Healthy Beginnings Meets HHS Criteria

Model effectiveness research report last updated: 2015

Model overview

Theoretical approach

Healthy Beginnings was designed to prevent children from becoming overweight and obese. The program drew on research demonstrating the link between being overweight and obese during childhood and immediate and long-term adverse health and social-emotional effects. Recognizing that a child’s environment influences nutrition and physical activity, the program used a family-focused approach to address risk factors associated with childhood obesity.

The model emphasized the following messages:

  • “Breast is best”
  • “No solids for me until 6 months”
  • “I eat a variety of fruit and vegetables everyday”
  • “Only water in my cup”
  • “I am part of an active family”
  • “TV away let’s go play”
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Model services

In Healthy Beginnings, nurses provided home visits to first-time mothers with newborns. Nurse home visitors addressed the following topics during each visit: infant nutrition and physical activity, family nutrition and physical activity, and family social support. Using questions tailored to the child’s age, the nurses initiated discussions and provided information on topics listed in a visit checklist. The home visitors offered referrals if the family had questions or concerns unrelated to the discussion topics. Telephone support was available between visits.
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Intended population

Healthy Beginnings served first-time mothers of infants from socially and economically disadvantaged areas of South Western Sydney.
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Where to find out more

Li Ming Wen, M.D., M.Med., Ph.D.
Associate Professor, Sydney Medical School, University of Sydney
Research and Evaluation Manager, Sydney Local Health District Health Promotion Service

Phone:
 (612) 9505 9055
Email:
 liming.wen@sydney.edu.au
 lmwen@email.cs.nsw.gov.au
 Health.Promotion@sswahs.nsw.gov.au
Website:
http://www.healthybeginnings.net.au/
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Effects shown in research

Maternal health

Findings rated moderate

Healthy Beginnings
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Mother activity time >=150 minutes/week-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 458 children Unadjusted mean = 0.48 Unadjusted mean = 0.38 Mean difference = 0.10 HomVEE calculated = 0.24 Statistically significant,
p = 0.04
Mother drink soft drink-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 497 mothers Unadjusted mean = 0.44 Unadjusted mean = 0.52 Mean difference = -0.08 HomVEE calculated = -0.19 Not statistically significant,
p = 0.08
Mother eat fast food-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 497 mothers Unadjusted mean = 0.83 Unadjusted mean = 0.86 Mean difference = -0.03 HomVEE calculated = -0.15 Not statistically significant,
p = 0.33
Mother eat french fries-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 497 mothers Unadjusted mean = 0.81 Unadjusted mean = 0.86 Mean difference = -0.06 HomVEE calculated = -0.25 Not statistically significant,
p = 0.09
Mother eat processed meat-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 495 mothers Unadjusted mean = 0.20 Unadjusted mean = 0.28 Mean difference = -0.08 HomVEE calculated = -0.28 Statistically significant,
p = 0.03

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Mother fruit >2 serving/day-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 497 mothers Unadjusted mean = 0.22 Unadjusted mean = 0.18 Mean difference = 0.04 HomVEE calculated = 0.16 Not statistically significant,
p = 0.25
Mother vegetable >2 servings/day-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 496 mothers Unadjusted mean = 0.52 Unadjusted mean = 0.36 Mean difference = 0.16 HomVEE calculated = 0.41 Statistically significant,
p = 0.00
Mother watch TV >=120 minutes/day-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 496 children Unadjusted mean = 0.65 Unadjusted mean = 0.64 Mean difference = 0.01 HomVEE calculated = 0.02 Not statistically significant,
p = 0.84
Mother water >=8 cups/day-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 497 mothers Unadjusted mean = 0.16 Unadjusted mean = 0.17 Mean difference = 0.00 HomVEE calculated = 0.00 Not statistically significant,
p = 0.99
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Child health

Findings rated moderate

Healthy Beginnings
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Bottle at bedtime
FavorableUnfavorable or ambiguousNo Effect
 12 months Sydney, Australia Healthy Beginnings Trial 527 mothers Unadjusted mean = 0.35 Unadjusted mean = 0.44 Mean difference = -0.09 HomVEE calculated = -0.23 Statistically significant,
p = 0.04

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Breastfeeding (yes/no)-Chi-square 12 months
FavorableUnfavorable or ambiguousNo Effect
 12 months Sydney, Australia Healthy Beginnings Trial 527 mothers Unadjusted mean = 0.21 Unadjusted mean = 0.15 Mean difference = 0.06 HomVEE calculated = 0.25 Statistically significant,
p < 0.05
Breastfeeding (yes/no)-Chi-square 6 months
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.42 Unadjusted mean = 0.32 Mean difference = 0.10 HomVEE calculated = 0.26 Not statistically significant,
p = <0.05
Breastfeeding duration (weeks)-12 months
FavorableUnfavorable or ambiguousNo Effect
 12 months Sydney, Australia Healthy Beginnings Trial 527 mothers Unadjusted mean = 0.17 Unadjusted mean = 0.13 Mean difference = 0.04 Not available Statistically significant,
p = 0.03
Breastfeeding exclusive (yes/no)-6 months
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.04 Unadjusted mean = 0.02 Mean difference = 0.02 HomVEE calculated = 0.45 Not statistically significant,
p = 0.14
Food used as reward
FavorableUnfavorable or ambiguousNo Effect
 12 months Sydney, Australia Healthy Beginnings Trial 527 mothers Unadjusted mean = 0.18 Unadjusted mean = 0.25 Mean difference = -0.07 HomVEE calculated = -0.27 Statistically significant,
p = 0.04

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Introduction of solids (4 months or younger)
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.18 Unadjusted mean = 0.26 Mean difference = -0.08 HomVEE calculated = -0.30 Statistically significant,
p = 0.00

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Introduction of solids (5 months)
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.44 Unadjusted mean = 0.48 Mean difference = -0.04 HomVEE calculated = -0.10 Statistically significant,
p = 0.00

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Introduction of solids (6 months)
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.39 Unadjusted mean = 0.26 Mean difference = 0.13 HomVEE calculated = 0.35 Statistically significant,
p = 0.00
Introduction of solids (before 6 months)
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.62 Unadjusted mean = 0.74 Mean difference = -0.12 HomVEE calculated = -0.34 Statistically significant,
p = 0.00

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Healthy Beginnings
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
BMI-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 483 children Unadjusted mean = 16.49 Unadjusted mean = 16.87 Mean difference = -0.38 HomVEE calculated = -0.22 Statistically significant,
p = 0.01

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Child drink soft drink-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 495 children Unadjusted mean = 0.24 Unadjusted mean = 0.26 Mean difference = -0.03 HomVEE calculated = -0.09 Not statistically significant,
p = 0.48
Child eat dinner in front of TV-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 494 children Unadjusted mean = 0.56 Unadjusted mean = 0.68 Mean difference = -0.12 HomVEE calculated = -0.31 Statistically significant,
p = 0.01

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Child eat french fries-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 496 children Unadjusted mean = 0.86 Unadjusted mean = 0.88 Mean difference = -0.02 HomVEE calculated = -0.09 Not statistically significant,
p = 0.65
Child eat salty snack-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 496 children Unadjusted mean = 0.65 Unadjusted mean = 0.70 Mean difference = -0.04 HomVEE calculated = -0.12 Not statistically significant,
p = 0.29
Child eat sweet snack everyday-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 497 children Unadjusted mean = 0.73 Unadjusted mean = 0.77 Mean difference = -0.04 HomVEE calculated = -0.13 Not statistically significant,
p = 0.31
Child fruit >= 1 serving/day-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 497 children Unadjusted mean = 0.90 Unadjusted mean = 0.93 Mean difference = -0.02 HomVEE calculated = -0.18 Not statistically significant,
p = 0.43
Child outdoor play >=120 minutes/day-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 484 children Unadjusted mean = 0.62 Unadjusted mean = 0.61 Mean difference = 0.01 HomVEE calculated = 0.01 Not statistically significant,
p = 0.90
Child vegetable >= 1 serving/day-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 497 children Unadjusted mean = 0.89 Unadjusted mean = 0.83 Mean difference = 0.07 HomVEE calculated = 0.35 Statistically significant,
p = 0.03
Child water >3 cups/day-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 496 children Unadjusted mean = 0.24 Unadjusted mean = 0.19 Mean difference = 0.06 HomVEE calculated = 0.21 Not statistically significant,
p = 0.12
Food used as a reward-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 493 children Unadjusted mean = 0.62 Unadjusted mean = 0.72 Mean difference = -0.09 HomVEE calculated = -0.25 Statistically significant,
p = 0.03

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Length-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 483 children Unadjusted mean = 88.73 Unadjusted mean = 88.42 Mean difference = 0.31 Not available Not statistically significant,
p = 0.35
TV on during meal-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 496 children Unadjusted mean = 0.66 Unadjusted mean = 0.76 Mean difference = -0.10 HomVEE calculated = -0.29 Statistically significant,
p = 0.02

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Weight-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 483 children Unadjusted mean = 12.98 Unadjusted mean = 13.15 Mean difference = -0.17 Not available Not statistically significant,
p = 0.24
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Child development and school readiness

Findings rated moderate

Healthy Beginnings
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance
Child use of cup
FavorableUnfavorable or ambiguousNo Effect
 12 months Sydney, Australia Healthy Beginnings Trial 527 mothers Unadjusted mean = 0.92 Unadjusted mean = 0.85 Mean difference = 0.07 HomVEE calculated = 0.43 Statistically significant,
p = 0.01
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Positive parenting practices

Findings rated moderate

Healthy Beginnings
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Tummy time-age started (4 to 8 weeks)
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.22 Unadjusted mean = 0.26 Mean difference = -0.04 HomVEE calculated = -0.12 Statistically significant,
p = 0.03

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Tummy time-age started (later than 8 weeks)
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.19 Unadjusted mean = 0.25 Mean difference = -0.06 HomVEE calculated = -0.20 Statistically significant,
p = 0.03

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
Tummy time-age started (less than 4 weeks)
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.58 Unadjusted mean = 0.49 Mean difference = 0.09 HomVEE calculated = 0.22 Statistically significant,
p = 0.03
Tummy time-if daily
FavorableUnfavorable or ambiguousNo Effect
 6 months Sydney, Australia Healthy Beginnings Trial 561 mothers Unadjusted mean = 0.83 Unadjusted mean = 0.76 Mean difference = 0.07 HomVEE calculated = 0.25 Statistically significant,
p = 0.05
Healthy Beginnings
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Child watch TV >60 minutes/day-Complete Case Analysis
FavorableUnfavorable or ambiguousNo Effect
 24 months Sydney, Australia Healthy Beginnings Trial 434 children Unadjusted mean = 0.14 Unadjusted mean = 0.22 Mean difference = -0.08 HomVEE calculated = -0.35 Statistically significant,
p = 0.02

footnote209

Submitted by user on

Authors indicated that negative effect favors the treatment group.
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In brief

Evidence of model effectiveness

Title General population Tribal population Domains with favorable effects
Healthy Beginnings Yes, Meets HHS Criteria Meets HHS criteria Does not meet HHS criteria for tribal population because the model has not been evaluated with a tribal population.
  • Child development and school readiness,
  • Child health,
  • Maternal health,
  • Positive parenting practices,

Model description

Healthy Beginnings was a demonstration project in Sydney, Australia, implemented from 2007 to 2010. Healthy Beginnings targeted first-time mothers of infants from socially and economically disadvantaged areas. The model aimed to prevent childhood obesity by improving children’s and families’ eating patterns, reducing sedentary activities such as television viewing, and increasing physical activity. In Healthy Beginnings, nurse home visitors addressed the following topics during each visit: infant nutrition and physical activity, family nutrition and physical activity, and family social support. The home visitors offered referrals if the family had questions or concerns unrelated to the discussion topics. Telephone support was available between visits. Families received eight home visits from the prenatal period through age 24 months. Each visit ranged in length from 45 to 90 minutes. 
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Extent of evidence

Results of search and review
Number of manuscripts
At least one finding was eligible for review…
3
  …and at least one finding rated high
0
  …and at least one finding rated moderate (but none rated high)
2
  …and all findings that were eligible for review rated low or indeterminate2
1
  …but manuscript is additional source3
0

1When an individual manuscript reports findings from multiple studies, HomVEE reviews each study as a distinct manuscript. In these rare instances, HomVEE counts that manuscript multiple times in this table, once for each study identified, screened, and reviewed by HomVEE.

2Manuscripts that receive a rating of indeterminate have findings that may rate moderate or high in response to additional information from the author. The indeterminate rating was applied to manuscripts beginning with the 2023 review.

3Additional sources have findings or details that perfectly overlap with another manuscript and are not rated.

For more information, see the research database. For more information on the criteria used to rate research, please see details of HomVEE’s methods and standards.
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Summary of findings

To see details on each finding HomVEE reviewed in well-designed research, click on the name of an outcome domain in the tables below. Findings rated low quality by HomVEE are not summarized here.

Outcomes
Findings

Outcome Child Development and School Readiness

Findings:
Favorable: 1
No effect: 0
Unfavorable or ambiguous: 0

Outcome Child Health

Findings:
Favorable: 14
No effect: 10
Unfavorable or ambiguous: 0

Outcome Family Economic Self-Sufficiency

Not measured

Outcome Linkages and Referrals

Not measured

Outcome Maternal Health

Findings:
Favorable: 3
No effect: 6
Unfavorable or ambiguous: 0

Outcome Positive Parenting Practices

Findings:
Favorable: 5
No effect: 0
Unfavorable or ambiguous: 0

Outcome Reductions in Child Maltreatment

Not measured

Outcome Reductions in Juvenile Delinquency, Family Violence, and Crime

Not measured

The section above focuses on findings from the full sample in a study. Subgroups that have been replicated in distinct samples also have findings reported above. HomVEE does not report the findings of non-replicated subgroups. Beginning with research reviewed in 2021, however, HomVEE lists those subgroups on the details page of each manuscript that had at least one finding that rated moderate or high.

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Criteria established by the U.S. Department of Health and Human Services

Information based on comprehensive review of all high- and moderate-rated manuscripts
CriterionCriterion descriptionCriterion met?
1High- or moderate-quality impact study?Yes
2Across high- or moderate-quality studies, favorable impacts in at least two outcome domains within one sample OR the same domain for at least two non-overlapping samples?Yes
3Favorable impacts on full sample?Yes
4Any favorable impacts on outcome measures sustained at least 12 months after model enrollment?
Reported for all research but only required for RCTs.		Yes
5One or more favorable, statistically significant impact reported in a peer-reviewed journal?
Reported for all research but only required for RCTs.		Yes

Notes: If the model does not meet criterion 3 but meets criteria 1 and 2 based on findings from subgroups, the impacts must be replicated in the same domain in two or more studies using non-overlapping analytic study samples. HomVEE assesses and reports criteria 4 and 5 for all models that have well-designed research, but meeting those two criteria is only required of models for which all findings are from randomized controlled trials. Please read the HHS criteria for evidence-based models for more information.

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