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Study Detail

Olds, D. L., Henderson, Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1988). Improving the lifecourse development of socially disadvantaged parents: A randomized trial of nurse home visitation. American Journal of Public Health, 78, 1436–1445.

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
Notes:

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 the 6th, 10th, 22nd, and 46th months of the children’s lives. The study sample included 354 women, 189 in the program group and 165 in the comparison group.
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. 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 nurses (none with baccalaureate degrees). Nurse home visitors participated in a three-month training program in which each trainee worked with two families.
Funding Source Bureau of Community Health Services (HHS-MCJ-360403-07 and HHS-MCJ-363378-01-0), the Robert Wood Johnson Foundation (Grant Nos. 5263 and 6729), the W.T. Grant Foundation (Grant Nos. 800723-80 and 840723-80), the Ford Foundation (Grant Nos. 840-0545 and 875-0559), a Biomedical Research Support Grant (NIH) (PHSS7RR05403-25), and a Faculty Scholars Award from the W.T. Grant Foundation to the first author (Grant No. 861080-86).
Author Affiliation David L. Olds, a study author, is a developer of this program model.

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