Implementing Healthy Beginnings Meets HHS Criteria

Last updated: June 2015

This report summarizes information on how a given model was implemented in the studies reviewed. The report includes only information provided in (1) implementation studies and (2) effectiveness studies that rate moderate or high. These studies vary in the level of detail they provide about implementation features. Thus, the report does not provide an exhaustive picture of how the model was implemented across the programs studied. HomVEE notes, in the text or in parentheses, the number of studies that reported information on a given implementation feature.

Implementation experiences

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 Studies for Implementation Experiences for a list of the studies and to link to the characteristics of the samples examined in the effectiveness 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 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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Model services

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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Model adaptations or enhancements

The study did not include information on 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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Lessons learned

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

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