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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