footnote110
High rating applies to 12 outcomes. Analyses of two outcomes—NCAST total score and NCAST mother’s score—receive a moderate rating because of high attrition.
Manuscript Detail
Model(s) Reviewed: Early Intervention Program for Adolescent Mothers
| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Not Applicable | None | None |
Notes:
| Study participants | Participants were recruited via referrals to a county public health department and assigned randomly to either the intervention or the comparison group. Initially 144 mothers were randomly assigned, 75 to the treatment group and 69 to the comparison group (information obtained from authors). One hundred twenty-one young mothers and their children participated in the study. Most were poor, unmarried, and expecting their first child. Mothers ranged in age from 14 to 19 years old at intake (26 weeks or less gestation). Sixty-four percent of the mothers were Latina, 11 percent were African American, and 20 percent were white. Participants were followed from pregnancy through year six weeks postpartum. Note: This study contains the same samples as postpartum. Note: This study contains the same samples as is a follow-up to Koniak-Griffin et al. (1999). |
|---|---|
| Setting | The study was conducted in San Bernardino County, California, a large, ethnically diverse county adjacent to Los Angeles. |
| Intervention services | The intervention included a combination of home visits and motherhood preparation classes, both conducted by specially trained public health nurses. The intervention began in mid-pregnancy and continued through the first year of the infant’s life. Participants received approximately 17 home visits by a public health nurse. Each visit lasted between two and two and a half hours. In addition, participants attended four “Preparation for Motherhood” classes lasting six hours each. In addition, The intervention covered five main content areas: (1) health, (2) sexuality and family planning, (3) life skills, (4) maternal role, and (5) social support systems. |
| Comparison conditions | Comparison group members received traditional public health nursing services, consisting of three home visits: one at intake, one for prenatal care, and one for postpartum/well-baby care information. |
| Staff characteristics and training | The public health nurses in this study had a minimum education level of a bachelor’s degree in nursing. They received special training and used written protocols as guides in implementing the intervention and the traditional public health nursing services. |
| Funding sources | National Institutes of Nursing Research, Grants R0-1 NR02325 and NR02325-S1, and the Office of Research on Women’s Health, Grant NR02325-S2. |
| Author affiliation | The authors are developers of this model. |
Findings details
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Birth weight | FavorableUnfavorable or ambiguousNo Effect |
San Bernardin o sample | 6 weeks postpartum | 121 mothers | Mean = 3280430.00 | Mean = 3206430.00 | Mean difference = 74.00 | HomeVEE calculated = 0.04 | Statistical significance not reported | |
| High | Additional days of rehospitalization | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | 6 weeks postpartum | 121 mothers | Number of days = 23.00 | Number of days = 36.00 | Difference = -13.00 | Not available | Statistically significant, p = 0.046 | footnote101Statistical significance is based on the results of the authors’ analysis using a chi-square test. |
| High | Percentage premature | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Intrapartum | 121 mothers | Percentage = 0.03 | Mean % = 0.08 | Mean difference = -0.05 | HomeVEE calculated = -0.62 | Statistical significance not reported | |
| High | Total number of days for birth-related infant hospitalization | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | 6 weeks postpartum | 121 mothers | Number of days = 91.00 | Number of days = 110.00 | Difference = -19.00 | Not available | Not statistically significant, p = 0.07 | footnote101Statistical significance is based on the results of the authors’ analysis using a chi-square test. |
| High | Total number of days for infant re-hospitalization during the first 6 weeks of life | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | 6 weeks postpartum | 121 mothers | Number of days = 114.00 | Number of days = 146.00 | Difference = -32.00 | Not available | Statistically significant, p = 0.01 | footnote101Statistical significance is based on the results of the authors’ analysis using a chi-square test. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Positive education outcome | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | 6 weeks postpartum | 121 mothers | Not available | Not available | Not Reported | Not available | Statistically significant, p < 0.009 | footnote101Statistical significance is based on the results of the authors’ analysis using a chi-square test. |
| High | Positive education transitions | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | 6 weeks postpartum | 121 mothers | Not available | Not available | Not Reported | Not available | Statistically significant, p =0.02 | footnote101Statistical significance is based on the results of the authors’ analysis using a chi-square test. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | External social competence | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | 6 weeks postpartum | 121 mothers | Mean = 80.18 | Mean = 77.11 | Mean difference = 3.07 | HomeVEE calculated = 0.40 | Statistically significant, p =0.03 | footnote106Information on outcomes was received through communication with the authors. footnote107Although the treatment group has a higher mean, the authors report that the comparison group showed a significantly greater gain on this measure. |
| High | Internal social competence | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | 6 weeks postpartum | 121 mothers | Mean = 70.68 | Mean = 66.97 | Mean difference = 3.71 | HomeVEE calculated = 0.28 | Not statistically significant, p > 0.05 | footnote102Authors report whether the groups are significantly different or not, but do not report actual p-values. footnote106Information on outcomes was received through communication with the authors. |
| High | Number of prenatal health problems | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | 6 weeks postpartum | 121 mothers | Mean = 0.64 | Mean = 0.72 | Mean difference = -0.08 | HomeVEE calculated = -0.03 | Not statistically significant, p ≥ 0.05 | footnote102Authors report whether the groups are significantly different or not, but do not report actual p-values. |
| High | Substance use | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | 6 weeks postpartum | 121 mothers | Not available | Not available | Not Reported | Not available | Not statistically significant, p ≥ 0.05 | footnote102Authors report whether the groups are significantly different or not, but do not report actual p-values. |
| High | Total number of prenatal visits | FavorableUnfavorable or ambiguousNo Effect |
San Bernardion sample | 6 weeks postpartum | 121 mothers | Mean = 9.69 | Mean = 9.34 | Mean difference = 0.35 | HomeVEE calculated = 0.03 | Not statistically significant, p ≥ 0.05 | footnote102Authors report whether the groups are significantly different or not, but do not report actual p-values. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | NCAST mother’s score | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample, NCAST sample | 6 weeks postpartum | 97 mothers | Not available | Not available | Not Reported | Not available | Not statistically significant, p ≥ 0.05 | footnote102Authors report whether the groups are significantly different or not, but do not report actual p-values. |
| Moderate | NCAST total score | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample, NCAST sample | 6 weeks postpartum | 97 mothers | Mean = 39.31 | Mean = 41.40 | Mean difference = -2.09 | HomeVEE calculated = -0.28 | Not statistically significant, p ≥ 0.05 | footnote102Authors report whether the groups are significantly different or not, but do not report actual p-values. footnote106Information on outcomes was received through communication with the authors. |
Outcome measure summary
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Additional days of rehospitalization |
Additional days of newborn rehospitalization | Review of medical records | Not applicable |
Additional days of rehospitalization |
The number of additional days an infant was hospitalized beyond birth related hospitalization. Reasons for infant rehospitalization included respiratory difficulties, fever, dehydration, and jaundice. | Review of medical records | Not applicable |
Birth weight |
The child’s recorded birth weight in grams | Review of delivery room or nursery records | Not applicable |
Birth weight |
Weight of the infant at birth | Review of medical records | Not applicable |
Percentage premature |
Percentage of infants born earlier than 36 weeks gestation | Review of medical records | Not applicable |
Percentage premature |
Percentage of children that were born at less than 36 weeks gestation | Review of medical records | Not applicable |
Total number of days for birth-related infant hospitalization |
Total number of days of birth-related newborn hospitalization | Review of medical records | Not applicable |
Total number of days for birth-related infant hospitalization |
Total number of days an infant was hospitalization for birth–related issues. This does not include later re–hospitalizations | Review of medical records | Not applicable |
Total number of days for infant re-hospitalization during the first 6 weeks of life |
Total number of days for birth–related infant hospitalization plus additional days of rehospitalization during the first six weeks of life | Review of medical records | Not applicable |
Total number of days for infant re-hospitalization during the first 6 weeks of life |
Total number of days infants were re-hospitalized during their first six weeks of life | Review of medical records | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Positive education outcome |
Percentage of participants experiencing positive education outcomes such as attending high school or junior college or having successfully graduated from high school | Parent/caregiver report | Not applicable |
Positive education transitions |
Four categories of education transitions from pregnancy (intake) to postpartum were examined for group differences: positive change, negative change, positive status quo, and negative status quo. | Parent/caregiver report | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
External social competence |
Socialcompetence measureswerecomposites derivedfrom (1)the Rosenberg Self–Esteem Inventory,(2)Pearlin’sSenseofMastery Scale, (3)the Centerfor EpidemiologicalStudies DepressionScale,(4) thePerceived StressScale;(5)the Community Life SkillsScale(CLSS), and (6)the SocialSkills Inventory (SSI). Factor analysis was used to develop two conceptual factors representing Internal and external social competence. Composite measures were formed by first standardizing each measure to a 0–100 scale with higher numbers representing higher skills, then averaging the relevant translated scores. | Parent/caregiver report | Not reported by author |
Internal social competence |
Socialcompetence measureswerecomposites derivedfrom (1)the Rosenberg Self–Esteem Inventory;(2)Pearlin’sSenseofMastery Scale, (3)the Centerfor EpidemiologicalStudies DepressionScale,(4) thePerceived StressScale,(5)the Community Life SkillsScale(CLSS), and (6)the SocialSkills Inventory (SSI). Factor analysis was used to develop two conceptual factors representing Internal and external social competence. Composite measures were formed by first standardizing each measure to a 0–100 scale with higher numbers representing higher skills, then averaging the relevant translated scores. | Parent/caregiver report | Not reported by author |
Number of prenatal health problems |
Count of the number of prenatal health problems experienced by mothers | Review of medical records | Not applicable |
Substance use |
This measure of parents’ substance use include frequency–of–use categories(e.g., 0, 1 or 2, 3 to 9, 10 to 19, or 20+ times) during the past 30 days, 12 months, and lifetime for tobacco, alcohol, marijuana, cocaine, hallucinogens, and heroin. | Parent/caregiver report | Not applicable |
Total number of prenatal visits |
Count of the number of prenatal visits completed by EIP and TPHN home visitors | Review of medical records | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Nursing Child Assessment Teaching Scale (NCAST) mother’s score |
The NCAST is a 73–item binary scale that measures maternal and child contributions to dyadic interactive quality. |
Coding of videotaped parent-child interaction during structured play episodes |
Cronbach’s α = 0.77 |
Nursing Child Assessment Teaching Scale (NCAST) total score |
The NCAST is a 73–item binary scale that measures maternal and child contributions to dyadic interactive quality. |
Coding of videotaped parent-child interaction during structured play episodes |
Cronbach’s α = 0.80 |