| 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. | Yes | None |
| Study participants | The sample included 527 pregnant women who were living in neighborhoods assigned either to Home-Start (n = 274 women) or to the control group (n = 253 women). After discovering that mothers who received Home-Start were significantly different from mothers in the control group, the authors decided to create a matched control sample. Authors present results comparing three groups: (1) mothers living in areas assigned to the Home-Start program who received services, (2) a comparison group of mothers living in areas assigned to Home-Start, but who declined services, and (3) a matched sample of mothers who lived in neighborhoods that were initially assigned to the comparison group. To be eligible, mothers had to have a score of 9 or greater on the Social Disadvantage Screening Index (SDI). Within the analytic sample, mothers had a mean maternal age of 29. In the Home-Start group, almost 83 percent of mothers were white; in the group of mothers who did not receive services (group 2) approximately 73 percent were white; in the matched comparison group (group 3), 86 percent were white. |
|---|---|
| Setting | Three regions in England: North, Midlands, South |
| Intervention services | Home-Start trains parent volunteers to deliver the program. Decisions about the length and intensity of the home visits are made jointly by the Home-Start staff and families. Home visitors provide a range of support including assistance with family tasks, parenting information, and companionship for families. |
| Comparison conditions | There were two comparison groups: (1) mothers who were living in areas originally assigned to receive Home-Start support but who declined, and (2) a matched control group of participants who did not receive any services. |
| Staff characteristics and training | The program is staffed primarily by volunteers who are parents in the community. They typically receive ten half-day trainings; two additional training days were added for the group that was the focus of this study. |
| Funding sources | A grant from the Health Foundation, number 1665/608. |
| Author affiliation | None of the study authors are developers of this model. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | EPDS | FavorableUnfavorable or ambiguousNo Effect |
Home-Start and matched controls | 12 months | 184 mothers | Not available | Not available | Not Reported | Not available | Not available | footnote116Results were pooled across three groups and thus cannot be reported separately for the two groups of interest. Because of the lack of sufficient information, this outcome has been categorized as no effect. In their analysis, the authors also reported no significant difference (<em>p</em>=0.75) across the groups. |
| Moderate | SCID: Major or Minor Depression at 12 months | FavorableUnfavorable or ambiguousNo Effect |
Home-Start and matched controls | 12 months | 184 mothers | Not available | Not available | Not Reported | Not available | Not statistically significant, p = 0.45 | |
| Moderate | EPDS | FavorableUnfavorable or ambiguousNo Effect |
Home-Start and No Home-Start Support | 12 months | 184 mothers | Not available | Not available | Not Reported | Not available | Not available | footnote116Results were pooled across three groups and thus cannot be reported separately for the two groups of interest. Because of the lack of sufficient information, this outcome has been categorized as no effect. In their analysis, the authors also reported no significant difference (<em>p</em>=0.75) across the groups. |
| Moderate | SCID: Major or Minor Depression at 12 months | FavorableUnfavorable or ambiguousNo Effect |
Home-Start and No Home-Start Support | 12 months | 184 mothers | Not available | Not available | Not Reported | Not available | Not statistically significant, p = 0.65 |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
SCID : Major or Minor Depression at 12 months |
The Structured Clinical Interview for Diagnosticand Statistical Manual Third EditionRevised DepressionSection fromthe Mood DisordersModule(SCID)was used to assess nine symptoms: depressed mood; loss of interest or pleasure; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or guilt; impaired concentration or ability to make decisions; and thoughts of suicide or self–harm. A minor depressive episode is two to four of the nine symptoms while a major depressive episode is five or more. Depressed mood and/or loss of interest or pleasure are required for diagnosis. | Parent/caregiver report | Cronbach’s α = 0.93 |
EPDS |
The Edinburgh Postnatal Depression Scale (EPDS) is a 10–item questionnaire designed to identify postnatal depression. Items are scored 0–3, with a cut–off of 13 or more indicating depression. | Parent/caregiver report | Cronbach’s α = 0.87 |
