Manuscript Detail

View Revisions

Kemp, L., Harris, E., McMahon, C., Matthey, S., Vimpani, G., Anderson, T., Schmied, V., & Aslam, H. (2012). Benefits of psychosocial intervention and continuity of care by child and family health nurses in the pre- and postnatal period: Process evaluation. Journal of Advanced Nursing. DOI: 10.1111/jan.12052

Model(s) Reviewed: Maternal Early Childhood Sustained Home-Visiting Program (MECSH)
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
Moderate Randomized controlled trial Low Equivalent on SES, information on race/ethnicity not available None None
Notes:

footnote154

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

In order to receive a high rating, randomized controlled trials (RCTs) with low attrition must control for race/ethnicity, socioeconomic status (SES), and, if applicable, baseline outcomes if statistically significant differences exist between treatment and control groups. In this case, there were no significant differences in terms of race/ethnicity, but we had insufficient information to assess baseline equivalence on SES because the only SES measure collected at baseline was maternal education. HomVEE prefers to see equivalence on income, earnings, or poverty levels according to federal thresholds, but also considers other measures of SES (that is, maternal education, employment, and Aid to Families with Dependent Children/Temporary Assistance for Needy Families or food stamps receipt), if at least two such alternative measures of SES are provided.

footnote155

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

Moderate rating does not apply to infant sleeping environment and mother enablement outcomes which had high attrition.

Study characteristics
Study participants Pregnant women were eligible to participate if they did not require the use of an interpreter and reported at least one risk factor for poor maternal or child outcomes during routine psychosocial and domestic violence screenings conducted by midwives in a local hospital. After consenting to participate in the study, 208 eligible mothers were randomly assigned to the program (Maternal Early Childhood Sustained Home Visiting Program, or MECSH) or comparison group before baseline data were collected. One hundred eleven were assigned to MECSH and 97 to the comparison group. This study reports on prenatal and birth outcomes, as well as outcomes measured at four to six weeks postpartum.
Setting The study was conducted in a socioeconomically disadvantaged suburb of Sydney, Australia.
Intervention services Women in the intervention group received an average of 16.3 visits (range 0–52, 60 to 90 minutes long). Visits were conducted by a child health nurse. Visits began, on average, at 26 weeks gestation and continued to the child’s second birthday. Home visits included information and activities to encourage child development and linkages to community activities (such as parenting groups).
Comparison conditions Women in both study conditions received usual antenatal midwifery, obstetric, and birthing services. Comparison group women were expected to receive a home visit by a child health nurse within two weeks of giving birth, in accordance with standard practice in New South Wales.
Staff characteristics and training Child and family health nurses provided all intervention home visits.
Funding sources The trial was funded by the Australian Research Council, Sydney South West Area Health Service, the New South Wales (NSW) Department of Community Services, and the NSW Department of Health.
Author affiliation Lynn Kemp, a study author, is a developer 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
Moderate Breastfeeding fully or partially at 4 weeks
FavorableUnfavorable or ambiguousNo Effect
Western Sydney 4 weeks 161 mothers Unadjusted % = 58.00 Unadjusted % = 52.10 Difference = 5.90 Study reported = 0.12 Not statistically significant, p ≥ 0.05
Moderate Breastfeeding initiated
FavorableUnfavorable or ambiguousNo Effect
Western Sydney Birth 202 mothers Unadjusted % = 87.20 Unadjusted % = 85.10 Difference = 2.10 Study reported = 0.06 Not statistically significant, p ≥ 0.05
Moderate Infant admission to special care nursery
FavorableUnfavorable or ambiguousNo Effect
Western Sydney Birth 203 mothers Unadjusted % = 5.60 Unadjusted % = 8.40 Difference = -2.80 Study reported = 0.12 Not statistically significant, p ≥ 0.05
Moderate SIDS risk knowledge
FavorableUnfavorable or ambiguousNo Effect
Western Sydney 4 weeks 137 mothers Unadjusted % = 83.30 Unadjusted % = 68.30 Difference = 15.00 Study reported = 0.35 Statistically significant, p = 0.04
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 Assisted vaginal delivery
FavorableUnfavorable or ambiguousNo Effect
Western Sydney Birth 199 mothers Unadjusted % = 2.80 Unadjusted % = 9.70 Difference = -6.90 Study reported = 0.30 Not statistically significant, p ≥ 0.05
Moderate Caesarean section
FavorableUnfavorable or ambiguousNo Effect
Western Sydney Birth 199 mothers Unadjusted % = 17.00 Unadjusted % = 21.50 Difference = -4.50 Study reported = 0.13 Not statistically significant, p ≥ 0.05
Moderate Genitourinary infection in pregnancy
FavorableUnfavorable or ambiguousNo Effect
Western Sydney Birth 203 mothers Unadjusted % = 19.40 Unadjusted % = 21.30 Difference = -1.90 Study reported = 0.05 Not statistically significant, p ≥ 0.05
Moderate Gestational diabetes
FavorableUnfavorable or ambiguousNo Effect
Western Sydney Birth 203 mothers Unadjusted % = 6.50 Unadjusted % = 12.60 Difference = -6.10 Study reported = 0.20 Not statistically significant, p ≥ 0.05
Moderate Maternal general health, very good or excellent
FavorableUnfavorable or ambiguousNo Effect
Western Sydney 4-6 weeks 141 mothers Unadjusted % = 51.30 Unadjusted % = 35.40 Difference = 15.90 Study reported = 0.44 Statistically significant, p = 0.03
Moderate Pregnancy-induced hypertension
FavorableUnfavorable or ambiguousNo Effect
Western Sydney Birth 203 mothers Unadjusted % = 0.00 Unadjusted % = 4.20 Difference = -4.20 Study reported = 0.40 Not statistically significant, p ≥ 0.05
Moderate Unassisted vaginal delivery
FavorableUnfavorable or ambiguousNo Effect
Western Sydney Birth 199 mothers Unadjusted % = 80.20 Unadjusted % = 68.80 Difference = 11.40 Study reported = 0.25 Not statistically significant, p ≥ 0.05

Outcome measure summary

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

Breastfeeding fully or partially at 4 weeks

Percentage of infants breastfed fully or partially at 4 weeks postpartum Parent/caregiver report

Not applicable

Breastfeeding initiated

Percentage of mothers who initiated breastfeeding Obstetric data record and parent/caregiver report

Not applicable

Infant admission to special care nursery

Percentage of infants admitted to the special care nursery or neonatal intensive care unit for a period of more than four hours Obstetric data record

Not applicable

SIDS risk knowledge

Percentage of mothers who could name two or more SIDS risk factors at 4-6 weeks postpartum Parent/caregiver report

Not applicable

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

Assisted vaginal delivery

Percentage of mothers who had instrument-assisted vaginal deliveries Obstetric data record

Not applicable

Caesarean section

Percentage of mothers who had caesarean deliveries Obstetric data record

Not applicable

Genitourinary infection in pregnancy

Percentage of mothers who had a genitourinaryinfection during pregnancy Obstetric data record

Not applicable

Gestational diabetes

Percentage of mothers who had gestational diabetes Obstetric data record

Not applicable

Maternal general health, very good or excellent

Percentage of mothers who reported their healthwas very good or excellent at 4-6 weeks postpartum Parent/caregiver report

Not applicable

Pregnancy-induced hypertension

Percentage of mothers who had pregnancy-induced hypertension Obstetric data record

Not applicable

Unassisted vaginal delivery

Percentage of mothers who had unassisted vaginal deliveries Obstetric data record

Not applicable