatal and well-child care at local clinics and doctors’ offices. The second comparison group also received the 12- and 24-month developmental screening.
Staff Characteristics and Training All home visitors were registered nurses.
Funding Source Bureau of Community Health Services (MCJ-360579 and MCJ-360403); the National Center for Nursing Research (R01 NR001691-01A1); the Robert Wood Johnson Foundation (grants 5263 and 6729); the W.T. Grant Foundation (grants 800723-80); the Ford Foundation (grants 840-0545 and 840723-0559); a Biomedical Research Support Grant (National Institutes of Health) (PHSS7RR05403-25); the Commonwealth Fund (grant 10443); and a William T. Grant Faculty Scholars Award to the first author (grant 861-080-86).
Author Affiliation David L. Olds, a study author, is a developer of this program model.


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