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Abstract
Objective Nurse home visiting (NHV) is designed to redress child and maternal health inequities. Of the previous trials to investigate NHV benefits beyond preschool, none were designed for populations with universal healthcare. To address this evidence gap, we investigated whether the Australian ‘right@home’ NHV programme improved child and maternal outcomes when children turned 6 and started school.
Methods A screening survey identified pregnant women experiencing adversity from antenatal clinics across two states (Victoria, Tasmania). 722 were randomised: 363 to the right@home programme (25 visits promoting parenting and home learning environment) and 359 to usual care. Child measures at 6 years (first school year): Strengths and Difficulties Questionnaire (SDQ), Social Skills Improvement System (SSIS), Childhood Executive Functioning Inventory (CHEXI) (maternal/teacher-reported); general health and paediatric quality of life (maternal-reported) and reading/school adaptation items (teacher-reported). Maternal measures: Personal Well-being Index (PWI), Depression Anxiety Stress Scales, warm/hostile parenting, Child-Parent Relationship Scale (CPRS), emotional abuse and health/efficacy items. Following best-practice methods for managing missing data, outcomes were compared between groups (intention-to-treat) using regression models adjusted for stratification factors, baseline variables and clustering (nurse/site level).
Results Mothers reported on 338 (47%) children, and teachers on 327 (45%). Patterns of group differences favoured the programme arm, with small benefits (effect sizes ranging 0.15–0.26) evident for SDQ, SSIS, CHEXI, PWI, warm parenting and CPRS.
Conclusions Four years after completing the right@home programme, benefits were evident across home and school contexts. Embedding NHV in universal healthcare systems from pregnancy can offer long-term benefits for families experiencing adversity.
Trial registration number ISRCTN89962120.
- child development
- mental health
- health services research
- child health services
- primary health care
Data availability statement
Data are available on reasonable request. We invite researchers to request access to study data, including individual participant data and a data dictionary defining each field, from the Melbourne Children’s Campus LifeCourse institutional data access platform (https://lifecourse.melbournechildrens.com/data-access/). Data will be shared after the necessary approvals (such as approvals from the study representatives, researcher-initiated ethics approval and data sharing agreements). Related documents, such as the study protocol, statistical analysis plan, informed consent form, can also be available on request.
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Data availability statement
Data are available on reasonable request. We invite researchers to request access to study data, including individual participant data and a data dictionary defining each field, from the Melbourne Children’s Campus LifeCourse institutional data access platform (https://lifecourse.melbournechildrens.com/data-access/). Data will be shared after the necessary approvals (such as approvals from the study representatives, researcher-initiated ethics approval and data sharing agreements). Related documents, such as the study protocol, statistical analysis plan, informed consent form, can also be available on request.
Footnotes
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Contributors AP: conceptualisation, methodology, writing—original draft, writing—review and editing, funding acquisition, supervision, project administration. HB: conceptualisation, methodology, validation, formal analysis, investigation, data curation, writing—review and editing, visualisation, supervision, project administration. FKM: conceptualisation, methodology, writing—review and editing, funding acquisition. BK: methodology, investigation, writing—review and editing. XW: validation, formal analysis, data curation, writing—review and editing, visualisation. FO: conceptualisation, validation, formal analysis, data curation, writing—review and editing, visualisation. LG: conceptualisation, methodology, writing—review and editing, funding acquisition. LK: conceptualisation, methodology, investigation, resources, writing—review and editing, funding acquisition. TB: conceptualisation, methodology, investigation, writing—review and editing. PD: conceptualisation, methodology, resources, writing—review and editing, funding acquisition. KN: methodology, resources, writing—review and editing. MM: methodology, writing—review and editing. SG: conceptualisation, methodology, investigation, resources, writing—review and editing, supervision, project administration, funding acquisition. AP and SG are guarantors. They accept full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. The corresponding author (AP) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. SG is senior author.
Funding This work is supported by the state governments of Victoria and Tasmania, the Ian Potter Foundation, Sabemo Trust, Sidney Myer fund, the Vincent Fairfax Family Foundation and the National Health and Medical Research Council (NHMRC, 1079148). Research at the MCRI is supported by the Victorian Government's Operational Infrastructure Support Programme. AP was supported by The Erdi Foundation Child Health Equity (COVID-19) scholarship. FM was supported by NHMRC Career Development Fellowship (1111160). SG was supported by NHMRC Practitioner Fellowship (1155290).
Disclaimer The MCRI administered the research grant for the study and provided infrastructural support to its staff but played no role in the conduct or analysis of the trial. The funders played no role in the study design; collection, analysis and interpretation of data; writing the report or decision to submit the paper for publication.
Competing interests The 'right@home' sustained nurse home visiting trial is a research collaboration between the Australian Research Alliance for Children and Youth (ARACY); the Translational Research and Social Innovation (TReSI) Group at Western Sydney University and the Centre for Community Child Health (CCCH), which is a department of The Royal Children’s Hospital and a research group of Murdoch Children’s Research Institute. Ownership of the right@home implementation and support license, which is purchased by Australian state governments for roll out for fidelity support, is shared between institutes.
Provenance and peer review Not commissioned; externally peer reviewed.
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