None listed
Conditions
Brief summary
This study is generating Australian evidence of effective sustained nurse home visiting (SNHV) interventions that are implementable and sustainable in the context of the local service system to reduce the impact of social and environmental factors predisposing urban Aboriginal infants and children to ill health and reducing their life potential. This study is the first international study to examine the immediate and longer-term effectiveness of a comprehensive SNHV program commencing antenatally and continuing to child-age 2 years for families of Indigenous infants. The study uses a quasi-experimental design comparing three cohorts of families to explore the effectiveness of SNHV for Aboriginal families. Primary research question What are the differences in length of time breastfeeding, child development at 18 months, and child body mass index and developmental outcomes at 4 years of age between Aboriginal children of vulnerable mothers receiving SNHV (Group A) and: a. non-Aboriginal children of a matched contemporary cohort of vulnerable mothers receiving SNHV (Group B)? b. an historical cohort of Aboriginal children who did not receive SNHV intervention (Group C)? Hypotheses 1. There will be no significant differences in the primary outcomes between Aboriginal children of vulnerable mothers receiving SNHV (Group A) and non-Aboriginal children in a matched contemporary cohort receiving SNHV (Group B). 2. There will be a difference between Aboriginal children of vulnerable mothers receiving SNHV (Group A) and Aboriginal children in the historical cohort who did not receive SNHV (Group C) of more than: (i) 5 weeks of breast feeding, and (ii) 5 points in the Griffiths2 Quotient (GQ) measure of child development at 18 months. (iii) 15% difference in proportion of children overweight/obese at 4 years. (iv) 5 points difference in the Griffiths Quotient (GQ) at 4 years; and 0.5SD difference in child vocabulary development at 4 years. Secondary research questions 1. What are the differences in program implementation for, and the way the program is received by vulnerable mothers and families of Aboriginal and non-Aboriginal children receiving SNHV? 2. What are the patterns of health and illness for Aboriginal compared with non-Aboriginal children of vulnerable mothers receiving SNHV, and compared with Aboriginal children who do not receive intervention? 3. What are the patterns of maternal health and health knowledge and behaviours, family and environmental conditions and service usage for vulnerable mothers and families of Aboriginal compared with non-Aboriginal children receiving SNHV, and compared with Aboriginal children who do not receive intervention?
Interventions
The intervention groups received the Maternal (formerly Miller) Early Childhood Sustained Home-visiting (MECSH) program, consisting of at least 25 home visits (actual number of visits determined by need) primarily by the same program nurse, commencing at approximately 26 weeks gestation and continuing through the first 2 years post birth. The nurse is supported by a social worker, and nurses working with Aboriginal families are also supported by Aboriginal Health Workers. The nurses, social work
The intervention groups received the Maternal (formerly Miller) Early Childhood Sustained Home-visiting (MECSH) program, consisting of at least 25 home visits (actual number of visits determined by need) primarily by the same program nurse, commencing at approximately 26 weeks gestation and continuing through the first 2 years post birth. The nurse is supported by a social worker, and nurses working with Aboriginal families are also supported by Aboriginal Health Workers. The nurses, social worker and Aboriginal Health Workers work as an integrated, collocated multidisciplinary team providing both single and joint visits to families as appropriate and interdisciplinary support. All intervention staff (nurses, Aboriginal health workers and social worker) receive additional training in the program model and cultural competency. Program model training consisted of three face-to-face days and completion of a six-module online course within the first 6 months of MECSH practice. The training is delivered by the MECSH Support Service at Western Sydney University (formerly at University of NSW). The MECSH program home visits are standardised as follows: a) Antenatal and postnatal care in accordance with the NSW Supporting Families Early Health Home Visiting Practice Guidelines: antenatal home visits at least 2nd weekly and postnatal visits within one week of birth, and then at least weekly until 6 weeks; second weekly till 12 weeks; 3-weekly to 6 months; 6-weekly to 1 year; then bi-monthly until 2 years, with continuity of nurse provider throughout. The content of each home visit was individually tailored by the nurse to the mother’s needs, skills, strengths, capacity and cultural needs, including engaging the multidisciplinary team as required. b) Structured child development parent education program: Parents as Teachers. c) Facilitated access to Aboriginal and non-Aboriginal early childhood health services, volunteer home visiting services and family support services within the Campbelltown area. d) Group activities and community links, and linking into community activities in the local area. Quality of service delivery was monitored by the MECSH Support Service including collection of data on visit delivery schedule and content, and client satisfaction and impact. The MECSH Support Service conducts a biannual feedback and quality improvement workshop with the intervention teams.
Sponsors
Western Sydney University
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
15 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
Mothers in Group A were eligible if they are pregnant with an Aboriginal infant, that is, they or the baby’s father are an Aboriginal person, and had one or more of the following vulnerability factors identified from the routine assessment: Vulnerability factors: maternal age under 20 years; unsupported parent determined as those mothers who were not married or living with partner; late antenatal care (after 20 weeks); major stressors in the past 12 months determined by a positive response to the question “Have you had any major stressors, changes or losses recently?”; current or history of mental health problem or disorder determined by the mother reporting current or past treatment for emotional problems; current probable psychosocial distress determined by an Edinburgh Depression Scale score of 10 or more; relationship issues with the mother’s parents if they report that they were hurt or abused as a child in any way; current substance misuse will be determined by a positive response to questions about the use of prohibited substances and/or alcohol; history of domestic violence if they report that they get so angry that they hit or hurt their partner, that their partner or anyone else hits them, hurts them or makes them afraid. Mothers in Group B were eligible if they were pregnant with a non-Aboriginal infant, that is, neither they nor the baby’s father are an Aboriginal person, and had one or more of the vulnerability factors described above. Historical data for Group C were eligible if there were data available on the antenatal risk profile of mother, and they had any of the above risk factors.
Exclusion criteria
Mothers who had insufficient English-language proficiency to undertake the antenatal risk assessment in English (that is, those who required the use of a translated assessment instrument or an interpreter) were ineligible to participate.
Outcome results
None listed