What are the outcomes of antenatal nurse home visiting

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What are the outcomes of antenatal nurse home
visiting?

• Kemp L, Harris E, McMahon C, Matthey S, Vimpani
  G, Anderson TM,
• Schmied VA, Aslam H,
• Chavez R

Australian Research Council NSW Health NSW
Department of Community Services Sydney South
West Area Health Service
Centre for Health Equity Training, Research
Evaluation
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Miller Early ChildhoodSustained Home visiting

• Randomised controlled trial of sustained nurse
  home visiting
• Intervention commences antenatally
• Continues until child is 2 years old
• Child, maternal, family and environmental
  outcomes measured at 4 weeks, 6, 12, 14, 18, 24
  and 26 months postnatal for whole sample

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Risk Factors in Total Population of 2168

• Depression 16.9
• Major stressors 13.8
• Late antenatal care 13.0
• Mental health problems 10.9
• Abused themselves as child 4.7
• Domestic violence 3.3
• Under 20 7.6
• Unsupported parent 1.7
• Substance misuse 0.7

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Ethnicity

• No significant difference in ethnicity
• women born overseas (I 48.6, C 49.2)
• women who have parents born overseas in
  non-English speaking countries (I 66.2, C
  60.3).

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Children

• Number of previous children

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MECSH Intervention
Antenatal
Post-natal
Outcomes Healthy mother Healthy baby Positive
parent-infant interaction Optimal child
development Positive family relationships Effectiv
e social support network
Processes underpinning the intervention Observatio
n Reflection Exploring assumptions Problem
solving Following the lead Scaffolding Modelling/e
xpansion Coaching/mentoring Knowledge and skill
development
Biological physical issues
Psychosocial issues
Environmental issues
Enabler Relationship with parent
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Role of SHV

• Sustained home visiting promotes and
• improves
• child health
• family functioning
• immunisation rates
• quality of home environment
• parent-child interaction
• child development

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Number of antenatal visits
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Content of visits

• Over 90 of women who received at least one visit
  received the following
• Maternal health
• Familys social support network
• Relationship with extended family
• Maternal mood
• Maternal nutrition
• Expectations of having a baby
• Physical activity

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Content of visits

• Finance/budget 80
• Partnership issues 77
• Housing 75
• Caregiver aspirations for self 74
• Cultural issues 59
• Drugs and alcohol 21
• Maternal smoking 20
• Domestic violence 14

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Outcomes
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Role of SHV

• Sustained home visiting promotes and
• improves
• child health (SIDS, parent smoking,
  breastfeeding)
• family functioning (social support)
• immunisation rates (vaccination beliefs)
• quality of home environment (maternal health,
  home inventory, client enablement)
• parent-child interaction
• child development

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Child health

• Knowledge of SIDS prevention
• Significantly higher proportion of women in the
  intervention group could name two or more
  measures that reduce the risk of cot death (I
  83.8, C 68.3) ?2 4.6, p .04
• 51.2 in the intervention group maintained
  baby-sleeping areas according to SIDS standards,
  44.7 in the control group.
• infants sleeping either in a cot/bassinet or
  cradle (I 84.6, C 76.2).
• infants sleeping with their parents (I 15.4,
  C 23.8).

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Child health

• Smoking
• Self Smoking(I 20.3, C 23.8)
• Smoking in the home (I 47.3, C 52.4)

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Child health

• Breastfeeding
• Started breastfeeding (I 78.4, C 73.0, NSW
  89.9)
• still breastfeeding (I 59.5, C 50.8, NSW
  76.5)

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Family Functioning

• Family Functioning
• Median score for NSW 1.65
• median score for family functioning 2.5 for both
  intervention and the control group
• Social Support
• No significant difference between groups
• (z -.015 p .98)

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Immunisation rates

• Vaccination beliefs
• Strongly support childhood vaccination (I 80.8
  , C 71.0 , NSW 81.6)

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Quality of home environment

• The HOME inventory to identify parent behaviours
  through observation and interview questions
• I mean 23.04, SD 5.16
• C mean 23.83, SD 5.738

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Quality of home environment

• Maternal health
• Self rated health is significantly better for the
  intervention group than for the control group
  (p.04)

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Quality of the home environment
Maternal health
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Quality of the home environment

• Enablement
• 6 items to assess how enabled a mother feels
  after receiving her first postnatal visit
  confidence, ability to cope
• t4.584, p .001

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Conclusion

• Proportional and significant differences between
  groups suggest that antenatal home visiting can
  impact on some maternal knowledge and practice in
  areas of most immediate relevance
• Level of commitment required to take-up practice
  may also have an impact (i.e. practice of SIDS vs
  giving up habit of smoking)
• Better maternal health and enablement suggest
  gains that will lay the foundation for later
  change

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