footnote101
Statistical significance is based on the results of the authors’ analysis using a chi-square test.
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 |
|---|---|---|---|---|---|
| Moderate | Randomized controlled trial | High | Established on race/ethnicity, SES, and baseline outcomes. | None | None |
| 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). At the two-year follow-up, 101 adolescent mothers participated in the study, 56 in the intervention group and 45 in the comparison group. 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-two percent of the mothers were Latina, 13 percent were African American, and 18 percent were white. Participants were followed from pregnancy through two years postpartum. Note: This is a follow-up to Koniak-Griffin et al. (1999, 2000, 2002). |
|---|---|
| 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 (NINR), Grants R0-1 NR02325 and NR02325-S1, and the Office of Research on Women’s Health, Grant NR02325-S2. Financial support for the second author was also provided by the NINR (5-T32-NR7077). |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Number of episodes of hospitalizations | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Two years postpartum | 101 mothers | Number of episodes = 19.00 | Number of episodes = 36.00 | Difference = -17.00 | Not available | Statistically significant, p =0.002 | |
| Moderate | Percentage never using the ER for child’s health problems | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Two years postpartum | 101 mothers | Percentage = 0.36 | Mean % = 0.11 | Mean difference = 0.25 | HomeVEE calculated = 0.92 | Statistically significant, p =0.004 | footnote101Statistical significance is based on the results of the authors’ analysis using a chi-square test. |
| Moderate | Percentage of children hospitalized | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Two years postpartum | 101 mothers | Percentage = 0.21 | Mean % = 0.36 | Mean difference = -0.15 | HomeVEE calculated = -0.45 | Statistical significance not reported | |
| Moderate | Percentage using both ER and hospital | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Two years postpartum | 101 mothers | Percentage = 0.21 | Mean % = 0.36 | Mean difference = -0.15 | HomeVEE calculated = -0.45 | Statistical significance not reported | |
| Moderate | Total number of ER visits | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Two years postpartum | 101 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 | Total number of days for nonbirth-related infant hospitalizations | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Two years postpartum | 101 mothers | Number of days = 143.00 | Number of days = 211.00 | Difference = -68.00 | Not available | Statistically significant, p < 0.001 | footnote101Statistical significance is based on the results of the authors’ analysis using a chi-square test. |
| Moderate | Number of episodes of hospitalization per hospitalized child | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample, hospitalized children | Two years postpartum | 28 children | Mean = 1.58 | Mean = 2.19 | Mean difference = -0.61 | HomeVEE calculated = -0.14 | Statistical significance not reported | |
| Moderate | Percentage of children adequately immunized | FavorableUnfavorable or ambiguousNo Effect |
San Bernardion sample | Two years postpartum | 101 mothers | Percentage = 0.77 | Mean % = 0.87 | Mean difference = -0.10 | HomeVEE calculated = -0.42 | Not statistically significant, p > 0.5 | footnote105In contrast to the study-reported results, <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr> calculations showed this difference to be statistically significant (p = 0.05). The <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr> tests of statistical significance are based on the <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr> calculated effect sizes, whereas authors may have used other techniques, such as regression models or analyses of variance (ANOVA), to determine statistical significance. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | External social competence | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Two years postpartum | 101 mothers | Mean = 82.96 | Mean = 82.57 | Mean difference = 0.39 | HomeVEE calculated = 0.06 | 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. |
| Moderate | Internal social competence | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Two years postpartum | 101 mothers | Mean = 71.86 | Mean = 69.56 | Mean difference = 2.30 | HomeVEE calculated = 0.29 | Not statistically significant, p =0.057 | footnote106Information on outcomes was received through communication with the authors. footnote108Statistical significance is based on the results of the authors’ analysis using repeated-measures ANOVA. |
| Moderate | Repeat pregnancy rate | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample | Two years postpartum | 101 mothers | Percentage = 0.32 | Mean % = 0.47 | Mean difference = -0.15 | HomeVEE calculated = -0.38 | 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 child’s score | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample, NCAST sample | Two years postpartum | 90 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 mother’s score | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample, NCAST sample | Two years postpartum | 90 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 | Two years postpartum | 90 mothers | Mean = 51.67 | Mean = 52.61 | Mean difference = -0.94 | HomeVEE calculated = -0.22 | 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. |
| Moderate | HOME | FavorableUnfavorable or ambiguousNo Effect |
San Bernardino sample, HOME sample | Two years postpartum | 99 mothers | Mean = 38.07 | Mean = 38.80 | Mean difference = -0.73 | HomeVEE calculated = -0.16 | 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 |
|---|---|---|---|
Number of episodes of hospitalization per hospitalized child |
Count of the number of episodes of hospitalization per hospitalized child during the first 24 months of the child’s life | Parent/caregiver report confirmed by review of medical records for 80% of hospitalizations and 61% of ER episodes. | Not applicable |
Number of episodes of hospitalizations |
Count of the number of episodes of hospitalization during the first 24 months of the child’s life | Parent/caregiver report confirmed by review of medical records for 80% of hospitalizations and 61% of ER episodes. | Not applicable |
Percentage never using the ER for child’s health problems |
Percentage of mothers that had not used emergency room services for their child’s health during the first 24 months of the child’s life | Parent/caregiver report confirmed by review of medical records for 80% of hospitalizations and 61% of ER episodes. | Not applicable |
Percentage of children adequately immunized |
Percentage of children that had received four or more doses of diphtheria–tetanus–pertussis vaccine, three or more doses of poliovirus vaccine, and one or more doses of measles–containing vaccine were received by 24 months of age, as recommended by the Centers for Disease Control and Prevention (CDC) | Review of medical records orimmunization cards | Not applicable |
Percentage of children hospitalized |
Percentage of children that had been hospitalized during the first 24 months of the child’s life | Parent/caregiver report confirmed by review of medical records for 80% of hospitalizations and 61% of ER episodes. | Not applicable |
Percentage using both ER and hospital |
Percentage of mothers that had had used both emergency room and hospital services for their child’s health during the first 24 months of the child’s life | Parent/caregiver report confirmed by review of medical records for 80% of hospitalizations and 61% of ER episodes. | Not applicable |
Total number of ER visits |
The total number of child ER visits during the first 24 months of life | Parent/caregiver report confirmed by review of medical records for 80% of hospitalizations and 61% of ER episodes. | Not applicable |
Total number of days for nonbirth-related infant hospitalizations |
Count of the total number of days of nonbirth–related child hospitalization during the first 24 months of life | Parent/caregiver report confirmed by review of medical records for 80% of hospitalizations and 61% of ER episodes. | 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 |
Repeat pregnancy rate |
Percentage of mothers that experienced a repeat pregnancy | Parent/caregiver report | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
NCAST child’s score |
The Nursing Child Assessment Teaching Scale (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 = 0.71 |
NCAST mother’s score |
The Nursing Child Assessment Teaching Scale (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 |
NCAST total score |
The Nursing Child Assessment Teaching Scale (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 |
Home Observation for Measurement of the Environment (HOME) |
The HOME scale is a 45–item measure that assesses parenting practices and the child’s home environment, including physical structure, play materials, and amount of stimulation. | Parent/caregiver report and observational assessment | Cronbach’s α = 0.71 |