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Kemp, L., Harris, E., McMahon, C., Matthey, S., Vimpani, G., Anderson, T., Schmied, V., Aslam, H., & Zapart, S. (2011). Child and family outcomes of a long-term nurse home visitation programme: A randomised controlled trial. Archives of Disease in Childhood, 96, 533-540.

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:

footnote139

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

Moderate rating applies to outcomes (birthweight and preterm birth) measured at the one-month post partum follow-up, which had low attrition. Outcomes measured after one month postpartum had high attrition. Because of missing data on race and ethnicity, baseline equivalence could not be established and all other outcomes receive a low rating.

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 (MECSH) or comparison group before baseline data were collected, assigning 111 to MECSH and 97 to the comparison group. There were no significant differences between the two groups on age, marital status, educational attainment, source of income, or number of risk factors. The study did not report baseline information on race or ethnicity, so equivalence could not be established on this factor. Participants were followed for 24 months.
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), each of 60 to 90 minutes duration, by a child health nurse. Visits began, on average, at 26 weeks gestation and continued up 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 (LP0560285), 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 duration (weeks)
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 12 months 139 children Mean = 16.12 Mean = 8.24 Mean difference = 7.88 HomeVEE calculated = 0.52 Statistically significant, p = 0.002
Moderate Gastroenteritis
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 166 children % = 58.00 % = 60.00 OR = 1.10 HomeVEE calculated = -0.05 Not Statistically significant, p = 0.76
Moderate Immunization up to date
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 166 children % = 100.00 % = 100.00 Not Reported Not available Not statistically significant, p ≥ 0.05
Moderate Low birth weight (< 2500 g)
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 1 month 201 mothers % = 7.00 % = 2.00 OR = 3.22 HomeVEE calculated = 0.79 Not Statistically significant, p = 0.15
Moderate Preterm (< 37 weeks)
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 1 month 203 mothers % = 10.00 % = 6.00 OR = 1.69 HomeVEE calculated = 0.33 Not Statistically significant, p = 0.32
Moderate Respiratory infection
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 166 children % = 33.00 % = 31.00 OR = 0.90 HomeVEE calculated = 0.06 Not Statistically significant, p = 0.76
Moderate Transition to solids (weeks)
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 12 months 162 children Mean = 21.74 Mean = 23.06 Mean difference = -1.32 Not available 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
Moderate Family functioning
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 208 mothers Mean = 1.83 Mean = 1.77 Mean difference = 0.06 Not available Not Statistically significant, p = 0.21
Moderate Maternal depression
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 208 mothers Mean = 7.34 Mean = 7.07 Mean difference = 0.30 Not available Not Statistically significant, p = 0.55
Moderate Maternal experience of being a mother
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 12 months 138 mothers Mean = 30.05 Mean = 29.83 Mean difference = 0.22 Not available Not statistically significant, p ≥ 0.05
Moderate Maternal general health
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 208 mothers Mean = 2.42 Mean = 2.50 Mean difference = -0.08 Not available Not Statistically significant, p = 0.33
Moderate Maternal mental health
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 208 mothers Mean = 51.60 Mean = 51.33 Mean difference = 0.28 Not available Not Statistically significant, p = 0.69
Moderate Maternal physical health
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 208 mothers Mean = 48.34 Mean = 48.23 Mean difference = 0.11 Not available Not Statistically significant, p = 0.84
Moderate Maternal social support
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 208 mothers Mean = 20.11 Mean = 20.45 Mean difference = -0.34 Not available Not Statistically significant, p = 0.26
Moderate Mother never smoked
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 208 mothers % = 62.00 % = 68.00 OR = 1.30 HomeVEE calculated = 0.00 Not Statistically significant, p = 0.38
Moderate Stressful life events
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 208 mothers Mean = 3.07 Mean = 3.06 Mean difference = 0.01 Not available Not Statistically significant, p = 0.98
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
Moderate HOME avoidance of restriction and punishment
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 174 mothers Mean = 5.75 Mean = 5.50 Mean difference = 0.25 Not available Not Statistically significant, p = 0.18
Moderate HOME maternal involvement with child
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 174 mothers Mean = 3.24 Mean = 3.19 Mean difference = 0.05 Not available Not Statistically significant, p = 0.76
Moderate HOME organization of environment
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 174 mothers Mean = 4.92 Mean = 4.84 Mean difference = 0.09 Not available Not Statistically significant, p = 0.43
Moderate HOME provision of appropriate play materials
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 174 mothers Mean = 6.90 Mean = 6.68 Mean difference = 0.23 Not available Not Statistically significant, p = 0.21
Moderate HOME responsivity
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 174 mothers Mean = 9.35 Mean = 8.88 Mean difference = 0.47 Study reported = 0.26 Statistically significant, p = 0.02
Moderate HOME variety in daily stimulation
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 174 mothers Mean = 3.75 Mean = 3.67 Mean difference = 0.08 Not available Not Statistically significant, p = 0.49
Moderate Household always smoke free
FavorableUnfavorable or ambiguousNo Effect
Sydney sample 24 months 208 mothers % = 35.00 % = 35.00 OR = 1.00 HomeVEE calculated = 0.00 Not Statistically significant, p = 0.99

Outcome measure summary

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

Breastfeeding duration (weeks)

Total number of weeks that mother breastfed Maternal self-report

Not applicable

Gastroenteritis

Child has experienced at least one episode of gastrointestinal illness during first two years of life Parent/caregiver report

Not applicable

Immunization up to date

Whether child was fully immunized Parent/caregiver report

Not applicable

Low birth weight (< 2500 g)

Whether child was less than 2500 grams at birth Hospital clinical records

Not applicable

Low birth weight (< 2500 g)

Percentage of infants born of low birth weight (< 2500 g) Review of birth records

Not applicable

Preterm (< 37 weeks)

Whether child was born at less than 37 weeks gestation Hospital clinical records

Not applicable

Preterm (< 37 weeks)

Percentage of infants born at less than 37 weeks gestation Review of birth records

Not applicable

Respiratory infection

Child has experienced at least one episode of respiratory infection during first two years of life Parent/caregiver report

Not applicable

Transition to solids (weeks)

Child's age (in weeks) when solid food was introduced Maternal self-report

Not applicable

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

Family functioning

McMaster Family Assessment Device Parent/caregiver report

Not reported

Household always smoke free

Whether household was always reported as smoke-free Parent/caregiver report

Not applicable

Maternal depression

Edinburgh Depression Scale (EDS) Parent/caregiver report

Not reported

Maternal experience of being a mother

Being a Mother Scale (Matthey, 2011), which assessed satisfaction with the role of motherhood Maternal self-report

Not applicable

Maternal general health

Not reported Parent/caregiver report

Not reported

Maternal mental health

12-Item Short Form Health Survey (SF-12), Mental Component Summary Parent/caregiver report

Not reported

Maternal physical health

12-Item Short Form Health Survey (SF-12), Physical Component Summary Parent/caregiver report

Not reported

Maternal social support

Not reported Parent/caregiver report

Not reported

Mother never smoked

Whether mother ever smoked Parent/caregiver report

Not applicable

Stressful life events

Number of stressful life evens in the previous year using the modified Life Events Inventory Parent/caregiver report

Not reported

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

Home Observation for Measurement of the Environment (HOME)

The HOME assesses parenting practices and aspects of the home environment. The researchers examined the following subscales: avoidance of restriction and punishment, maternal involvement with child, organization of the environment, variety in daily stimulation, parental responsivity, and provision of appropriate play materials. Parent/caregiver interview and observational assessment

Not reported