Embedding nurse home visiting in universal healthcare: 6-year follow-up of a randomised trial

Anna Price; Hannah Bryson; Fiona K Mensah; Bridget Kenny; Xiaofang Wang; Francesca Orsini; Lisa Gold; Lynn Kemp; Tracey Bruce; Penny Dakin; Kristy Noble; Maureen Makama; Sharon Goldfeld

doi:10.1136/archdischild-2023-325662

Embedding nurse home visiting in universal healthcare: 6-year follow-up of a randomised trial

Arch Dis Child. 2023 Oct;108(10):824-832. doi: 10.1136/archdischild-2023-325662. Epub 2023 Jun 30.

Authors

Anna Price^{1

2

3}, Hannah Bryson^{4

2}, Fiona K Mensah^{2

3}, Bridget Kenny^{4

2}, Xiaofang Wang^{5

6}, Francesca Orsini^{5

6}, Lisa Gold⁷, Lynn Kemp⁸, Tracey Bruce⁸, Penny Dakin⁹, Kristy Noble⁹, Maureen Makama^{4

2}, Sharon Goldfeld^{4

2

3}

Affiliations

¹ Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia anna.price@mcri.edu.au.
² Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia.
³ Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.
⁴ Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia.
⁵ Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁶ Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Vic, Australia.
⁷ School of Health and Social Development, Deakin University, Geelong, Vic, Australia.
⁸ Ingham Institute, Western Sydney University, Penrith South, New South Wales, Australia.
⁹ Policy & Projects, Australian Research Alliance for Children and Youth, Canberra, Australian Capital Territory, Australia.

PMID: 37399321
DOI: 10.1136/archdischild-2023-325662

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.

Keywords: child development; child health services; health services research; mental health; primary health care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Australia
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Parenting
Pregnancy
Quality of Life*
Universal Health Care*