Effectiveness Of Home Visits Research Articles

The Effect of Homevisit on The Implementation of IVA Tests At Women in The Working Area of The Salimbatu Health Center In 2023

Homevisit is a health service in the form of visits by health workers to community residences, to obtain data and information on public health conditions, as well as environmental health efforts in a sustainable and coordinated manner. Examination with the IVA method is an examination to prevent cervical cancer, which is efficient and effective and lower cost. This study aims to see the effect of homevisit on the implementation of iva tests on wus in the region area of Puskesmas Salimbatu. Research design using quantitative research type with quasy experimental control group design research design. The intervention in this study was to make 4 homevisits. Activities carried out during the homevisit are providing education about cervical cancer, providing counseling related to IVA test screening, and family involvement. Sampling technique with probability sampling with a total sample of 45 women of childbearing age. The ratio between the intervention and control groups was 1:2 (15 wus intervention group and 30 people control group. In this study, researchers used primary data or original data, namely collecting respondents' consent sheets to take the iva test. This study used univariate data analysis and bivariate data analysis. Based on the researchers' assumptions in the success of the homevisit program on the implementation of iva tests on WUS in the Salimbatu Health Center work area in 2023, between the intervention group after 4 home visits with the control group, it was seen that in the intervention group the Sig value of the homevisit group was 0.02 smaller than 0.05 which means there is a difference between before and after the homevisit. While in the control group the significance value was 0.180. Homevisits are effective in increasing the scope of iva tests. The recommendation of the results of this study can be used as one of the models of midwifery services that are right morning wus that require focused services.

Effectiveness of Home Visits by Public Health Workers in Maternal and Child Health in Naga City

This study aimed to assess the effectiveness of home visits conducted by public health workers (PHW), specifically public health nurses and midwives, in promoting maternal and child health in Naga City. The study utilized a descriptive research design with 45 purposively selected PHW (22 midwives and 23 nurses) as respondents. The majority of the 45 respondents were female (91.1\%), aged 28-57 years old, and had been serving for 1-10 years. Most of them (33.3\%) served up to 1,000 families, while only a small percentage served more than 3,000 families. Only one respondent fell within the youngest age group of 18-27. A survey questionnaire was used as the primary research instrument, which contained three parts: the respondents' profile, the effectiveness of home visits on maternal health, and the effectiveness of home visits on child health outcomes. The gathered data were analyzed using descriptive statistics, and the results showed that home visits by public health workers are perceived to be effective in improving maternal and child health outcomes across various domains. However, there is still room for improvement in addressing maternal mental health issues economic needs, and reducing delays in seeking medical care. The researcher proposed a needs assessment nursing intervention to identify the specific healthcare needs of Naga City women, improve the delivery of home visits by Public Health Nurses and Midwives, and eventually enhance maternal and child health outcomes in Naga City.

Role of Home Visits on Improving Cancer Screening and Early Detection

Cancer which falls under the umbrella of non-communicable disease is responsible for posing significant burden of morbidity and mortality globally. The prevalence of cancer continues to rise worldwide, with significant variations in mortality and morbidity rates as per age, ethnicity, gender, and type of cancer. In order to reduce the global cancer burden effective and locally specific cancer preventive and control methods are essential. Cancer screening is one way of prevention. Additionally, it aids in early diagnosis and prompt management thus reducing mortality and complications. Since there is a significant lag period in the malignant transition, screening presents an opportunity to detect premalignant lesions, engage in early intervention in the carcinogenic process, and delay the onset of cancer. Most cancer risk factors are preventable. Home visits for cancer screening is one of the effective ways to encourage cancer screening and prevention among the community. Compared to hospital visits, patient visits at home result in more balanced interactions. The purpose of this research is to review the available information about the role of home visits in improving cancer screening and early detection. Home visit is a beneficial approach especially in rural and resource limited areas. Various findings support the role of home visits as they had a positive effect on cancer screening while few studies reported contradictory results. Further research is however needed for the assessment of outcomes and effectiveness of home visits in aspect of cancer screening

Efektivitas Home Visit dalam Program Penguatan Keluarga Oleh Sos Children’s Village Medan

Family strengthening program by SOS Children's Village Medan is one form of family level social intervention that aims to prevent conditions that resulting children being separated from their family, mainly from economic factors. In implementing, educators obliged to do home visits. Home visit means that educator carried out in the client's home. One of the village assisted by this program is the village of kwala bekala, where most of the clients work in the informal sector and spend their daily lives working outside their home, thus hinder the process of home visits. In fact, through home visits, educators will be able to explore problems and developments experienced by clients that will affect the termination process.The purpose of this study is to know the effectiveness of home visits in Family strengthening programs by SOS Children’s village. Techniques being used for data collection includes literature study, observation, interviews, and documentation. The data obtained in the field were analyzed qualitatively to obtain conclusions. The result of this study shows that home visits in this program have been effective, as measured by three approaches, namely, resource approach, the second approach is the process approach and lastly based on the target approach seen from the achievement of the home visit goal in this program.

Effects of home visits on quality of life among older adults: a systematic review protocol

BackgroundHome visiting services for older adults have been offered for decades to maintain and promote health and independent functioning, thus enhancing quality of life. Previous systematic reviews have provided a mixed picture of the benefits of home visiting programmes in older adults, primarily because of heterogeneity in study designs, targeted populations, and intervention strategies. These reviews may also become out of date; thus, an updated synthesis of relevant studies is warranted. Our objective is to perform a systematic review of recently published primary studies on the effectiveness of multi-professional home visits on quality of life among older adults.MethodsWe will perform a comprehensive search for studies investigating the effect of a multi-professional home visit approach on quality of life among older adults. We will conduct the literature search in selected electronic databases and relevant research websites from January 2010 onwards. We will include randomised controlled trials (RCTs), cluster randomised controlled trials (cluster RCTs), and observational studies that enrolled older adults without dementia over 60 years old, along with studies involving multi-professional preventive–promotive home visit approaches not related to recent hospital discharge. We will report our planned review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will retrieve and record relevant data in a standardised data extraction form and evaluate the quality of the included articles using the Cochrane risk of bias tool and the quality assessment tool for studies with diverse designs (QATSDD). Where appropriate, outcomes will be pooled for meta-analysis using a random-effects model. The main outcomes include quality of life, incidence of falls, depression, dementia, and emergency department admissions.DiscussionThis review may provide evidence for the effectiveness of home visits in improving older adults’ quality of life. It will potentially benefit health care professionals, policymakers, and researchers by facilitating the design and delivery of interventions related to older generations and improve service delivery in future.Systematic review registrationPROSPERO CRD42021234531.

The effect of home visits as an additional recruitment step on the composition of the final sample: a cross-sectional analysis in two study centers of the German National Cohort (NAKO)

BackgroundParticipation in epidemiologic studies has been declining over the last decades. In addition to postal invitations and phone calls, home visits can be conducted to increase participation. The aim of this study was therefore to evaluate the effects of home visits in terms of response increase and composition of the additionally recruited and final sample.MethodsIn the framework of the German National Cohort (NAKO) recruitment process, two of 18 study centers, Halle (Saale) and Berlin-Center, performed home visits as additional recruitment step after postal invitation and reminders. Response increase was calculated and differences between participants recruited via home visits and standard recruitment were examined. Proportions are presented as percentages with 95%-confidence intervals.ResultsIn the general population in Halle, 21.3-22.8% participated after postal invitation and two reminders in the five assessed recruitment waves. The increase of the overall response was 2.8 percentage points (95%confidence interval: 1.9-4.0) for home visits compared to 2.4 percentage points (95%CI: 1.7-3.3) for alternatively sent third postal reminder. Participants recruited via home visits had similar characteristics to those recruited via standard recruitment. Among persons of Turkish descent in Berlin-Center site of the NAKO, home visits conducted by native speakers increased the participation of women, persons living together with their partner, were born in Turkey, had lower German language skills, lower-income, lower education, were more often smokers and reported more often diabetes and depression to a degree which changed overall estimates for this subsample.ConclusionsAs an additional recruitment measure in the general population, home visits increased response only marginally, and the through home visits recruited participants did not differ from those already recruited. Among persons with migration background, home visits by a native speaker increased participation of persons not reached by the standard recruitment, but the effects of using a native speaker approach could not be separated from the effect of home visits.

Effect of home visit on the learning outcomes of class 3 students in SD IQ Al-Islam

Background: Home environment as the first place of education for students should be able to provide a good role for its development. In fact, it is realized that there are still many problematic families or home environments that cause problems for students, especially in the learning process at school. Students' problems can be seen from where the problems come from, both from relationships in the family and family situations. Family problems and family situations can affect students in school in terms of learning concentration and school activities, resulting in decreased student achievement. Therefore, guidance and counseling teachers need to carry out home visits.
 Purpose: The purpose of this study was to analyze the effect of implementing a home visit on student learning outcomes.
 Design and methods: This study uses quantitative research where data collection in the field is carried out by means of a questionnaire (Questionnaire). The object of this research is the home visit service and the learning outcomes of grade 3 students at SD IQ Al-Islam. The location in this study was conducted at SD IQ Al-Islam and the time of the study was conducted in November 2020.
 Results: The results of this study indicate that the implementation of a home visit has a positive effect on student learning outcomes by 96% in grade 3 SD IQ Al-Islam, meaning the better the implementation of the home visit will improve student learning outcomes.

Effect of household water treatment with chlorine on diarrhea among children under the age of five years in rural areas of Dire Dawa, eastern Ethiopia: a cluster randomized controlled trial

BackgroundDiarrheal disease is a leading cause of child mortality and morbidity worldwide. Household water treatment with chlorine significantly reduces morbidity due to waterborne diseases. However, the effect of point-of-use (POU) water treatment in improving the quality of water in areas where POU is not provided free of charge and the effectiveness of home visits in inspiring household members to use POU regularly have not been studied. The objective of this study was to evaluate the effectiveness of drinking water disinfection by chlorination on diarrheal disease reduction among children under the age of 5 years in rural eastern Ethiopia.MethodsA cluster randomized controlled trial was carried out in rural Dire Dawa from October 2018 through January 2019. The 405 households were randomized to intervention and control arms and intervention materials were distributed after conducting a baseline survey. This trial evaluated the effectiveness of household drinking water disinfection by chlorination in reducing incidence of diarrhea among children under the age of 5 years. Intervention households received 1.2% sodium hypochlorite with demonstration of its proper use. Participants in the control households continued with their usual habits of water collection and water storage. Generalized estimation equations (GEE) with log link Poisson distribution family and exchangeable correlation matrix was used to compute crude incidence rate ratio (IRR), adjusted IRR and the corresponding 95% confidence intervals.ResultsIn the intervention households, in total, 281 cases of diarrhea were documented (8.7 cases per 100 person-weeks observation); in the control households, in total 446 cases of diarrhea were documented (13.8 cases per 100 person-weeks observation). A 36.0% (adjusted IRR = 0.64, 95% CI: 0.57–0.73) reduction in incidence of diarrhea was observed in the intervention arm when compared with the control arm. The highest and the lowest reductions were obtained in children of age ranges 1 to 2 years and 3 to 4 years, 42.7 and 30.4%, respectively. Adherence to the intervention was 81.3% as measured by free residual chlorine test.ConclusionsIn rural areas where diarrhea is the second leading cause of morbidity, water chlorination at the household level using liquid bleach considerably reduced episodes of diarrhea among children under the age of 5 years. Therefore, chlorinating drinking water at the household level may be a valuable interim solution for reducing the incidence of diarrheal diseases until potable water is made accessible to the majority of the population in Dire Dawa Administration and other Ethiopian communities.Trial registrationPACTR, PACTR201807815961394. Registered 16 July 2018, www.pactr.org

Effectiveness of Home Visits in Adult Patients with Asthma: A Systematic Review of Randomized Controlled Trials

The effectiveness of home visits is well discussed for children with asthma, but limited in adults. The present systematic review aimed to investigate the potential role of home visits in improving outcomes among adult patients with asthma. The systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An extensive literature search was conducted using databases such as PubMed, ProQuest, CINAHL, The Cochrane Library, PsycINFO, and Google Scholar from inception to June 2019. The studies included were randomized controlled trials, which reported asthma outcomes in adult patients. The literature search yielded 8331 publications, of which 63 studies were selected for full-text review, and of these studies, 9 studies with a total of 2011 patients were included in the final analysis. The included randomized controlled trials reported quality of life, asthma symptoms, exacerbations, health care utilization, and pulmonary function. Improvements in asthma outcomes were observed predominantly in quality of life. The effects on asthma symptom control were inconsistent. The evidence on the impact of home visits in asthma exacerbations and health care utilization was rather limited. There were no significant differences observed between intervention versus control arms in terms of pulmonary function; however, 1 study reported significant improvements in peak expiratory flow rate. Home visits may serve as an adjuvant activity that complements the existing health care system-based initiatives. It may be concluded that home visits have the potential to improve outcomes in adult patients with asthma; however, the randomized controlled trials reviewed in the present systematic review reported several limitations that warrant further investigation.

Effect of home visit intervention on joint function and life ability of patients after hip arthroplasty

Objective To observe the effect of home visit on joint function and complications of patients undergoing hip replacement. Methods Ninety cases of patients with artificial hip replacement who were admitted to our hospital from January to December 2017 were randomly divided into two groups by random Number Table Method.45 patients in the control group were given routine nursing after discharge, and 45 patients in the observation group were treated with home visit nursing. The hip function and living ability of the two groups were evaluated 8, 12, 16 weeks after discharge,and the complication rate was compared. Results The self-care ability scores of the observation group at 8, 12 and 16 weeks after discharge were 102.23±11.20, 108.36±10.41, 116.25±10.36 higher than those of the control group at 97.86±10.35), 100.21±14.26, 104.23±15.6, with significant differences (t=1.922, 3.097, 4.294, P < 0.05 or 0.01). The Harris scores of the observation group at 8, 12 and 16 weeks after discharge were 82.31±11.27, 87.38±10.05, 95.10±11.23 higher than those of the control group at 78.02±10.23, 83.41±11.74, 89.43±11.62, with significant differences (t=1.891, 1.723, 2.343, P < 0.05). The incidence of complications in the observation group at 16 weeks after discharge was 0 lower than 13.33% (6/45) in the control group (χ2=6.429, P=0.011). Conclusions Home visit intervention can improve the self-nursing ability of the patients after hip joint operation, promote the recovery of hip function and life ability, and reduce the complications. Key words: Home visit; Artificial hip joint replacement; Joint function; Complication

Effects of Home Visits on Medication Adherence of Elderly Individuals with Diabetes and Hypertension

Effects of Home Visits on Medication Adherence of Elderly Individuals with Diabetes and Hypertension

Quantifying the effect of home visit occupational therapy on the quality of life of elderly individuals

Quantifying the effect of home visit occupational therapy on the quality of life of elderly individuals

Effectiveness of Home Visits in Pregnancy as a Public Health Measure to Improve Birth Outcomes.

BackgroundBirth outcomes, such as preterm birth, low birth weight (LBW), and small for gestational age (SGA), are crucial indicators of child development and health.PurposeTo evaluate whether home visits from public health nurses for high-risk pregnant women prevent adverse birth outcomes.MethodsIn this quasi-experimental cohort study in Kyoto city, Japan, high-risk pregnant women were defined as teenage girls (range 14–19 years old), women with a twin pregnancy, women who registered their pregnancy late, had a physical or mental illness, were of single marital status, non-Japanese women who were not fluent in Japanese, or elderly primiparas. We collected data from all high-risk pregnant women at pregnancy registration interviews held at a public health centers between 1 July 2011 and 30 June 2012, as well as birth outcomes when delivered from the Maternal and Child Health Handbook (N = 964), which is a record of prenatal check-ups, delivery, child development and vaccinations. Of these women, 622 women were selected based on the home-visit program propensity score-matched sample (pair of N = 311) and included in the analysis. Data were analyzed between January and June 2014.ResultsIn the propensity score-matched sample, women who received the home-visit program had lower odds of preterm birth (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.39 to 0.98) and showed a 0.55-week difference in gestational age (95% CI: 0.18 to 0.92) compared to the matched controlled sample. Although the program did not prevent LBW and SGA, children born to mothers who received the program showed an increase in birth weight by 107.8 g (95% CI: 27.0 to 188.5).ConclusionHome visits by public health nurses for high-risk pregnant women in Japan might be effective in preventing preterm birth, but not SGA.

Effects of Home Visitation on Maternal Competencies, Family Environment, and Child Development: a Randomized Controlled Trial.

Based on the US Nurse-Family Partnership (NFP) program, the German home visiting program "Pro Kind" offered support for socially and financially disadvantaged first-time mothers from pregnancy until the children's second birthday. A multi-centered, longitudinal randomized controlled trial (RCT) was conducted to assess its effectiveness on mothers and children. A total of 755 women with multiple risk factors were recruited, 394 received regular home visits (treatment group), while 361 only had access to standard community services (control group). Program influences on family environment (e.g., quality of home, social support), maternal competencies (e.g., maternal self-efficacy, empathy, parenting style), and child development (e.g., cognitive and motor development) were assessed from mothers' program intake in pregnancy to children's second birthday based on self-reports in regular interviews and developmental tests. Generalized estimating equations (GEE) models showed small, but significant positive treatment effects on parental self-efficacy, and marginally significant effects on social support, and knowledge on child rearing. Maternal stress, self-efficacy, and feelings of attachment in the TG tend to show a more positive development over time. Subgroup effects were found for high-risk mothers in the TG, who reported more social support over time and, generally, had children with higher developmental scores compared to their CG counterparts. Post hoc analyses of implementation variables revealed the quality of the helping relationship as a significant indicator of treatment effects. Results are discussed in terms of implementation and public policy differences between NFP and Pro Kind.

The Influence of Various Intervention Types on Treatment Success Rates among Category II Tuberculosis Patients

Background: Category II tuberculosis (TB) patients (i.e. re-treatment TB patients) are at an increased risk for defaulting on treatment compared to Category I TB patients. Therefore, extra steps need to be taken to help Category II TB patients follow through with their treatment. The goal of this study was to examine the effectiveness of three different types of interventions to help improve treatment success rates among Category II patients. Materials and Methods: Three different interventions that were implemented among Category II TB patients in the Bardhaman, Hugli, Malda and Murshidabad districts in West Bengal, India, were: 1) setting up group patient provider meetings (PPMs), 2) making home visits and reinforcing the message of full course of treatment, and 3) linking poor TB patients to social welfare schemes (SWSs) to incentivize them to complete treatment. Results: PPMs and SWSs improved treatment success rates among Category II patients. The treatment success rates for patients who received PPMs and patients who received SWSs were 94.2% and 90.7%, respectively, compared to the 74.5% treatment success rate of patients who received no intervention. The effectiveness of home visits, however, depended on the number of home visits the patient received. Conclusion: PPMs and SWSs improve treatment success among Category II TB patients and may easily be incorporated in Directly Observed Treatment, Short-Course programming as feasible ways. A conclusion regarding home visits, however, could not be drawn from this study.

Effects of Home Visits by Paraprofessionals and by Nurses on Children

The Nurse-Family Partnership delivered by nurses has been found to produce long-term effects on maternal and child health in replicated randomized trials. A persistent question is whether paraprofessional home visitors might produce comparable effects. To examine the impact of prenatal and infancy/toddler home visits by paraprofessionals and by nurses on child development at child ages 6 and 9 years. Randomized trial in public and private care settings in Denver, Colorado, of 735 low-income women and their first-born children (85% of the mothers were unmarried; 47% were Hispanic, 35% were non-Hispanic white, 15% were African American, and 3% were American Indian/Asian). Home visits provided from pregnancy through child age 2 years delivered in one group by paraprofessionals and in the other by nurses. Reports of children's internalizing, externalizing, and total emotional/behavioral problems, and tests of children's language, intelligence, attention, attention dysfunction, visual attention/task switching, working memory, and academic achievement. We hypothesized that program effects on cognitive-related outcomes would be more pronounced among children born to mothers with low psychological resources. We report paraprofessional-control and nurse-control differences with P < .10 given similar effects in a previous trial, earlier effects in this trial, and limited statistical power. There were no significant paraprofessional effects on emotional/behavioral problems, but paraprofessional-visited children born to mothers with low psychological resources compared with control group counterparts exhibited fewer errors in visual attention/task switching at age 9 years (effect size = -0.30, P = .08). There were no statistically significant paraprofessional effects on other primary outcomes. Nurse-visited children were less likely to be classified as having total emotional/behavioral problems at age 6 years (relative risk [RR] = 0.45, P = .08), internalizing problems at age 9 years (RR = 0.44, P = .08), and dysfunctional attention at age 9 years (RR = 0.34, P = .07). Nurse-visited children born to low-resource mothers compared with control-group counterparts had better receptive language averaged over ages 2, 4, and 6 years (effect size = 0.30, P = .01) and sustained attention averaged over ages 4, 6, and 9 years (effect size = 0.36, P = .006). There were no significant nurse effects on externalizing problems, intellectual functioning, and academic achievement. Children born to low-resource mothers visited by paraprofessionals exhibited improvement in visual attention/task switching. Nurse-visited children showed improved behavioral functioning, and those born to low-resource mothers benefited in language and attention but did not improve in intellectual functioning and academic achievement. clinicaltrials.gov Identifier: NCT00438282 and NCT00438594.

Effect of Postnatal Home Visits on Maternal/Infant Outcomes in Syria: A Randomized Controlled Trial

Early postpartum home visiting is universal in many Western countries. Studies from developing countries on the effects of home visits are rare. In Syria, where the postpartum period is rather ignored, this study aimed to assess whether a community-based intervention of postnatal home visits has an effect on maternal postpartum morbidities; infant morbidity; uptake of postpartum care; use of contraceptive methods; and on selected neonatal health practices. A randomized controlled trial was carried out in Damascus. Three groups of new mothers were randomly allocated to receive either 4 postnatal home visits (A), one visit (B), or no visit (C). A total of 876 women were allocated and followed up. Registered midwives with special training made a one or a series of home visits providing information, educating, and supporting women. A significantly higher proportion of mothers in Groups A and B reported exclusively breastfeeding their infants (28.5% and 30%, respectively) as compared with Group C (20%), who received no visits. There were no reported differences between groups in other outcomes. While postpartum home visits significantly increased exclusive breastfeeding, other outcomes did not change. Further studies framed in a nonbiomedical context are needed. Other innovative approaches to improve postnatal care in Syria are needed.

WITHDRAWN: Home-based support for disadvantaged adult mothers.

Babies born to socio-economically disadvantaged mothers are at higher risk of a range of problems in infancy. Home visiting programs are thought to improve outcomes, both for mothers and children, largely through advice and support. To assess the effectiveness of home visiting programmes for women who have recently given birth and who are socially or economically disadvantaged. We searched the following electronic databases: The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2006); MEDLINE (1966 to March 2006); EMBASE (1980 to 2006 week 12); CINAHL (1982 to March week 4 2006); PsycINFO (1872 to March week 4 2006); ASSIA (1987 to March 2006); LILACS (1982 to March 2006); and Sociological Abstracts(1963 to March 2006). We searched grey literature using ZETOC (1993 to March 2006); Dissertation Abstracts International (late 1960s to 2006); and SIGLE (1980 to March 2006). We also undertook communication with published authors about ongoing or unpublished research. Included studies were randomised controlled trials investigating the efficacy of home visiting directed at disadvantaged adult mothers. Two reviewers (EC and JP or CB) independently assessed titles and abstracts identified in the search for eligibility. Data were extracted and entered into RevMan (EC, JP and CB), synthesised and presented in both written and graphical form (forest plots). Outcomes included in this review were established at the protocol stage by an international steering group. The review does not report on all outcomes reported in included studies. We included 11 studies with 4751 participants in this review. Data show no statistically significant differences for those receiving home visiting, either for maternal outcomes (maternal depression, anxiety, the stress associated with parenting, parenting skills, child abuse risk or potential or breastfeeding) or child outcomes (preventive health care visits, psychosocial health, language development, behaviour problems or accidental injuries. Evidence about uptake of immunisations is mixed, and the data on child maltreatment difficult to interpret. This review suggests that for disadvantaged adult women and their children, there is currently no evidence to support the adoption of home visiting as a means of improving maternal psychosocial health, parenting or outcomes for children. For reasons discussed in the review, this does not amount to a conclusion that home visiting programmes are ineffective, but indicates a need to think carefully about the problems that home visiting might influence, and improvements in the conduct of outcome studies in this area.

Effects of Home Visits by Paraprofessionals and by Nurses: Age 4 Follow-Up Results of a Randomized Trial

To examine the effects of prenatal and infancy home visiting by paraprofessionals and by nurses from child age 2 through age 4 years. We conducted, in public and private care settings in Denver, Colorado, a randomized, controlled trial with 3 arms, ie, control, paraprofessional visits, and nurse visits. Home visits were provided from pregnancy through child age 2 years. We invited 1178 consecutive, low-income, pregnant women with no previous live births to participate, and we randomized 735; 85% were unmarried, 47% Mexican American, 35% white non-Mexican American, 15% black, and 3% American Indian/Asian. Outcomes consisted of maternal reports of subsequent pregnancies, participation in education and work, use of welfare, marriage, cohabitation, experience of domestic violence, mental health, substance use, and sense of mastery; observations of mother-child interaction and the home environment; tests of children's language and executive functioning; and mothers' reports of children's externalizing behavior problems. Two years after the program ended, women who were visited by paraprofessionals, compared with control subjects, were less likely to be married (32.2% vs 44.0%) and to live with the biological father of the child (32.7% vs 43.1%) but worked more (15.13 months vs 13.38 months) and reported a greater sense of mastery and better mental health (standardized scores [mean = 100, SD = 10] of 101.25 vs 99.31 and 101.21 vs 99.16, respectively). Paraprofessional-visited women had fewer subsequent miscarriages (6.6% vs 12.3%) and low birth weight newborns (2.8% vs 7.7%). Mothers and children who were visited by paraprofessionals, compared with control subjects, displayed greater sensitivity and responsiveness toward one another (standardized score [mean = 100, SD = 10] of 100.92 vs 98.66) and, in cases in which the mothers had low levels of psychologic resources at registration, had home environments that were more supportive of children's early learning (score of 24.63 vs 23.35). Nurse-visited women reported greater intervals between the births of their first and second children (24.51 months vs 20.39 months) and less domestic violence (6.9% vs 13.6%) and enrolled their children less frequently in preschool, Head Start, or licensed day care than did control subjects. Nurse-visited children whose mothers had low levels of psychologic resources at registration, compared with control group counterparts, demonstrated home environments that were more supportive of children's early learning (score of 24.61 vs 23.35), more advanced language (score of 91.39 vs 86.73), superior executive functioning (score of 100.16 vs 95.48), and better behavioral adaptation during testing (score of 100.41 vs 96.66). There were no statistically significant effects of either nurse or paraprofessional visits on the number of subsequent pregnancies, women's educational achievement, use of substances, use of welfare, or children's externalizing behavior problems. Paraprofessional-visited mothers began to experience benefits from the program 2 years after the program ended at child age 2 years, but their first-born children were not statistically distinguishable from their control group counterparts. Nurse-visited mothers and children continued to benefit from the program 2 years after it ended. The impact of the nurse-delivered program on children was concentrated on children born to mothers with low levels of psychologic resources.

Effects of home visitation on ETS exposure among wheezing children from low-income families

Effects of home visitation on ETS exposure among wheezing children from low-income families