Abstract
Nurse-Family Partnership (NFP) involves public health nurses providing frequent home visits from early pregnancy until children reach age 2 years, focusing on first-time parents experiencing socioeconomic disadvantage. Our aim was to evaluate NFP's effectiveness in improving child and maternal health. We conducted an analysis of prenatal secondary outcomes in an ongoing randomized controlled trial in British Columbia; the data used in this analysis were collected from January 2014 to May 2017. Participants were pregnant girls and women aged 14-24 years who were preparing to parent for the first time and experiencing socioeconomic disadvantage. They were randomly allocated 1:1 to the intervention (NFP plus existing services) or control group (existing services). Prespecified prenatal secondary outcome indicators were changes in use of nicotine cigarettes and alcohol use by 34-36-weeks' gestation. We also report on prespecified exploratory cannabis and street drug use measures. We used mixed-effect models for longitudinal and clustered data to estimate intervention effects. Analyses were by intention to treat. The median gestational age at baseline for the 739 participants (368 participants in the intervention group, 371 in the comparison group) was 20 weeks, 6 days. By 34-36 weeks' gestation, NFP significantly reduced cigarette counts (over the past 2 d) (difference in changes [DIC] of count -1.6, 95% confidence interval [CI] -6.4 to -1.3) in those who smoked. NFP also significantly reduced rates of prenatal cannabis use (DIC -6.4, 95% CI -17.0 to -1.7), but not rates of street drug or "any" substance use. While we observed decreased rates of cigarette and alcohol use in both groups (DIC of proportions -2.8, 95% CI -15.3 to 0.6; DIC -0.5, 95% CI -8.7 to 1.8, respectively), these changes were not statistically significant. We found no evidence that NFP was effective in reducing rates of prenatal cigarette and alcohol use; however, it led to reduced prenatal cannabis use, and in smokers it led to modest reductions in cigarette use. NFP may therefore hold promise for reducing some types of prenatal substance use in disadvantaged populations. Trial registration: ClinicalTrials.gov, no. NCT01672060.
Highlights
MethodsWe conducted an analysis of prenatal secondary outcomes in an ongoing randomized controlled trial in British Columbia; the data used in this analysis were collected from January 2014 to May 2017
Nurse-Family Partnership (NFP) involves public health nurses providing frequent home visits from early pregnancy until children reach age 2 years, focusing on first-time parents experiencing socioeconomic disadvantage
Intervention For the trial, nurses were recruited by health authorities completed NFP education comprising approximately 140 classroom hours and ongoing learning.[25] (Nurses consented to participate in the Randomized controlled trials (RCTs) and received research orientations.) After participants were allocated to a study group, nurses contacted those allocated to the intervention group to schedule initial visits and offer to deliver NFP
Summary
Setting This ongoing, single-blind RCT is being conducted in 26 urban and suburban local health areas across 4 of the 5 BC regional health authorities (Appendix 1A, available at www.cmajopen.ca/content/8/4/E667/suppl/DC1). For the RCT, health authorities were responsible for recruiting pregnant girls and young women. They contacted primary care providers and community agencies to encourage referrals to public health units, where staff screened referrals passed information on potential participants to the study team. Randomization procedures For the RCT, following baseline interviews, participants were randomly assigned (1:1) to either the intervention group (NFP plus existing services) or the comparison group (existing services). Intervention For the trial, nurses were recruited by health authorities completed NFP education comprising approximately 140 classroom hours and ongoing learning.[25] (Nurses consented to participate in the RCT and received research orientations.) After participants were allocated to a study group, nurses contacted those allocated to the intervention group to schedule initial visits and offer to deliver NFP.
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