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Olds, D. L., Henderson, Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1988). Improving the lifecourse development of socially disadvantaged parents: A randomized trial of nurse home visitation. American Journal of Public Health, 78, 1436–1445.

Model(s) Reviewed: Nurse-Family Partnership (NFP)®
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 and SES. None None
Notes:

footnote30

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

The Elmira sample included two deviations from the randomization procedure. First, six housemates of women already randomly assigned and enrolled in the study were assigned to the same treatment as the women already enrolled. Second, the probability of being assigned to one of the treatment groups was increased in the last 6 months of the 30 month enrollment period. The first issue suggests a mismatch between the unit of assignment (adult in the household) and the unit of analysis, which may lead to overstating the precision of the standard errors. The second issue should lead to a weighting strategy in the analysis, so that those who were enrolled later receive less weight in the analysis. Weighting, however, was not used in these studies.

Study characteristics
Study participants The sample included pregnant, first-time mothers who were less than 30 weeks pregnant. Women were recruited through health and human services agencies, including health clinics, Planned Parenthood, and public schools. In these locations, pregnant women who were less than 19 years old, were single parents, or had low socioeconomic status were actively recruited for the study. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. For this study, 46 nonwhite women were excluded from the sample. At enrollment, on average, the women were about 19 years old, 17 weeks pregnant, and had approximately 11 years of education. This study measured the sample at the 6th, 10th, 22nd, and 46th months of the children’s lives. The study sample included 354 women, 189 in the program group and 165 in the comparison group.
Setting The study was conducted in Elmira, a metropolitan area within a semi-rural county in the Appalachian region of New York that has approximately 100,000 residents.
Intervention services The study included two treatment groups, which were combined for the analyses. The first treatment group received home visits from a nurse during pregnancy. The nurse visited the family every other week and made nine visits, on average, which lasted one hour and 15 minutes. This treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. Home visits were weekly for the first month after delivery, decreasing over time to once every 6 weeks when the child was 18-24 months. Home visits focused on parent education, enhancing the women’s support systems, and linkages to community services. Nurses worked in two-person teams (one primary and one backup home visitor).
Comparison conditions The study included two comparison groups, which were combined for the analyses. The first comparison group did not receive any services during pregnancy. When the children were 12 and 24 months old, they were screened for sensory and developmental problems, and referred to other specialists, as appropriate. The second treatment group received free transportation (through a contract with a local taxi company) for prenatal and well-child care at local clinics and doctors’ offices. The second comparison group also received the 12- and 24-month developmental screening.
Staff characteristics and training All home visitors were nurses (none with baccalaureate degrees). Nurse home visitors participated in a three-month training program in which each trainee worked with two families.
Funding sources Bureau of Community Health Services (HHS-MCJ-360403-07 and HHS-MCJ-363378-01-0), the Robert Wood Johnson Foundation (Grant Nos. 5263 and 6729), the W.T. Grant Foundation (Grant Nos. 800723-80 and 840723-80), the Ford Foundation (Grant Nos. 840-0545 and 875-0559), a Biomedical Research Support Grant (NIH) (PHSS7RR05403-25), and a Faculty Scholars Award from the W.T. Grant Foundation to the first author (Grant No. 861080-86).
Author affiliation David L. Olds, a study author, is a developer of this model.

Findings details

Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Concern about finding work
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 10 months postpartum 202 mothers Adjusted mean = 2.38 Adjusted mean = 2.17 Mean difference = 0.21 Not available Not statistically significant,
p ≥ 0.05
High Concern about finding work
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 22 months postpartum 192 mothers Adjusted mean = 1.97 Adjusted mean = 1.92 Mean difference = 0.05 Not available Not statistically significant,
p ≥ 0.05
High Help with child care
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 22 months postpartum 197 mothers Adjusted mean = 2.83 Adjusted mean = 2.76 Mean difference = 0.07 Not available Not statistically significant,
p ≥ 0.05
High Help with child care
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 46 months postpartum 183 mothers Adjusted mean = 3.18 Adjusted mean = 3.00 Mean difference = 0.18 Not available Not statistically significant,
p ≥ 0.05
High Help with child care
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 10 months postpartum 204 mothers Adjusted mean = 2.76 Adjusted mean = 2.64 Mean difference = 0.12 Not available Not statistically significant,
p ≥ 0.05
High Number of days on public assistance (0–22 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 22 months postpartum 194 mothers Adjusted mean = 236.00 Adjusted mean = 244.00 Mean difference = -8.00 Not available Not statistically significant,
p ≥ 0.05
High Number of days on public assistance (0–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 48 months postpartum 208 mothers Adjusted mean = 437.00 Adjusted mean = 530.00 Mean difference = -93.00 Not available Not statistically significant,
p ≥ 0.05
High Number of months employed (0–22 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 22 months postpartum 194 mothers Adjusted mean = 6.15 Adjusted mean = 5.89 Mean difference = 0.26 Not available Not statistically significant,
p ≥ 0.05
High Number of months employed (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 46 months postpartum 208 mothers Adjusted mean = 15.18 Adjusted mean = 12.65 Mean difference = 2.53 Not available Not statistically significant,
p ≥ 0.05
High Concern about finding work
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 10 months postpartum 195 mothers Adjusted mean = 2.43 Adjusted mean = 2.17 Mean difference = 0.26 Not available Statistical significance not reported
High Concern about finding work
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 22 months postpartum 183 mothers Adjusted mean = 2.24 Adjusted mean = 1.92 Mean difference = 0.32 Not available Statistical significance not reported
High Help with child care
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 46 months postpartum 167 mothers Adjusted mean = 2.97 Adjusted mean = 3.00 Mean difference = -0.03 Not available Statistical significance not reported
High Help with child care
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 10 months postpartum 197 mothers Adjusted mean = 2.77 Adjusted mean = 2.64 Mean difference = 0.13 Not available Statistical significance not reported
High Help with child care
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 22 months postpartum 189 mothers Adjusted mean = 2.94 Adjusted mean = 2.76 Mean difference = 0.18 Not available Statistical significance not reported
High Number of days on public assistance (0–22 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 22 months postpartum 185 mothers Adjusted mean = 268.00 Adjusted mean = 244.00 Mean difference = 24.00 Not available Statistical significance not reported
High Number of days on public assistance (0–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 48 months postpartum 196 mothers Adjusted mean = 510.00 Adjusted mean = 530.00 Mean difference = -20.00 Not available Statistical significance not reported
High Number of months employed (0–22 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 22 months postpartum 185 mothers Adjusted mean = 7.57 Adjusted mean = 5.89 Mean difference = 1.68 Not available Statistical significance not reported
High Number of months employed (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 46 months postpartum 196 mothers Adjusted mean = 17.01 Adjusted mean = 12.65 Mean difference = 4.36 Not available Statistical significance not reported
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 Number of spontaneous abortions (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 46 months, postpartum 205 mothers Adjusted mean = 0.10 Adjusted mean = 0.13 Mean difference = -0.03 Not available Not statistically significant, p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of months between first and second child (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 46 months, postpartum 216 mothers Adjusted mean = 40.76 Adjusted mean = 37.11 Mean difference = 3.65 Not available Not statistically significant, p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of pregnancies (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 46 months, postpartum 205 mothers Adjusted mean = 0.82 Adjusted mean = 1.06 Mean difference = -0.24 Not available Not statistically significant, p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of births including first born (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 46 months, postpartum 216 mothers Adjusted mean = 1.65 Adjusted mean = 1.85 Mean difference = -0.20 Not available Not statistically significant, p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of pregnancies (0–22 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 22 months, postpartum 196 mothers Adjusted mean = 0.38 Adjusted mean = 0.44 Mean difference = -0.06 Not available Not statistically significant, p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of therapeutic abortions (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 46 months, postpartum 205 mothers Adjusted mean = 0.05 Adjusted mean = 0.04 Mean difference = 0.01 Not available Not statistically significant, p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of births including first born (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 46 months, postpartum 203 mothers Adjusted mean = 1.77 Adjusted mean = 1.85 Mean difference = -0.08 Not available Statistical significance not reported
High Number of months between first and second child (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 46 months, postpartum 203 mothers Adjusted mean = 41.58 Adjusted mean = 37.11 Mean difference = 4.47 Not available Statistical significance not reported
High Number of pregnancies (0–22 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 22 months postpartum 188 mothers Adjusted mean = 0.31 Adjusted mean = 0.44 Mean difference = -0.13 Not available Statistical significance not reported
High Number of pregnancies (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 46 months, postpartum 194 mothers Adjusted mean = 0.90 Adjusted mean = 1.06 Mean difference = -0.16 Not available Statistical significance not reported
High Number of spontaneous abortions (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 46 months, postpartum 194 mothers Adjusted mean = 0.12 Adjusted mean = 0.13 Mean difference = -0.01 Not available Statistical significance not reported
High Number of therapeutic abortions (0–46 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 46 months, postpartum 194 mothers Adjusted mean = 0.05 Adjusted mean = 0.04 Mean difference = 0.01 Not available Statistical significance not reported

Outcome measure summary

Family economic self-sufficiency
Outcome measure Description of measure Data collection method Properties of measure

Concern about finding work

Likert scale with a range of 1 to 4 indicating frequency of worrying about finding work Parent/caregiver report

Not reported by author

Help with child care

Scale ranging from 1 to 4 based on average frequency of help with specific child care tasks (e.g., diaper changing, dressing, toilet training, feeding, playing) provided by other family members and friends Parent/caregiver report

Not reported by author

Number of days on public assistance

Counts of the number of days the mother was on public assistance Review of county records for mothers that were at-risk or reported use of public assistance and had not moved out of the county during the period. Otherwise, parent/caregiver report was used.

Not applicable

Number of months employed

Counts of the number of months the mother was employed Parent/caregiver report

Not applicable

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

Number of births, including firstborn

The number of births experienced by the mother Parent/caregiver report

Not applicable

Number of months between first and second child

Number of months that passed between the birth of the mother’s first and second child Parent/caregiver report

Not applicable

Number of pregnancies

The number of subsequent pregnancies experienced by the mother Parent/caregiver report

Not applicable

Number of spontaneous abortions

The number of spontaneous abortions experienced by the mother Parent/caregiver report

Not applicable

Number of therapeutic abortions

The number of therapeutic abortions experienced by the mother Parent/caregiver report

Not applicable