Abstract
BackgroundNurse-Family Partnership is a nurse home visitation program that aims to improve the lives of young mothers and their children. The program focuses on women who are parenting for the first time and experiencing socioeconomic disadvantage. Nurse visits start as early in pregnancy as possible and continue until the child reaches age two years. The program has proven effective in the United States – improving children’s mental health and development and maternal wellbeing, and showing long-term cost-effectiveness. But it is not known whether the same benefits will be obtained in Canada, where public services differ. The British Columbia Healthy Connections Project therefore involves a randomized controlled trial evaluating Nurse-Family Partnership’s effectiveness compared with existing (usual) services in improving children’s mental health and early development and mother’s life circumstances. The trial’s main aims are to: reduce childhood injuries by age two years (primary outcome indicator); reduce prenatal nicotine and alcohol use; improve child cognitive and language development and behaviour at age two years; and reduce subsequent pregnancies by 24 months postpartum. Potential explanatory factors such as maternal mental health (including self-efficacy) are also being assessed, as is the program’s impact on exposure to intimate-partner violence. To inform future economic evaluation, data are also being collected on health and social service access and use.Methods/designEligible and consenting participants (N = 1040) are being recruited prior to 28 weeks gestation then individually randomized to receive existing services (comparison group) or Nurse-Family Partnership plus existing services (intervention group). Nurse-Family Partnership is being delivered following fidelity guidelines. Data are being collected during in person and telephone interviews at: baseline; 34–36 weeks gestation; and two, 10, 18 and 24 months postpartum. Additional data will be obtained via linkages from provincial datasets. Recruitment commenced in October 2013 and will continue for approximately three years.DiscussionThis trial will provide important information about the generalizability of Nurse-Family Partnership to the Canadian context. Findings will be published in peer-reviewed journals and shared with policymakers and practitioners through extensive public health collaborations already underway.Trial registrationRegistered July 18, 2013 with ClinicalTrials.gov Identifier: NCT01672060.
Highlights
Nurse-Family Partnership is a nurse home visitation program that aims to improve the lives of young mothers and their children
Nurse-family partnership Developed nearly 40 years ago by Olds and colleagues in the United States (US), Nurse-Family Partnership (NFP) is a nurse home visitation program that aims to improve the lives of young, first-time mothers and their children who are experiencing socioeconomic disadvantage [1,2,3,4]
As part of the British Columbia healthy connections project (BCHCP)’s policy and practice collaborations, Health Authorities are hiring and overseeing the public health nurses (PHNs), who receive their NFP education, preparing them to deliver the program to the intervention group as part of the randomized controlled trial (RCT)
Summary
The purpose of this trial is to determine NFP’s effectiveness compared with BC’s existing services in improving children’s mental health and early development and mother’s life circumstances. Some of NFP’s most compelling US findings have been demonstrated five to 20 years after the intervention ended including: reductions in child anxiety, depressive and substance misuse symptoms; reductions in serious antisocial behaviour in adolescence; demonstrations of cost-effectiveness; and decreased child and maternal mortality due to preventable causes [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20] This RCT is intentionally designed to permit long-term follow up – through both robust retention efforts and the inclusion of measures predictive of longer-term outcomes, e.g., child cognitive development and behaviour.
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