Abstract
BackgroundProfessional support to enhance the early parent-infant relationship in the first months after birth is recommended, but little is known about the effect of universal interventions. The objective was to investigate the effect of health visitors’ use of the Newborn Behavioral Observations system in new families.MethodsA cluster-randomised study was conducted in four Danish municipalities. Health visitors’ geographical districts constituted the units for randomisation (n = 17). In the intervention group, 1332 families received NBO from 3 weeks after birth; in the comparison group, 1234 received usual care. Self-administered questionnaires were collected at baseline one to two weeks after birth, and at follow-up three and nine months postpartum. The outcomes were change over time measured by The Karitane Parenting Confidence Scale (KPCS), The Major Depression Inventory (MDI), The Ages and Stages Questionnaire: social-emotional (ASQ:SE) and The Mother and Baby Interaction Scale (MABIC). Data were analysed with mixed-effects linear regression using the intention-to-treat approach.ResultsAt baseline, no significant differences between the two groups were seen regarding maternal and infant factors. At follow-up three and nine months after birth, the change in maternal confidence and mood, infant’s socio-emotional behaviour, and early parent-infant relationship moved in a slightly more positive direction in the intervention group than in the comparison group, though not statistically significant. The only significant effect was that the intervention mothers reported higher level of knowledge about infant’s communication skills, response to cues, and how to sooth and establish a relation with the infant, compared to the comparison group.ConclusionsWe found no effect of the NBO system delivered in a universal context to all families in a community setting. The only significant difference between groups was a higher maternal degree of knowledge regarding early parenting in the intervention group.Trial registrationClinicalTrials.gov ID: NCT03070652. Registrated February 22, 2017.
Highlights
Professional support to enhance the early parent-infant relationship in the first months after birth is recommended, but little is known about the effect of universal interventions
There were no significant differences between the two groups at baseline 2 weeks after birth with regard to maternal, infant, and relationship factors
This study evaluated the effects of implementing the Newborn Behavioural Observations (NBO) system provided by health visitors as a universal intervention to all new families in a community setting
Summary
Professional support to enhance the early parent-infant relationship in the first months after birth is recommended, but little is known about the effect of universal interventions. The early parent-infant relationship affects the later physical and psychosocial health and cognitive development of the child [1,2,3,4,5]. A recent review of universal home visiting interventions delivered by health visitors targeting new families, found small but positive effects in three of six outcomes; maternal life course, child cognitive and language skills, and parental behaviour and skills [20]. The purpose of the restricted randomisation was to ensure that both treatments appeared in each municipality and that the intervention and comparison group had approximately the same expected number of births.
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