Home Visitation Model Research Articles

Feasibility Testing of Digitise Home Visit Service(DHVS) Core Model

The COVID-19 pandemic precipitated a global surge in homeschooling (Ray et al., 2020). While support networks for homeschooling parents have expanded, access to in-home educational professionals, particularly in rural areas, remains a significant challenge (Bullock & Davis, 2018). This study introduces a novel "Digitized Home Visit Education Services (DHVS) (Sathya D H, 2024)" model to address this gap. Building on two years of experience delivering one- to-one home visit special education, our model integrates online monitoring with in-home support from a local trained resource person. The model's feasibility was assessed through a comprehensive evaluation, encompassing subject selection, learning profile analysis, teacher training, and online monitoring during home visits. Semi-structured interviews with the parent, the teacher, the trained resource person, and the passive observer provide qualitative data to refine the model. This paper delves into the Digitised Home Visit Service (DHVS) Core Model, evaluating its feasibility and acceptability. Findings will contribute to the development of DHVS as an alternative special education and therapy service delivery model (Sathya D H, 2024), informing rehabilitation and special education professionals about an innovative method leveraging technology to reach needy students. Parents of students with disabilities will appreciate the digitised home visit model when it becomes available for their children to receive education at home.

Expanding Access to Comprehensive Geriatric Evaluation via Telehealth: Development of Hybrid-Virtual Home Visits

BackgroundIn response to the aging population, the Department of Veterans Affairs (VA) seeks to expand access to evidence-based practices which support community-dwelling older persons such as the Geriatric Resources for Assessment and Care of Elders (GRACE) program. GRACE is a multidisciplinary care model which provides home-based geriatric evaluation and management for older Veterans residing within a 20-mile drive radius from the hospital. We sought to expand the geographic reach of VA-GRACE by developing a hybrid-virtual home visit (TeleGRACE).ObjectivesThe objectives were to: (1) describe challenges encountered and solutions implemented during the iterative, pre-implementation program development process; and (2) illustrate potential successes of the program with two case examples.DesignQuality improvement project with longitudinal qualitative data collection.Program DescriptionThe hybrid-virtual home visit involved a telehealth technician travelling to patients’ homes and connecting virtually to VA-GRACE team members who participated remotely.Approach & ParticipantsWe collected multiple data streams throughout program development: TeleGRACE staff periodic reflections, fieldnotes, and team meeting notes; and VA-GRACE team member interviews.Key ResultsThe five program domains that required attention and problem-solving were: telehealth connectivity and equipment, virtual physical examination, protocols and procedures, staff training, and team integration. For each domain, we describe several challenges and solutions. An example from the virtual physical examination domain: several iterations were required to identify the combination of telehealth stethoscope with dedicated headphones that allowed remote nurse practitioners to hear heart and lung sounds. The two cases illustrate how this hybrid-virtual home visit model provided care for patients who would not otherwise have received timely healthcare services.ConclusionsThese results provide a blueprint to translate an in-person home-based geriatrics program into a hybrid-virtual model and support the feasibility of using hybrid-virtual home visits to expand access to comprehensive geriatric evaluation and ongoing care for high-risk, community-dwelling older persons who reside geographically distant from the primary VA facility.Graphical

Addition of community paramedics to a physician home-visit program: A prospective cohort study.

Home-based primary care promotes aging in place but is not immediately responsive to urgent needs. Community paramedicine leverages emergency medical services clinicians to expedite in-home care, though limited evidence supports this model. We evaluated the primary care and acute care use of older adults evaluated urgently by a community paramedic with telemedicine physician compared to a physician home visit model. This prospective cohort study enrolled older adults in home-based primary care who requested an urgent evaluation. We allocated participants to the physician home visit model or physician home visit plus community paramedic model by ZIP code. We observed primary care and acute care use for 6 months following enrollment. The primary outcome was the median number of primary care and acute care visits per participant. Secondary outcomes included 30-day readmission rates, median wait times, and physician productivity. Data analysis included descriptive statistics, comparison of means and proportions, and negative binomial regression modeling reported as incidence rate ratios (IRR). We screened 255 participants, determined 203 eligible, allocated 199, and completed observation for 167 (84 community paramedicine, 83 physician home visit). Participants were mostly female, age 76-86 years, with 3-5 comorbidities, living in a home/apartment. Community paramedic participants had 29% more primary care visits (IRR 1.29, 95% confidence interval [CI] 1.06-1.57) and shorter wait times for urgent evaluations (1 vs. 5 days, p < 0.001) without increasing acute care use (IRR 0.75, 95% CI 0.48-1.18) or 30-day readmissions (IRR 1.32, 95% CI 0.49-3.55). Physician productivity increased 81% (40 vs. 22 visits/week, p < 0.001). Older adults evaluated by a community paramedic for urgent needs were seen sooner, used acute care similarly to patients evaluated by a physician home visit, and nearly doubled physician efficiency. This suggests that older adults may benefit from combining emergency medical services and primary care resources for urgent evaluations.

Piloting a Home Visual Support Intervention with Families of Autistic Children and Children with Related Needs Aged 0-12.

29 families with children (n = 20 males; mean age 6.59 years [Range 3.64-12.21 years SD 2.57]) receiving support for autism or related needs participated in the study. Parents engaged in an individualised assessment and intervention process through home visits, completing pre- and post-measures. Qualitative methods were used to explore the parents' experiences of the intervention. The intervention led to a statistically significant improvement in parent-reported quality of life (t28 = 3.09, p = 0.005) and parent-reported perception of autism-specific difficulties (t28 = 2.99, p = 0.006). Parents also reported improved access to resources and relevant information and increased confidence in using visual supports at home. The home visit model was strongly supported by the parents. The results provide initial evidence of the acceptability, practicality, and utility of the home-based visual supports intervention. These findings suggest that outreach into the family home may be a beneficial mechanism for delivering interventions related to visual supports. This study highlights the potential of home-based interventions to improve access to resources and information for families and the importance of visual supports in the home setting.

Evidence of the Effectiveness of a Home Visiting Model in Rural Communities: Early Steps to School Success

Evidence of the Effectiveness of a Home Visiting Model in Rural Communities: Early Steps to School Success

Empowering Patient Self-Management: A Community Paramedicine Model of Care in Ontario

Community Paramedicine Remote Patient Monitoring (CPRPM) was launched in Ontario in April 2015 to address high health system usage in vulnerable patients living with chronic disease. CPRPM expands on the home visit model of community paramedicine (CP) to bridge gaps in patient care and address inefficiencies in resource utilization. At patient and systems levels, CPRPM aims to promote patient self-management of chronic diseases. Several reports driving the development of the Ontario Seniors Strategy, which include key recommendations for expanding CP programs, provided the impetus for government to deliver on their electoral platform promise to increase health care spending. The Local Health System Integration Act, 2006 gave Local Health Integration Networks the authority to make home and community care services accessible to Ontario residents, including the supplies and equipment required by patients and their caregivers to support their care at home. Outcome measures of CPRPM point to positive benefits for encouraging patient self-management of chronic diseases and reducing health system strain, with a return on investment of 542%. The variety of options for patient interaction and ability to lessen health system burden makes CPRPM a desirable model of care.

Identification of families in need of support: Correlates of adverse childhood experiences in the right@home sustained nurse home visiting program.

Little is known about the efficacy of pregnancy screening tools using non-sensitive sociodemographic questions to identify the possible presence of as yet undiagnosed disease in individuals and later adverse childhood events disclosure. The study aims were to: 1) record the prevalence of risk disclosed by families during receipt of a sustained nurse home visiting program; and 2) explore patterns of relationships between the disclosed risks for their child having adverse experiences and the antenatal screening tool, which used non-sensitive demographic questions. Retrospective, observational study. Data about the participants in the intervention arm of the Australian right@home trial, which is scaffolded on the Maternal Early Childhood Sustained Home-visiting model, collected between 2013 and 2017 were used. Screening data from the 10-item antenatal survey of non-sensitive demographic risk factors and disclosed risks recorded by the nurse in audited case files during the subsequent 2 year intervention were examined (n = 348). Prevalence of disclosed risks for their child having adverse experiences were analysed in 2019 using multiple response frequencies. Phi correlations were conducted to test associations between screening factors and disclosed risks. Among the 348 intervention participants whose files were audited, 300 were noted by nurses to have disclosed risks during the intervention, with an average of four disclosures. The most prevalent maternal disclosures were depression or anxiety (57.8%). Mental health issues were the most prevalent partner and family disclosures. Screening tool questions on maternal smoking in pregnancy, not living with another adult, poverty and self-reporting anxious mood were significantly associated with a number of disclosed risks for their child having adverse experiences. These findings suggest that a non-sensitive sociodemographic screening tool may help to identify families at higher risk for adverse childhood experiences for whom support from a sustained nurse home visiting program may be beneficial.

In-the-moment ratings on the Early Relational Health Screen: A pilot study of application in home visiting and primary care.

Early infant-parent interaction sets a critical foundation for young children's well-being, and evidence regarding the protective role of secure early relationships has led to increased interest in effective screening and promotion of early relational health in pediatric primary care and home visiting settings. We report findings from two pilot studies conducted in the United States that describe the reliability and validity of a relational health screening tool, the Early Relational Health Screen (ERHS), implemented in two different contexts: an innovative model of relational health promotion in pediatric primary care (Study 1) and an Infant Mental Health Home Visiting (IMH-HV) model (Study 2). Across both studies, a trained clinician rated the ERHS following real-time observation of interaction (i.e., "in-the-moment" ratings). Reliability was assessed by comparing "in-the-moment" ERHS ratings to subsequent coding of the same interaction from video by an independent evaluator. In addition, Study 2 data permitted evaluation of the validity of "in-the-moment" ERHS ratings. Results from both studies indicated reliability of "in-the-moment" ERHS ratings. In addition, Study 2 clinician "in-the-moment" ratings were associated with maternal depression and ratings of child-parent interaction derived from a separateobservational task coded by independent evaluators using a different well-validated research-based measure. Discussion highlights the potential of the ERHS as a screening, promotion, and prevention tool that may be feasibly administered by providers across pediatric primary care and home visiting settings.

Integrating early stimulation and play at scale: study protocol for \u201cMAHAY Mikolo\u201d, a multi-arm cluster-randomized controlled trial

BackgroundHundreds of millions of children living in poverty worldwide are not reaching their full, developmental potential. Programs to promote nurturing and responsive caregiving, such as those in which community health workers (CHWs) conduct home visits to support optimal early childhood development (ECD), have been effective in small trials, but have not achieved similar success at scale. This study will explore two approaches to scale-up: converting a home-visiting model to a group-based model; and integrating the ECD curriculum into an existing government program. The objectives of the study are to: 1) Measure how the integration of ECD activities affects time and task allocation of CHWs and CHW psychosocial wellbeing; 2) Examine how the integration of ECD activities affects caregiver-child dyad participation in standard health and nutrition activities; and 3) Explore how the availability of age-appropriate play materials at home affects caregiver-child dyad participation rates in a group-based ECD program.MethodsWe will randomize 75 communities in rural Madagascar into three arms: 1) [C], which is the status quo (community-based health and nutrition program); 2) [T], which is C + ECD group sessions [T]; and 3) [T +], which is T with the addition of an enhanced play materials package for home use. All children between 6–30 months old at the time of the intervention launch will be eligible to participate in group activities. The intervention will last 12 months and is comprised of fortnightly group sessions in which the CHWs provide caregiver-child dyads with information relating to ECD; CHWs will also include structured time for caregivers to practice the play and child stimulation activities they have learned. We will administer monthly surveys to measure CHW time use and task allocation, and we will leverage administrative data to measure caregiver-child dyad participation in the group sessions.DiscussionThe results from the trial will provide the evidence base required to implement an integrated package of nutrition, health and ECD promotion activities at scale in Madagascar, and findings may be relevant in other low-income countries.Trial registrationThis trial is registered on the AEA Social Science Registry (AEARCTR-0004704) on November 15, 2019 and on ClinicalTrials.gov (NCT05129696) on November 22, 2021.

Strategies for implementation of virtual home visitation in the United States

Utilising telepractice videoconferencing technology to offer home visitation services has the potential to provide access and parenting support through a high-tech and high-touch service delivery option. Families can receive evidence-based, family support intervention from their home via videoconferencing technology, removing the need for the provider to be physically in the home. While the expansion of telehealth and telepractice services for families is essential for meeting the needs of both parents and their children, well-documented engagement barriers to digital health/computer-mediated interventions exist across treatment modalities and technology platforms. Semi-structured interviews with 15 providers were conducted and analysed to identify engagement strategies utilised to sustain families in a home visitation model offered through live videoconferencing technology on a telehealth platform. Analysis revealed four themes that were deemed essential for successfully attracting and maintaining families in a telepractice-based home visitation programme: (a) engagement strategies to encourage families to participate; (b) clinical skills used within sessions; (c) articulation of benefits to the family; and (d) exploration of rationale for ending services. This study was able to identify strategies for engagement and sustained involvement of families in telehealth-based home visitation. Findings include evidence that providers should be able to move between telehealth and on-ground service provision with relative ease.

Development of an Asthma Home-Visit Training Program for Community Health Workers and Their Supervisors in Washington State.

The community health worker (CHW) asthma home-visiting model developed by Public Health-Seattle & King County (PHSKC) is an evidence-based approach proven to improve health outcomes and quality of life. In addition, it has been shown to be an effective and culturally appropriate approach to helping people with asthma understand the environmental and behavioral causes of uncontrolled asthma, while acquiring the skills they need to control their asthma. This paper describes the development and implementation of training curricula for CHWs and supervisors in the asthma home visiting program. To facilitate dissemination, this program took advantage of the current healthcare landscape in Washington State resulting from Centers for Medicare & Medicaid Services (CMS) approval of the 1115 Medicaid Waiver project. Key aspects of the training program development included: (1) Engagement: forming a Community Advisory Board with multiple stakeholders to help prioritize training content; (2) Curriculum Development: building the training on evidence-based home-visit protocols previously developed at PHSKC; (3) Implementation of the training program; (4) Evaluation of the training; and (5) Adaptation of the training based on lessons learned. We describe key factors in the training program's improvement including the use of a community-based participatory approach to engage stakeholders at multiple phases of the project and ensure regional adaption; combining in-person and online modules for delivery; and holding learning collaboratives for post-training and technical support. We also outline our training program evaluation plan and the planned evaluation of the home visit program which the trainees will deliver, both of which follow the RE-AIM framework. However, because the COVID-19 pandemic has curtailed training activities and prohibited the trainees from implementation of these CHW home visit practices, our evaluation is currently incomplete. Therefore, this case study provides insight into the adaptation of the training program, but not the delivery of the home visit program, the outcomes of which remain to be seen.

With the radio blaring, can information from community-health-worker home talks be heard? Evaluation of a COVID-19 home-talk programme in Kisoro, Uganda

BackgroundAs the rate of COVID-19 infections grew in Kisoro, Uganda, fear and misinformation about the virus were rife. Accurate, trustworthy community education seemed essential to support prevention efforts in the villages, allay widespread fear of death, and avoid the overwhelming of Kisoro District Hospital (KDH). Since 2005, KDH has collaborated with an NGO, Doctors for Global Health (DGH) and the Albert Einstein College of Medicine, NY, USA, to sponsor a robust Village Health Worker (VHW) programme in 52 villages in the Kisoro district. Community health education has been a cornerstone of the programme since its inception, and VHW-delivered home talks with portable, pictorial flip charts have shown success as a model for health education. Here, we describe a COVID-19 home-talk programme developed in a short time in response the COVID-19 pandemic and evaluate learning from this programme compared with learning from local radio (the main channel of information) and other regional information sources. In a COVID-19 lockdown, would the home-visit model be applicable? Would a health-worker delivered home-talk programme add to learning otherwise garnered from radio, television or neighbours? MethodsWe developed a 30 min COVID-19 home talk in 10 days; we trained 48 VHWs in an intense 2-day training, then monitored and certified VHW's skills over three sessions of field observation. Home talks were then fully implemented with a maximum of four adults per talk and social distancing was observed. To measure the retained learning from home talks, one adult per talk answered a six-item pre-test, and 3–5 weeks later, we randomly selected 20% of these participants and invited them to complete an identical post-test. To control for media exposure and assess contamination of the talk messages over time in study villages, residents of non-participating villages also completed tests at the same time that study participants completed post-tests in participating villages. FindingsIn the 3 months between April 20, 2020, and June 16, 2020, 48 VHWs gave 4308 COVID-19 home talks to more than 14 000 adults who have minimal education. Participants' post-test scores were 20% higher than pre-test scores and 30% higher than controls' test scores (p<0·0001) and were independent of the VHW's presentation skills. Significant learning was seen surrounding COVID-19 symptoms, mechanisms of spread, disease prevention, and risks of mortality, but not about when to go to the hospital with symptoms. Most participants (82%) reported understanding and valuing information from the COVID-19 home talks more than they did information heard via the radio. InterpretationDespite ubiquitous coverage of COVID-19 issues in the popular media, small group home talks by VHWs were preferred by rural villagers in Uganda and resulted in new, retained learning. We believe that this preference was probably the result of trust in the VHW and the opportunity to focus and ask questions. Corollary learning by word of mouth also occurred in home talk villages. FundingAlbert Einstein College of Medicine, Global Health.

Evidence of Effectiveness of a Home Visitation Program on Infant Weight Gain and Breastfeeding.

Adequate weight gain is important to reduce the risk of infant morbidity and mortality. Breastfeeding is also important to prevent infant morbidity. Home visitation programs have been used for many years to prevent infant and child morbidity and maltreatment. Nurses for Newborns is a home visitation model with the goals of preventing infant mortality and maltreatment. This study evaluated the impact of the Nurses for newborns program on infant weight gain and breastfeeding. We used a retrospective case-control propensity matched model to evaluate outcomes. We received secondary data from Vanderbilt Research Derivative Group and Tennessee Office of Health Statistics to conduct the analysis. Data were accessed for infants born in 2013, 2014 and 2015 and limited to those with at least four NFN visits and no more than 2days in the NICU. We conducted chi square analysis and logistic regression to test our hypotheses. NFN infants were two times more likely to triple their birth weight in the first year. NFN infants were also two times more likely to be breast fed at 2weeks, but this finding was not statistically significant. Home visitation models can be effective in encouraging adequate weight gain in the first year of life. In addition, home visitors can encourage women to breastfeed. Significance Home visitation models can prevent infant morbidity and mortality. Few studies, however, have demonstrated that infant weight gain, an important factor in the health of infants, can be enhanced using this approach. In addition, home visitation can positively impact breastfeeding, another important factor in preventing infant morbidity. Findings from this study suggest that the NFN model of home visitation can improve weight gain and breastfeeding, indicating the impact of this model.

Home visiting: A lifeline for families during the COVID-19 pandemic

Home visiting: A lifeline for families during the COVID-19 pandemic

Home visits by community health workers in rural South Africa have a limited, but important impact on maternal and child health in the first two years of life

BackgroundMore than 50% of Africa’s population lives in rural areas, which have few professional health workers. South Africa has adopted task shifting health care to Community Health Workers (CHWs) to achieve the Sustainable Development Goals, but little is known about CHWs’ efficacy in rural areas.MethodsIn this longitudinal prospective cohort study, almost all mothers giving birth (N = 470) in the Zithulele Hospital catchment area of the OR Tambo District were recruited and repeatedly assessed for 2 years after birth with 84.7–96% follow-up rates. During the cohort assessment we found that some mothers had received standard antenatal and HIV care (SC) (n = 313 mothers), while others had received SC, supplemented with home-visiting by CHWs before and after birth (HV) (n = 157 mothers, 37 CHWs). These visits were unrelated to the cohort study. Multiple linear and logistic regressions evaluated maternal comorbidities, maternal caretaking, and child development outcomes over time.ResultsCompared to mothers receiving SC, mothers who also received home visits by CHWs were more likely to attend the recommended four antenatal care visits, to exclusively breastfeed at 3 months, and were less likely to consult traditional healers at 3 months. Mothers in both groups were equally likely to secure the child grant, and infant growth and achievement of developmental milestones were similar over the first 2 years of life.ConclusionCHW home visits resulted in better maternal caretaking, but did not have direct benefits for infants in the domains assessed. The South African Government is planning broad implementation of CHW programmes, and this study examines a comprehensive, home-visiting model in a rural region.

Infant mental health home visiting therapists' fidelity to the Michigan IMH-HV model in community practice settings.

Implementation research suggests that fidelity to a therapeutic model is important for enhancing outcomes, yet can be difficult to achieve in community practice settings. Furthermore, few published studies have reported on characteristics of treatment fidelity. The present study examined fidelity to the Infant Mental Health Home Visiting (IMH-HV) model among 51 therapists with a range of experience practicing in community settings across the state of Michigan. IMH therapists completed fidelity checklists after every session with participating families to track use of 15 treatment strategies central to the IMH-HV model across the 12-month study period. Results indicated that the most commonly endorsed components utilized in home visits were developmental guidance and infant-parent psychotherapy, followed by the provision of emotional support. Use of IMH-HV components did not vary over time for the entire sample; however, patterns of strategies used showed somewhat more variability among more experienced therapists and when serving higher risk families. Findings demonstrate that IMH-HV therapists report a range of adherence to the model in community settings, with greatest fidelity to several model core components. Ongoing training in the flexible use of all core strategies may further enhance fidelity and contribute to positive outcomes for caregivers and their children receiving IMH-HV services.

Home visits for pediatric asthma - A strategy for comprehensive asthma management through prevention and reduction of environmental asthma triggers in the home

Families often struggle to manage their child's asthma. Clinicians caring for children with asthma struggle too as they are tasked with balancing the limited time available in clinic and the need to provide comprehensive care. As a direct consequence, critical gaps in asthma care remain with respect to asthma education and the identification and reduction of environmental asthma triggers in the home. A home visit model that augments clinic-based care is a viable way to fill gaps in understanding, address incomplete adherence patterns, improve disease control by shifting the focus of asthma management to reduction of environmental asthma triggers, and bring cost savings to the health care system.

A MIXED-METHODS EVALUATION OF A 20-YEAR SENIOR MENTOR PROGRAM FOR MEDICAL STUDENTS

The purpose of this mixed-methods evaluation is to demonstrate the success from the past 20 class years of continuous use of senior mentors to teach geriatrics to approximately 3400 Year 1 and Year 2 medical students in a home visit model. Using a pre-test post-test design (N=131), we evaluated student satisfaction, self-confidence in various geriatrics assessments, and performance on an Objective Structured Clinical Evaluation (OSCE). We additionally conducted a formal qualitative evaluation of students’ open-ended reflections (N=97) across three years, from 2016-18, on what they learned. In addition, relying on the principles of community-based research, we collaborated with a volunteer senior on all aspects of this evaluation, and included a community of seniors at a large urban senior care high-rise to enhance our interpretive validity by asking seniors to reflect on a set of representative quotes for each qualitative theme. The senior mentor home visit model demonstrated high satisfaction, improved self-confidence in geriatric assessment, attainment of competencies, and improvement in attitude scores. With regard to the qualitative portion of the evaluation, six themes about learning were recognized: (1) how to perform an interview and exam in a home setting, (2) how life for seniors is different than students expected, (3) the value of physical infrastructure and amenities in senior housing, (4) the importance of senior’s community, including family, neighbors, spiritual community, (5) challenges with aging, and (6) strengths among seniors in coping with such challenges while maintaining individual agency.

Informing Precision Home Visiting: Identifying Meaningful Subgroups of Families Who Benefit Most from Family Spirit.

The Maternal, Infant, and Early Childhood Home Visiting Program was reauthorized February 8, 2018, and invests $2 billion over 5years to improve mothers' and children's outcomes across the life course. Along with this investment, the home-visiting field is striving for implementation innovations to deliver the greatest impact to the most families at the most efficient cost through a focus on precision home visiting. Consistent with the precision home-visiting approach to identify meaningful subgroups to guide content tailoring, the purpose of this paper is to answer (1) how and to what degree an evidence-based home-visiting model benefits mothers and children with substance use or depression and (2) what baseline characteristics indicate who can benefit most. We completed a secondary data analysis of the most recently completed randomized controlled trial (RCT) of Family Spirit (N =322), a federally endorsed home-visiting intervention designed for young Native American mothers and their children. We examined how baseline differences in mothers' substance use, depression, and demographic characteristics (household mobility, education, parity, and premature birth) moderated mothers' and children's intervention-related outcomes. Children born to mothers with past substance use histories benefited more from the intervention than children born to abstinent mothers (p < 0.01). Unstable housing, parity, and low educational attainment emerged as moderators of intervention effectiveness. Results from this investigation will serve as a basis for designing and evaluating a precision approach to Family Spirit and may provide lessons for other models to explore tailoring variables for optimal impact and efficiency. Trial Registry: NCT00373750.

Family Spirit Nurture (FSN) \u2013 a randomized controlled trial to prevent early childhood obesity in American Indian populations: trial rationale and study protocol

BackgroundChildhood overweight and obesity is a persistent public health issue in the US. Risk for obesity and obesity-related morbidity throughout the life course begins in utero. Native Americans suffer the greatest disparities in the US in childhood overweight and obesity status of any racial or ethnic group. Existing early childhood home-visiting interventions provide an opportunity for addressing obesity during the first 1000 days. However, to date, no evidence-based model has been specifically designed to comprehensively target early childhood obesity prevention.MethodsThis study is a randomized controlled trial to test the efficacy of home-visiting intervention, called Family Spirit Nurture, on reducing early childhood obesity in Native American children. Participants are expectant Native American mothers ages 14–24 and their child, enrolled from pregnancy to 24 months postpartum and randomized 1:1 to receive the Family Spirit Nurture intervention or a control condition. The intervention includes 36 lessons delivered one-on-one by locally-hired Native American Family Health Coaches to participating mothers from pregnancy until 18 months postpartum. A mixed methods assessment includes maternal self-reports, maternal and child observations, and physical and biological data collected at 11 time points from 32 weeks gestation to 2 years postpartum to measure the intervention’s primary impact on maternal feeding behaviors; children’s healthy diet and physical activity; children’s weight status. Secondary measures include maternal psychosocial factors; household food and water security; infant sleep and temperament; and maternal and child metabolic status.DiscussionNone of the 20 current federally-endorsed home-visiting models have demonstrated impacts on preventing early childhood obesity. The original Family Spirit program, upon which Family Spirit Nurture is based, demonstrated effect on maternal and child behavioral health, not including obesity related risk factors. This trial has potential to inform the effectiveness of home-visiting intervention to reduce obesity risk for tribal communities and other vulnerable populations and expand public health solutions for the world’s obesity crisis.Trial registrationClinicaltrials.gov (Identifier: NCT03334266 - Preventing Early Childhood Obesity, Part 2: Family Spirit Nurture, Prenatal - 18 Months; Retrospectively registered on 07 November 2017).