Manuscript Detail | Home Visiting Evidence of Effectiveness

Klinnert, M. D., Liu, A. H., Pearson, M. R., Ellison, M. C., Budhiraja, N., & Robinson, J. L. (2005). Short-term impact of a randomized multifaceted intervention for wheezing infants in low-income families. Archives of Pediatrics & Adolescent Medicine, 159(1), 75-82.

Model(s) Reviewed: Childhood Asthma Prevention Study (CAPS)

Manuscript screening details
Screening decision	Screening conclusion
Passes screens	Eligible for review

Study design details
Rating	Design	Attrition	Baseline equivalence	Reassignment	Confounding factors
High	Randomized controlled trial	Low	Not applicable	None	None

Notes:

footnote129

High rating applies to most outcomes. Medical record outcomes receive a low rating because of high attrition and failure to demonstrate baseline equivalence.

Study characteristics
Study participants	Participants (infants and their families) were recruited from local hospitals and clinics in the Denver, Colorado, area and assigned randomly to either the intervention or the comparison group. Initially 181 infants were randomly assigned, 90 to the treatment group and 91 to the comparison group. At baseline, the study groups were split among European Americans (22 percent treatment, 21 percent control), African American (23 percent treatment, 22 percent control), U.S.-born Hispanic (33 percent treatment, 31 percent control) and foreign-born Hispanic (22 percent treatment, 20 percent control). Approximately half of each group had incomes less than $12,000 per year. Participants were followed for one year after baseline data were collected.
Setting	The study was conducted in Denver, Colorado.
Intervention services	The intervention included home visits conducted by specially trained nurses. The intervention began when infants were from 9 to 24 months old and continued for 12 months. Participants received approximately 15 visits (or telephone calls) by a public health nurse. Each visit lasted an average of 53 minutes.
Comparison conditions	Comparison group members received an educational video at the baseline interview that described risk factors for developing asthma and actions that caregivers can take to mediate the risks.
Staff characteristics and training	The nurses in this study had bachelor’s of science degrees in nursing and had experience in community outreach.
Funding sources	National Institute of Allergy and Infectious Diseases; National Institute of Health/National Center for Research Resources.
Author affiliation	Mary D. Klinnert, a study author, is a developer of this model.

Findings details

Child health
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Cotinine level	FavorableUnfavorable or ambiguousNo Effect	Denver, Colorado sample	12 months	130 children	= 0.66	= 0.56	Mean difference = 0.10	HomeVEE calculated = 0.25	Not statistically significant, p = 0.28	footnote127 Submitted by user on Fri, 03/15/2019 - 14:29 Cotinine level outcome based on logistic regression model. Outcome from logrnormal regression model had high attrition and is not included in this report.
High	Functional Severity Score	FavorableUnfavorable or ambiguousNo Effect	Denver, Colorado sample	12 months	150 children	Mean = 1.03	Mean = 1.04	Mean difference = -0.01	Not available	Not Statistically significant, p = 0.60

Maternal health
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Caregiver quality of life score	FavorableUnfavorable or ambiguousNo Effect	Denver, Colorado sample	12 months	143 parents	Mean = 6.47	Mean = 6.34	Mean difference = 0.13	Not available	Not statistically significant, p = 0.72

Positive parenting practices
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	HOME score	FavorableUnfavorable or ambiguousNo Effect	Denver, Colorado sample	12 months	137 parents	Mean = 36.66	Mean = 36.64	Mean difference = 0.02	Not available	Not statistically significant, p = 0.94
High	Asthma knowledge score	FavorableUnfavorable or ambiguousNo Effect	Denver, Colorado sample	12 months	150 parents	Mean = 5.20	Mean = 4.84	Mean difference = 0.36	Not available	Statistically significant, p = 0.04
High	Cat dander	FavorableUnfavorable or ambiguousNo Effect	Denver, Colorado sample	12 months	140 parents	= 0.33	= 0.26	Mean difference = 0.07	HomeVEE calculated = 0.20	Not statistically significant, p = 0.25
High	Cockroach allergen	FavorableUnfavorable or ambiguousNo Effect	Denver, Colorado sample	12 months	140 parents	= 0.01	= 0.13	Mean difference = -0.12	HomeVEE calculated = -1.62	Statistically significant, p = 0.03
High	Collaborative relationship score	FavorableUnfavorable or ambiguousNo Effect	Denver, Colorado sample	12 months	146 parents	Mean = 6.13	Mean = 5.81	Mean difference = 0.33	Not available	Statistically significant, p = 0.04
High	Dog dander	FavorableUnfavorable or ambiguousNo Effect	Denver, Colorado sample	12 months	141 parents	= 0.13	= 0.24	Mean difference = -0.11	HomeVEE calculated = -0.45	Not statistically significant, p = -.07

Outcome measure summary

Child health
Outcome measure	Description of measure	Data collection method	Properties of measure
Cotinine level	The authors measured cotinine levels to detect environmental tobacco smoke exposure. The measure indicates the percentage of infants in whom cotinine levels, a metabolite of nicotine, were greater than 5 nanograms of cotinine per gram of creatinine.	Infant urine samples	Not applicable
Functional Severity Score	Incidence and severity of infant respiratory symptoms over the past six months.	Parent/caregiver report	Not applicable

Maternal health
Outcome measure	Description of measure	Data collection method	Properties of measure
Caregiver quality of life score	The Pediatric Asthma Caregiver's Quality of Life scale assesses the effects of a child's illness on the parent. The term "asthma" was replaced with words describing symptoms of wheezing illness. Items were coded on a 7-point scale.	Parent/caregiver report	Not reported by author

Positive parenting practices
Outcome measure	Description of measure	Data collection method	Properties of measure
HOME score	The Home Observation for Measurement of the Environment inventory (0-3 years) assesses parent-child interactions.	Observational assessment	Interrater reliability was 93.2%
Cat dander	Percentage of homes in which the presence of cat dander was higher than the standard cut-off levels.	House dust collection	Not applicable
Cockroach allergen	Percentage of homes in which the presence of cockroach allergen was higher than the standard cut-off levels.	House dust collection	Not applicable
Dog dander	Percentage of homes in which the presence of dog dander was higher than the standard cut-off levels.	House dust collection	Not applicable
Family Asthma Management System Scale--asthma knowledge and collaborative relationship subscales	The scale was adapted to assesses the caregiver's illness management practices with a wheezing infant. The authors used the asthma knowledge and collaborative relationship with medical care provider subscales. Items were coded on a 9-point scale.	Parent/caregiver report	Interrater reliability ranged from 0.82-0.96 for the asthma knowledge subscale and from 0.79-0.96 for the collaborative relationship subscale