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Williams, C. M., Asaolu, I., English, B., Jewell, T., Smith, K., & Robl, J. (2014). Maternal health improvement by HANDS home visiting program (Unpublished manuscript). University of Kentucky Department of Obstetrics and Gynecology, Lexington, KY.

Model(s) Reviewed: Health Access Nurturing Development Services (HANDS) Program
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
Moderate Non-experimental comparison group design Not applicable Established on race; established on SES. Outcome measures were not assessable at baseline. None None
Study characteristics
Study participants This study examined 4,506 mother–infant pairs. Among these, 2,253 were HANDS participants and 2,253 were in a comparison group. All study participants were first-time parents, had at least two risk factors, and were either pregnant or had a child who was age 3 months or younger. Risk factors included unemployment, isolation, history of substance abuse, unstable housing, limited parental education, domestic violence, poor prenatal care, and maternal depression. Study participants were 88 percent white, non-Hispanic; 9 percent black, non-Hispanic; 2 percent Hispanic; and 1 percent some other race. Most (78 percent) study participants had Medicaid coverage at the time of referral to HANDS, and 33 percent of the mothers had less than 12 years of education.
Setting Kentucky (statewide)
Intervention services Women could enroll in HANDS during pregnancy or until the infant was 3 months old. Home visiting services continued until the child's second birthday. Home visiting services included education and development of parenting skills, linking families to medical homes, assisting families to meet basic needs, and direct service delivery for the mother and child.
Comparison conditions Mother–infant pairs in the comparison groups were selected from the group of mothers referred to HANDS. Mothers in the comparison condition completed a screening tool and were found to be eligible for home visits, but chose not to participate and did not receive any home visits.
Staff characteristics and training Home visitors were professionals and paraprofessionals. Professionals were licensed public health nurses, social workers, college graduates with case management experience, or individuals with advanced training in early childhood education. Paraprofessionals had to be age 18 or older, supervised by a licensed public health nurse or social worker, and had to complete pre-service and ongoing training.
Funding sources Kentucky Department for Public Health, funded through MIECHV grants D89MC23538 and X02MC27402.
Author affiliation Two of the authors are affiliated with the University of Kentucky Department of Obstetrics and Gynecology and four with the Kentucky Department for Public Health. The Kentucky Department for Public Health developed the HANDS model.
Study Registration:
Clinicaltrials.gov Identifier: Not found. Study registration was assessed by HomVEE beginning with the 2014 review.

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
Moderate Breastfeeding (proportion)
FavorableUnfavorable or ambiguousNo Effect
Kentucky 2011-2012 matched Birth 4,506 mothers Unadjusted mean = 0.55 Unadjusted mean = 0.57 OR = 0.91 HomeVEE calculated = -0.06 Not statistically significant, p = 0.15
Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Maternal receipt of WIC (proportion)
FavorableUnfavorable or ambiguousNo Effect
Kentucky 2011-2012 matched Birth 4,506 mothers Unadjusted mean = 0.92 Unadjusted mean = 0.88 OR = 1.57 HomeVEE calculated = 0.27 Statistically significant, p = 0.00
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Adequate prenatal care (proportion)
FavorableUnfavorable or ambiguousNo Effect
Kentucky 2011-2012 matched Birth 4,506 mothers Unadjusted mean = 0.74 Unadjusted mean = 0.71 OR = 1.14 HomeVEE calculated = 0.08 Statistically significant, p = 0.05
Moderate Maternal complications during delivery (proportion)
FavorableUnfavorable or ambiguousNo Effect
Kentucky 2011-2012 matched Birth 4,506 mothers Unadjusted mean = 0.02 Unadjusted mean = 0.03 OR = 0.60 HomeVEE calculated = -0.31 Statistically significant, p = 0.01

footnote213

Submitted by user on Fri, 03/15/2019 - 14:29

Negative effect is favorable.

Moderate Maternal weight gain during pregnancy (pounds)
FavorableUnfavorable or ambiguousNo Effect
Kentucky 2011-2012 matched Birth 4,506 mothers Not reported Not reported Mean difference = -1.20 Not available Statistically significant, p = 0.05
Moderate Pregnancy-induced hypertension (proportion)
FavorableUnfavorable or ambiguousNo Effect
Kentucky 2011-2012 matched Birth 4,506 mothers Unadjusted mean = 0.09 Unadjusted mean = 0.18 OR = 0.51 HomeVEE calculated = -0.41 Statistically significant, p = 0.00

footnote213

Submitted by user on Fri, 03/15/2019 - 14:29

Negative effect is favorable.

Outcome measure summary

Child health
Outcome measure Description of measure Data collection method Properties of measure

Breastfeeding (proportion)

Percentage of women who were breastfeeding when discharged from the hospital Live birth records

Not reported by author

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

Adequate prenatal care (proportion)

Percentage of mothers who received adequate prenatal care during their pregnancy, as defined by the Kotelchuck Index Live birth records

Not reported by author

Maternal complications during delivery (proportion)

Percentage of women who experienced any complications associated with labor and delivery Live birth records

Not reported by author

Maternal receipt of WIC (proportion)

Percentage of women who received WIC for themselves during pregnancy Live birth records

Not reported by author

Maternal weight gain during pregnancy (pounds)

The change in reported weight (pounds) from pre-pregnancy to delivery Live birth records

Not reported by author

Pregnancy-induced hypertension (proportion)

Percentage of women who experienced pregnancy-induced hypertension Live birth records

Not reported by author