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Child and family outcomes of a long-term nurse home visitation programme: a randomised controlled trial
  1. Lynn Kemp1,
  2. Elizabeth Harris1,
  3. Catherine McMahon2,
  4. Stephen Matthey3,4,
  5. Graham Vimpani5,
  6. Teresa Anderson6,
  7. Virginia Schmied7,
  8. Henna Aslam1,
  9. Siggi Zapart1
  1. 1Centre for Health Equity Training Research and Evaluation (CHETRE), Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Liverpool Hospital, Liverpool, Australia
  2. 2Centre for Emotional Health, Psychology Department, Macquarie University, North Ryde, Australia
  3. 3University of Sydney and University of New South Wales, Australia
  4. 4Infant Child and Adolescent Mental Health Service, South Western Sydney Local Health Network, Liverpool Hospital (Mental Health Centre, L1), Liverpool, Australia
  5. 5School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
  6. 6Chief Executive, Sydney Local Health Network, Liverpool Hospital, Liverpool, Australia
  7. 7School of Nursing and Midwifery, University of Western Sydney, Penrith South, Australia
  1. Correspondence to Associate Professor Lynn Kemp, Centre for Health Equity Training Research and Evaluation (CHETRE), part of the Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia; l.kemp{at}unsw.edu.au

Abstract

Objective To investigate the impact of a long-term nurse home visiting programme, embedded within a universal child health system, on the health, development and well-being of the child, mother and family.

Design Randomised controlled trial.

Setting/participants 208 (111 intervention, 97 comparison) eligible at-risk mothers living in a socioeconomically disadvantaged area in Sydney, booking into the local public hospital for confinement.

Intervention A sustained and structured nurse home visiting antenatal and postnatal parenting education and support programme.

Control Usual universal care.

Main outcome measures The quality of the home environment for child development (12–24 months), parent–child interaction and child mental, psychomotor and behavioural development at 18 months.

Results Mothers receiving the intervention were more emotionally and verbally responsive (HOME observation) during the first 2 years of their child's life than comparison group mothers (mean difference 0.5; 95% CI 0.1 to 0.9). Duration of breastfeeding was longer for intervention mothers than comparison mothers (mean difference 7.9 weeks; 95% CI 2.9 to 12.9). There was no significant difference in parent–child interaction between the intervention and comparison groups. There were no significant overall group differences in child mental, psychomotor or behavioural development. Mothers assessed antenatally as having psychosocial distress benefitted from the intervention across a number of areas.

Conclusion This sustained nurse home visiting programme showed trends to enhanced outcomes in many, but not all, areas. Specifically, it resulted in clinically enhanced outcomes in breastfeeding duration and, for some subgroups of mothers, women's experience of motherhood and children's mental development.

Trial registration number ACTRN12608000473369.

http://dx.doi.org/10.1136/adc.2010.196279

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    Footnotes

    • Funding The trial was funded by the Australian Research Council (LP0560285), Sydney South West Area Health Service, the NSW Department of Community Services and the NSW Department of Health.

    • Competing interests None.

    • Ethics approval The trial received approval from both the Sydney South West Area Health Service (Western Zone) and the University of NSW Human Ethics Committees.

    • Provenance and peer review Not commissioned; externally peer reviewed.