Study Detail | Home Visiting Evidence of Effectiveness

Lutenbacher, M., Dietrich, M. S., & Elkins, T. (2016). Evaluation of the Maternal Infant Health Outreach Worker (MIHOW) model in a sample of Hispanic women: A collaborative project between Catholic Charities and Vanderbilt University School of Nursing. Report submitted to the Home Visiting Evidence of Effectiveness (HomVEE) Review.

Study Screening Details
Screening Decision	Screening Conclusion
Study 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; established on SES; established on outcomes	None	None

Notes:

footnote376

Outcome ratings vary by comparison and whether the outcome was assessable at baseline. Comparisons with low attrition rate high if the outcomes were not assessable at baseline or if measures of the outcomes were equivalent at baseline. Comparisons with low attrition rate moderate if measures of the outcomes were assessable at baseline but equivalence was not demonstrated. Comparisons with high attrition rate moderate if measures of the outcomes were not assessable at baseline and low if they were assessable at baseline but equivalence was not demonstrated. Information on baseline equivalence for race and ethnicity and socioeconomic status was based on correspondence with the author.

Study Characteristics
Study Participants	Pregnant Hispanic women older than 18 were recruited to participate in the study and then randomly assigned to MIHOW (94 women) or the comparison condition (94 women). At enrollment, participants were 29.6 years old, on average, and predominantly from Mexico (64.9 percent). Ten percent were employed full-time and an additional 16.5 percent were employed part-time. Fifty-six percent of participants had never been married.
Setting	The study was conducted in the urban Davidson County, Tennessee.
Home Visiting Services	Trained outreach workers conducted monthly home visits until children reached six months. Home visits lasted about one hour and consisted of parenting support, education, and linkages to medical and social services. MIHOW also provided participants with the opportunity to participate in social and educational groups. Participants received printed materials about maternal and child health and development.
Comparison Conditions	The minimal intervention group received printed materials about maternal and child health and development at the 35th week of pregnancy and 2 weeks, 2 months, and 6 months postpartum.
Staff Characteristics and Training	Health outreach workers were community members who completed 40 hours of training, shadowed an experienced outreach worker, and received feedback from a supervisor. Outreach workers also received monthly in-service trainings and attended both regional trainings and an annual conference.
Funding Sources	The evaluation was funded through the Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting Program D89MC23542.
Author Affiliation	The authors are affiliated with the Vanderbilt School of Nursing, which developed the MIHOW model and partnered in implementation.

Study Registration:

Clinicaltrials.gov Identifier: None found. Study registration was assessed by HomVEE beginning with the 2014 review.

Study Effects Details

Outcome domain: Maternal Health Outcome Effects
Rating	Outcome Measure	Effect	Sample	Timing of Follow-up	Sample Size	Program Group	Comparison Group	Group Difference	Effect size	Statistical significance	Outcome Type	Notes
High	Always receive social and emotional help needed	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted proportion = 0.97	Unadjusted proportion = 0.67	Mean difference = 0.29	HomeVEE calculated = 1.60	Statistically significant, p = 0.00	Secondary	footnote388 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of social and emotional support that included seven possible responses. Authors analyzed all seven responses collectively using a mixed effect linear model; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response.
High	Always receive social and emotional help needed	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.89	Unadjusted proportion = 0.67	Mean difference = 0.22	HomeVEE calculated = 0.82	Statistically significant, p = 0.00	Secondary	footnote388 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of social and emotional support that included seven possible responses. Authors analyzed all seven responses collectively using a mixed effect linear model; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response.
High	Always receive social and emotional help needed	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.96	Unadjusted proportion = 0.43	Mean difference = 0.53	HomeVEE calculated = 2.04	Statistically significant, p = 0.00	Secondary	footnote388 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of social and emotional support that included seven possible responses. Authors analyzed all seven responses collectively using a mixed effect linear model; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response.
High	Average number of prenatal visits during pregnancy	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	Not reported	177	Unadjusted mean = 9.00	Unadjusted mean = 9.20	Mean difference = -0.20	HomeVEE calculated = -0.09	Not statistically significant, p = 0.48	Secondary	footnote386 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using an independent t-test.
High	Median Edinburgh Postpartum Depression Scale (EPDS)	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted median = 0.00	Unadjusted median = 5.00	Median difference = -5.00	Not available	Not reported	Secondary	footnote387 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a mixed effect linear model. Negative effect is favorable to the intervention.
High	Median Edinburgh Postpartum Depression Scale (EPDS)	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted median = 0.00	Unadjusted median = 3.00	Median difference = -3.00	Not available	Not reported	Secondary	footnote387 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a mixed effect linear model. Negative effect is favorable to the intervention.
High	Median Edinburgh Postpartum Depression Scale (EPDS)	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted median = 0.00	Unadjusted median = 0.00	Median difference = 0.00	Not available	Not reported	Secondary	footnote387 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a mixed effect linear model. Negative effect is favorable to the intervention.
High	Median Parenting Stress Index (PSI) total stress score	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted median = 74.00	Unadjusted median = 76.00	Median difference = -2.00	Not available	Statistically significant, p = 0.00	Primary	footnote387 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a mixed effect linear model. Negative effect is favorable to the intervention.
High	Median Parenting Stress Index (PSI) total stress score	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted median = 74.00	Unadjusted median = 76.00	Median difference = -2.00	Not available	Statistically significant, p = 0.00	Primary	footnote387 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a mixed effect linear model. Negative effect is favorable to the intervention.
High	Median Parenting Stress Index (PSI) total stress score	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted median = 74.00	Unadjusted median = 77.00	Median difference = -3.00	Not available	Statistically significant, p = <0.001	Primary	footnote387 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a mixed effect linear model. Negative effect is favorable to the intervention.
High	Never receive social and emotional help needed	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.00	Unadjusted proportion = 0.00	Mean difference = 0.00	HomeVEE calculated = 0.00	Not statistically significant, p = 1.00	Secondary	footnote389 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of social and emotional support that included seven possible responses. Authors analyzed all seven responses collectively using a mixed effect linear model; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Never receive social and emotional help needed	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted proportion = 0.00	Unadjusted proportion = 0.00	Mean difference = 0.00	HomeVEE calculated = 0.00	Not statistically significant, p = 1.00	Secondary	footnote389 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of social and emotional support that included seven possible responses. Authors analyzed all seven responses collectively using a mixed effect linear model; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Never receive social and emotional help needed	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.01	Unadjusted proportion = 0.00	Mean difference = 0.01	HomeVEE calculated = 5.62	Statistically significant, p = 0.00	Secondary	footnote389 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of social and emotional support that included seven possible responses. Authors analyzed all seven responses collectively using a mixed effect linear model; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
Moderate	Median score on the Edinburgh Postpartum Depression Scale (EPDS)	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	Prenatal, at 35 weeks	172	Unadjusted median = 0.00	Unadjusted median = 4.00	Median difference = -4.00	Not available	Not reported	Secondary	footnote387 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a mixed effect linear model. Negative effect is favorable to the intervention.
Moderate	Percentage reporting having received prenatal care	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	Not reported	172	Unadjusted mean = 0.99	Unadjusted mean = 0.99	Mean difference = 0.00	HomeVEE calculated = 0.05	Not statistically significant, p = 0.96	Secondary	footnote390 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a chi-square test of independence.

Outcome domain: Child Health Outcome Effects
Rating	Outcome Measure	Effect	Sample	Timing of Follow-up	Sample Size	Program Group	Comparison Group	Group Difference	Effect size	Statistical significance	Outcome Type	Notes
High	Breastfeeding exclusively	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	176	Unadjusted proportion = 0.02	Unadjusted proportion = 0.01	Mean difference = 0.01	HomeVEE calculated = 0.37	Statistically significant, p = 0.01	Secondary	footnote379 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on duration of exclusive breastfeeding that included four possible responses. Authors analyzed all four responses collectively using a Mann-Whitney test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response.
High	Child given cereal	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.15	Unadjusted proportion = 0.17	Mean difference = -0.02	HomeVEE calculated = -0.08	Not statistically significant, p = 0.60	Secondary
High	Child given other food	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted proportion = 0.02	Unadjusted proportion = 0.01	Mean difference = 0.01	HomeVEE calculated = 0.37	Statistically significant, p = 0.01	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.
High	Child given other food	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.91	Unadjusted proportion = 0.92	Mean difference = -0.01	HomeVEE calculated = -0.06	Not statistically significant, p = 0.68	Secondary
High	Child given other liquid	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.90	Unadjusted proportion = 0.91	Mean difference = -0.01	HomeVEE calculated = -0.05	Not statistically significant, p = 0.74	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.
High	Child given other liquid	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.01	Unadjusted proportion = 0.06	Mean difference = -0.05	HomeVEE calculated = -1.03	Statistically significant, p = 0.00	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.
High	Ever breastfed child	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	177	Unadjusted proportion = 0.86	Unadjusted proportion = 0.83	Mean difference = 0.03	HomeVEE calculated = 0.14	Not statistically significant, p = 0.57	Secondary
High	Median duration of exclusive breastfeeding, in weeks	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	175	Unadjusted median = 1.40	Unadjusted median = 0.30	Median difference = 1.10	Not available	Statistically significant, p = 0.01	Secondary	footnote382 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a Mann-Whitney test.
High	Median number of weeks to first food	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	163	Unadjusted median = 21.00	Unadjusted median = 20.00	Median difference = 1.00	Not available	Not statistically significant, p = 0.20	Secondary	footnote382 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a Mann-Whitney test.
High	Median number of weeks to first other liquid	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	161	Unadjusted median = 20.00	Unadjusted median = 20.00	Median difference = 0.00	Not available	Statistically significant, p < 0.001	Secondary	footnote382 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance is based on the authors’ analysis using a Mann-Whitney test.
High	Median score on the breastfeeding self-efficacy scale (BSES)	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	121	Unadjusted median = 62.00	Unadjusted median = 51.00	Median difference = 11.00	Not available	Not reported	Primary
High	Never breastfed	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	175	Unadjusted proportion = 0.14	Unadjusted proportion = 0.18	Mean difference = -0.03	HomeVEE calculated = -0.14	Not statistically significant, p = 0.34	Secondary	footnote378 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on duration of breastfeeding practices that included five possible responses. Authors analyzed all five responses collectively using a Mann-Whitney test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Never breastfed exclusively	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	176	Unadjusted proportion = 0.56	Unadjusted proportion = 0.79	Mean difference = -0.24	HomeVEE calculated = -0.67	Statistically significant, p = 0.00	Secondary	footnote380 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on duration of exclusive breastfeeding that included four possible responses. Authors analyzed all four responses collectively using a Mann-Whitney test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative veffect size is favorable to the intervention.
High	Still breastfeeding	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	175	Unadjusted proportion = 0.50	Unadjusted proportion = 0.49	Mean difference = 0.01	HomeVEE calculated = 0.01	Not statistically significant, p = 0.92	Secondary	footnote377 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on duration of breastfeeding practices that included five possible responses. Authors analyzed all five responses collectively using a Mann-Whitney test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response.
High	Stopped breastfeeding	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	175	Unadjusted proportion = 0.02	Unadjusted proportion = 0.02	Mean difference = 0.00	HomeVEE calculated = -0.05	Not statistically significant, p = 0.72	Secondary	footnote378 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on duration of breastfeeding practices that included five possible responses. Authors analyzed all five responses collectively using a Mann-Whitney test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Stopped breastfeeding	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	175	Unadjusted proportion = 0.16	Unadjusted proportion = 0.09	Mean difference = 0.06	HomeVEE calculated = 0.35	Statistically significant, p = 0.02	Secondary	footnote378 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on duration of breastfeeding practices that included five possible responses. Authors analyzed all five responses collectively using a Mann-Whitney test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Stopped breastfeeding	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	175	Unadjusted proportion = 0.18	Unadjusted proportion = 0.21	Mean difference = -0.03	HomeVEE calculated = -0.13	Not statistically significant, p = 0.39	Secondary	footnote378 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on duration of breastfeeding practices that included five possible responses. Authors analyzed all five responses collectively using a Mann-Whitney test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Stopped breastfeeding exclusively	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	176	Unadjusted proportion = 0.23	Unadjusted proportion = 0.12	Mean difference = 0.12	HomeVEE calculated = 0.51	Statistically significant, p = 0.00	Secondary	footnote381 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on duration of exclusive breastfeeding that included four possible responses. Authors analyzed all four responses collectively using a Mann-Whitney test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Stopped breastfeeding exclusively	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.19	Unadjusted proportion = 0.08	Mean difference = 0.11	HomeVEE calculated = 0.59	Statistically significant, p = 0.00	Secondary	footnote381 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on duration of exclusive breastfeeding that included four possible responses. Authors analyzed all four responses collectively using a Mann-Whitney test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
Moderate	Child given other liquid	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	176	Unadjusted proportion = 0.00	Unadjusted proportion = 0.04	Mean difference = -0.04	HomeVEE calculated = -6.34	Statistically significant, p = 0.00	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.

Outcome domain: Positive Parenting Practices Outcome Effects
Rating	Outcome Measure	Effect	Sample	Timing of Follow-up	Sample Size	Program Group	Comparison Group	Group Difference	Effect size	Statistical significance	Outcome Type	Notes
High	Child always co-sleeps	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.01	Unadjusted proportion = 0.18	Mean difference = -0.17	HomeVEE calculated = -1.82	Statistically significant, p = 0.00	Secondary	footnote384 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of cosleeping that included five possible responses. Authors analyzed all five responses collectively using a likelihood chi-square test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Child always co-sleeps	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted proportion = 0.00	Unadjusted proportion = 0.24	Mean difference = -0.24	HomeVEE calculated = -7.65	Statistically significant, p = 0.00	Secondary	footnote384 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of cosleeping that included five possible responses. Authors analyzed all five responses collectively using a likelihood chi-square test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Child always co-sleeps	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.01	Unadjusted proportion = 0.20	Mean difference = -0.19	HomeVEE calculated = -1.87	Statistically significant, p = 0.00	Secondary	footnote384 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of cosleeping that included five possible responses. Authors analyzed all five responses collectively using a likelihood chi-square test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response. Negative effect size is favorable to the intervention.
High	Child never co-sleeps	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted proportion = 0.81	Unadjusted proportion = 0.33	Mean difference = 0.49	HomeVEE calculated = 1.33	Statistically significant, p = 0.00	Secondary	footnote385 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of cosleeping that included five possible responses. Authors analyzed all five responses collectively using a likelihood chi-square test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response.
High	Child never co-sleeps	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.86	Unadjusted proportion = 0.32	Mean difference = 0.54	HomeVEE calculated = 1.53	Statistically significant, p = 0.00	Secondary	footnote385 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of cosleeping that included five possible responses. Authors analyzed all five responses collectively using a likelihood chi-square test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response.
High	Child never co-sleeps	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.87	Unadjusted proportion = 0.28	Mean difference = 0.59	HomeVEE calculated = 1.70	Statistically significant, p = 0.00	Secondary	footnote385 Submitted by user on Fri, 03/15/2019 - 14:29 Proportions indicate the percentages of women who selected this response to a closed-ended question on frequency of cosleeping that included five possible responses. Authors analyzed all five responses collectively using a likelihood chi-square test; we report a <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated effect size and p-value associated with the individual response.
High	Child sleeps on back	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted proportion = 0.99	Unadjusted proportion = 0.66	Mean difference = 0.33	HomeVEE calculated = 2.31	Statistically significant, p = 0.00	Secondary
High	Child sleeps on back	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.98	Unadjusted proportion = 0.66	Mean difference = 0.32	HomeVEE calculated = 1.88	Statistically significant, p = 0.00	Secondary
High	Child sleeps on back	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.98	Unadjusted proportion = 0.75	Mean difference = 0.23	HomeVEE calculated = 1.64	Statistically significant, p = 0.00	Secondary
High	Child sleeps on side	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted proportion = 0.01	Unadjusted proportion = 0.34	Mean difference = -0.33	HomeVEE calculated = -2.31	Statistically significant, p = 0.00	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.
High	Child sleeps on side	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.02	Unadjusted proportion = 0.24	Mean difference = -0.22	HomeVEE calculated = -1.60	Statistically significant, p = 0.00	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.
High	Child sleeps on side	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.02	Unadjusted proportion = 0.33	Mean difference = -0.30	HomeVEE calculated = -1.85	Statistically significant, p = 0.00	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.
High	Child sleeps on stomach	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted proportion = 0.00	Unadjusted proportion = 0.00	Mean difference = 0.00	HomeVEE calculated = 0.00	Not statistically significant, p = 1.00	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.
High	Child sleeps on stomach	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.00	Unadjusted proportion = 0.01	Mean difference = -0.01	HomeVEE calculated = -5.68	Statistically significant, p = 0.00	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.
High	Child sleeps on stomach	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 0.00	Unadjusted proportion = 0.01	Mean difference = -0.01	HomeVEE calculated = -5.62	Statistically significant, p = 0.00	Secondary	footnote383 Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect size is favorable to the intervention.
High	Median Home Observation for Measurement of the Environment (HOME) Inventory Score	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	177	Unadjusted median = 21.00	Unadjusted median = 15.00	Median difference = 6.00	Not available	Statistically significant, p = 0.00	Primary
High	Median Home Observation for Measurement of the Environment (HOME) Inventory Score	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted median = 40.00	Unadjusted median = 33.00	Median difference = 7.00	Not available	Statistically significant, p = 0.00	Primary
High	Median Home Observation for Measurement of the Environment (HOME) Inventory Score	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	175	Unadjusted median = 27.00	Unadjusted median = 19.00	Median difference = 8.00	Not available	Statistically significant, p = 0.00	Primary
High	Median number of days during prior week reading to child	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	176	Unadjusted median = 5.00	Unadjusted median = 0.00	Median difference = 5.00	Not available	Statistically significant, p = 0.00	Secondary
High	Median number of days during prior week singing or telling stories to child	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 weeks postpartum	176	Unadjusted median = 6.00	Unadjusted median = 5.00	Median difference = 1.00	Not available	Statistically significant, p = 0.00	Secondary
High	Reads stories at least three times per week	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	2 months postpartum	176	Unadjusted proportion = 0.92	Unadjusted proportion = 0.37	Mean difference = 0.55	HomeVEE calculated = 1.81	Statistically significant, p = 0.00	Secondary
High	Reads stories at least three times per week	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	176	Unadjusted proportion = 0.97	Unadjusted proportion = 0.26	Mean difference = 0.71	HomeVEE calculated = 2.68	Statistically significant, p = 0.00	Secondary

Outcome domain: Linkages and Referrals Outcome Effects
Rating	Outcome Measure	Effect	Sample	Timing of Follow-up	Sample Size	Program Group	Comparison Group	Group Difference	Effect size	Statistical significance	Outcome Type
Moderate	Referred to resources	FavorableUnfavorableNo Effect	Davidson County, Tennessee, MIHOW vs. Educational Materials	6 months postpartum	178	Unadjusted proportion = 1.00	Unadjusted proportion = 0.28	Mean difference = 0.72	HomeVEE calculated = 8.92	Statistically significant, p = 0.00	Secondary

Study Outcome Measure Summary

Outcome Domain: Maternal Health Outcome Measures
Rating	Outcome Measure	Description of measure	Data collection method	Properties of measure	Outcome Type
High	Always receive social and emotional help needed	Mothers were asked how often they received the social and emotional support needed, with response options being Always, Usually, Sometimes, Rarely, Never, Don't Know, or to refuse to respond.	Mother report	Not reported by author	Secondary
High	Average number of prenatal visits during pregnancy	Question developed for the MIHOW Program	Mother report	Not reported by author	Secondary
High	Median Parenting Stress Index (PSI) total stress score	The PSI measures parental distress, parent-child dysfunction interaction, and difficult child.	Mother report	Cronbach's alpha of 0.88-0.89	Primary
High	Median score on the Edinburgh Postpartum Depression Scale (EPDS)	The EPDS measures depressive symptoms using a 10-question structured interview guide.	Mother report	Cronbach's alpha of 0.87-0.88	Secondary
High	Never receive social and emotional help needed	Mothers were asked how often they received the social and emotional support needed, with response options being Always, Usually, Sometimes, Rarely, Never, Don't Know, or to refuse to respond.	Mother report	Not reported by author	Secondary
Moderate	Median score on the Edinburgh Postpartum Depression Scale (EPDS)	The EPDS measures depressive symptoms using a 10-question structured interview guide.	Mother report	Cronbach’s alpha of 0.87-0.88	Secondary
Moderate	Percentage reporting having received prenatal care	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary

Outcome Domain: Child Health Outcome Measures
Rating	Outcome Measure	Description of measure	Data collection method	Properties of measure	Outcome Type
High	Breastfeeding exclusively	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary
High	Child given cereal	Question from the Infant Feeding Practices Study II	Mother report	Not reported by author	Secondary
High	Child given other food	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Child given other liquid	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary
High	Ever breastfed the child	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Median duration of exclusive breastfeeding, in weeks	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary
High	Median number of weeks to first food	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Median number of weeks to first other liquid	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary
High	Median score on the breastfeeding self-efficacy scale (BSES)	The BSES Short Form uses a 5-point scale on 14 questions to assess a mother's confidence breastfeeding her child.	Mother report	Cronbach’s alpha of 0.93–0.95	Primary
High	Never breastfed	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Never breastfed exclusively	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary
High	Still breastfeeding	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Stopped breastfeeding	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary
High	Stopped breastfeeding exclusively	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary
Moderate	Child given other liquid	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary

Outcome Domain: Positive Parenting Practices Outcome Measures
Rating	Outcome Measure	Description of measure	Data collection method	Properties of measure	Outcome Type
High	Child always co-sleeps	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Child never co-sleeps	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Child sleeps on back	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Child sleeps on side	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Child sleeps on stomach	Question from the Perinatal Risk Assessment Monitory System Survey	Mother report	Not reported by author	Secondary
High	Median Home Observation for Measurement of the Environment (HOME) Inventory Score	The HOME Inventory Score measures the stimulation available in the child's home environment.	Direct observation	Cronbach’s alpha equal or greater than .90 for total scores.	Primary
High	Median number of days during prior week reading to child	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary
High	Median number of days during prior week singing or telling stories to child	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary
High	Reads stories at least three times per week	Question from the National Survey of Children’s Health	Mother report	Not reported by author	Secondary

Outcome Domain: Linkages and Referrals Outcome Measures
Rating	Outcome Measure	Description of measure	Data collection method	Properties of measure	Outcome Type
Moderate	Referred to resources	Question developed for the MIHOW Program	Mother report	Not reported by author	Secondary