Manuscript Detail

View Revisions

Johnston, B. D., Huebner, C. E., Tyll, L. T., Barlow, W. E., & Thompson, R. S. (2004). Expanding developmental and behavioral services for newborns in primary care: Effects on parental well-being, practice, and satisfaction. American Journal of Preventative Medicine, 26(4), 356–366.

Model(s) Reviewed: PrePare supplement relative to Healthy Steps only subgroup
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 Established on race/ethnicity. A measure of at-risk status that included indicators of SES and some baseline maternal health measures was not equivalent, but was controlled for in the analysis. Controls for baseline scores of outcomes collected at baseline. None None
Study characteristics
Study participants The sample included 275 mothers with children age 3 months at assessment. All women were receiving Healthy Steps services and had enrolled before 22 weeks of gestation. Study enrollment occurred between July 20, 1998 and September 29, 2000. Most mothers had some postsecondary schooling (92%), with about one in three also having graduate-level training. Study participants were predominately white (77%). Over 80% of mothers had family incomes above $40,000, with over one in three family incomes exceeding $75,000.
Setting Two primary care clinics that are part of the Group Home Cooperative in the Pacific Northwest.
Intervention services The study randomly assigned mothers to receive either Healthy Steps only or Healthy Steps plus the PrePare supplement. Those in the Healthy Steps plus PrePare group received three prenatal home visits in addition to standard Healthy Steps program services following the child’s birth. Healthy Steps Specialists provided prenatal home visiting services to help parents prepare for their newborn. Specialists also screened and provided interventions for smoking, depression, and domestic violence. Following birth, Healthy Steps Specialists provided home visits, developmental and behavioral advice, a child development telephone information line, and links to community resources. The typical frequency of home visits by three months after birth is five in the standard implementation and eight with PrePare supplemental visits included.
Comparison conditions Women in the comparison group received the standard Healthy Steps program.
Staff characteristics and training Healthy Steps Specialists (HSS) underwent a five-day Healthy Steps training at Boston University, followed by one additional day of training in Seattle on how PrePare relates to Healthy Steps. HS S also underwent an additional 21 hours of training on different modules subsequent to the initial training.
Funding sources Funder(s) not listed.
Author affiliation None of the study authors are developers 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 Breastfeeding at 3 months
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.89 Mean = 0.92 OR = 0.98 HomeVEE calculated = -0.01 Not statistically significant, p ≥ 0.05
High Feels strongly supported to breastfeed
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.73 Mean = 0.77 OR = 0.98 HomeVEE calculated = -0.01 Not statistically significant, p ≥ 0.05
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 CES-D score above clinical cutoff
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.06 Mean = 0.07 OR = 0.65 HomeVEE calculated = -0.26 Not statistically significant, p ≥ 0.05
High Any CES-D mental health symptoms
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.14 Mean = 0.01 OR = 0.95 HomeVEE calculated = -0.03 Not statistically significant, p ≥ 0.05
High Household drug/alcohol concern
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.10 Mean = 0.05 OR = 1.62 HomeVEE calculated = 0.29 Not statistically significant, p ≥ 0.05
High Modified CES-D scale
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 4.18 Mean = 3.56 Mean difference = 0.33 Not available Not statistically significant, p ≥ 0.05
High Psychosocial profile (Daily Hassles) score
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 15.85 Mean = 15.21 Mean difference = 0.38 Not available Not statistically significant, p ≥ 0.05
High Support Behavior Inventory – Family
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 60.38 Mean = 60.43 Mean difference = 0.30 Not available Not statistically significant, p ≥ 0.05
High Support Behavior Inventory – Partner
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 58.71 Mean = 60.25 Mean difference = 0.30 Not available Not statistically significant, p ≥ 0.05
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 KIDI score
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.82 Mean = 0.83 Mean difference = 0.00 Not available Not statistically significant, p ≥ 0.05
High Endorsed appropriate discipline
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.90 Mean = 0.90 OR = 1.01 HomeVEE calculated = 0.01 Not statistically significant, p ≥ 0.05
High Home Safety Index
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 6.29 Mean = 6.27 Mean difference = 0.03 Not available Not statistically significant, p ≥ 0.05
High Knowledge of sleep positions
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.97 Mean = 0.98 OR = 0.60 HomeVEE calculated = -0.31 Not statistically significant,
p ≥ 0.05
High Parenting sense of competence
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 47.30 Mean = 48.05 Mean difference = -0.70 Not available Not statistically significant, p ≥ 0.05
High Read with infant in past week
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.78 Mean = 0.80 OR = 0.98 HomeVEE calculated = -0.01 Not statistically significant, p ≥ 0.05
High Role satisfaction
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.98 Mean = 0.98 OR = 1.01 HomeVEE calculated = 0.01 Not statistically significant, p ≥ 0.05
High Safe-sleep practices
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.81 Mean = 0.78 OR = 1.05 HomeVEE calculated = 0.03 Not statistically significant,
p
High Self-efficacy (health care specific)
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 16.54 Mean = 16.73 Mean difference = -0.17 Not available Not statistically significant, p ≥ 0.05
High Tobacco-free household
FavorableUnfavorable or ambiguousNo Effect
Healthy Steps sample 3 months 275 mothers Mean = 0.90 Mean = 0.91 OR = 1.01 HomeVEE calculated = 0.01 Not statistically significant, p ≥ 0.05

Outcome measure summary

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

Breastfeeding at 3 months

Percentage of mothers who had been breastfeeding at the child’s 3rd month of age

Parent/caregiver report

Not applicable

Feels strongly supported to breastfeed

Percentage of mothers who felt supported by their partner and extended family to breastfeed their child

Parent/caregiver report

Not applicable

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

CES-D score above clinical cutoff

A modified 14-item version of the CES-D that assesses depressive symptoms. The researchers analyzed the modified total score ranging from 0 to 42 and a binary variable dividing the sample into those who were at or above the clinical cutoff and those below it.

Parent/caregiver report

Not applicable

PPP: Daily Hassles Scale

The Daily Hassles Scale of the PPP assesses stress.

Parent/caregiver report

Cronbach’s α = .67

SBI: PartnerSBI: Family

The SBI assesses satisfaction with levels of social and emotional support. The researchers examined the support received from family and from a partner.

Parent/caregiver report

Cronbach’s α = .96 (Partner) Cronbach’s a = .94 (Family)

Any mental health symptoms

Percentage of parents reporting that they have mental health symptoms

Parent/caregiver report

Not applicable

Household drug/alcohol concern

Percentage of parents who reported concern about alcohol or drug use by themselves or by, another household member

Parent/caregiver report

Not reported by author

Modified CES-D scale

A modified 14-item version of the CES-D that assesses depressive symptoms. The researchers analyzed the modified total score ranging from 0 to 42 and a binary variable dividing the sample into those who were at or above the clinical cutoff and those below it.

Parent/caregiver report

Cronbach’s α = .83

Self-efficacy (health care specific)

This scale measures parents’ self-efficacy in addressing child health problems.

Parent/caregiver report

Cronbach’s α = .82

Positive parenting practices
Outcome measure Description of measure Data collection method Properties of measure

KIDI

The KIDI measures the parent’s knowledge of childrearing practices and developmental processes. The researchers analyzed the proportion of correct responses on the KIDI.

Parent/caregiver report during telephone interview

Not reported by author

PSOC

A Likert scale ranging from 16 to 64 that measured parenting self-efficacy

Parent/caregiver report during telephone interview

Cronbach’s α = .80

Endorsed appropriate discipline

Proportion of correctly answered age-appropriate questions about appropriate discipline, for undesirable infant behavior extracted from the KIDI

Parent/caregiver report during telephone interview

Not reported by author

Home Safety Index

A Home Safety Index was constructed using a 7-item count score comprised of answers, for questions about appropriate car seat use, safe storage of firearms, functioning smoke detector, scald prevention activities, and safe infant sleep practices.

Parent/caregiver report during telephone interview

Not reported by author

Knowledge of sleep positions

Proportion of correctly answered age-appropriate questions about sleeping and bedding extracted from the KIDI

Parent/caregiver report during telephone interview

Not reported by author

Read with infant in past week

The proportion of parents who read to their child at least once in the previous week

Parent/caregiver report during telephone interview

Not applicable

Role satisfaction

The proportion of parents who were “pleased” or “delighted” with their role as a parent

Parent/caregiver report during telephone interview

Not applicable

Safe-sleep practices

Proportion of parents reporting that their child was always put to sleep in the supine position without thick or very soft bedding

Parent/caregiver report during telephone interview

Not applicable

Self-efficacy (health care specific)

This scale measures parents’ self-efficacy in addressing child health problems.

Parent/caregiver report

Cronbach’s α = .82

Tobacco-free household

Percentage of households without smokers

Parent/caregiver report

Not applicable