Home Visitation Program Research Articles

Retaining participants in community-based health research: a case example on standardized planning and reporting

BackgroundEffective strategies for participant retention are critical in health research to ensure validity, generalizability and efficient use of resources. Yet standardized guidelines for planning and reporting on retention efforts have been lacking. As with randomized controlled trial (RCT) and systematic review (SR) protocols, retention protocols are an opportunity to improve transparency and rigor. An RCT being conducted in British Columbia (BC), Canada provides a case example for developing a priori retention frameworks for use in protocol planning and reporting.MethodsThe BC Healthy Connections Project RCT is examining the effectiveness of a nurse home-visiting program in improving child and maternal outcomes compared with existing services. Participants (N = 739) were girls and young women preparing to parent for the first time and experiencing socioeconomic disadvantage. Quantitative data were collected upon trial entry during pregnancy and during five follow-up interviews until participants’ children reached age 2 years. A framework was developed to guide retention of this study population throughout the RCT. We reviewed relevant literature and mapped essential retention activities across the study planning, recruitment and maintenance phases. Interview completion rates were tracked.ResultsResults from 3302 follow-up interviews (in-person/telephone) conducted over 4 years indicate high completion rates: 90% (n = 667) at 34 weeks gestation; and 91% (n = 676), 85% (n = 626), 80% (n = 594) and 83% (n = 613) at 2, 10, 18 and 24 months postpartum, respectively. Almost all participants (99%, n = 732) provided ongoing consent to access administrative health data. These results provide preliminary data on the success of the framework.ConclusionsOur retention results are encouraging given that participants were experiencing considerable socioeconomic disadvantage. Standardized retention planning and reporting may therefore be feasible for health research in general, using the framework we have developed. Use of standardized retention protocols should be encouraged in research to promote consistency across diverse studies, as now happens with RCT and SR protocols. Beyond this, successful retention approaches may help inform health policy-makers and practitioners who also need to better reach, engage and retain underserved populations.Trial registrationClinicalTrials.gov, NCT01672060. Registered on 24 August 2012.

Survive and Thrive in Brazil: The Boa Vista Early Childhood Program: study protocol of a stepped-wedge, randomized controlled trial

BackgroundA growing body of evidence suggests that early life health and developmental outcomes can be improved through parental support programs. The objective of this project was to test the feasibility, impact, and relative cost-effectiveness of an adapted “Reach Up and Learn” program delivered through home-visiting programs as well as through center-based parenting groups on child health and development in the municipality of Boa Vista, Brazil.MethodsA randomized, stepped-wedge design was used to roll out and evaluate the two parenting platforms in Boa Vista municipality. A total of 39 neighborhoods with a high Neighborhood Vulnerability Index were selected for the study. For the first phase of the program, nine neighborhoods were randomly selected for home visits, and two were randomly selected for the center-based parenting groups. In the second phase of the program, 10 neighborhoods were added to the home-visiting program, and eight were added to the center-based program. In the final phase of the program, the remaining 10 control areas will also be assigned to treatment. Study eligibility will be assessed through a baseline survey completed by all pregnant women in the 39 study areas. Pregnant women will be eligible to participate in the study if they are either classified as poor, were under age 20 years when they became pregnant, or if they indicate to have been exposed to domestic or sexual violence. To assess program impact, an endline survey will be conducted when children reach age 2 years. The primary study outcome is child development at age 2 years as measured by the PRIDI instrument. Secondary outcome will be infant mortality, which will be assessed linking municipal vital registration systems to the program rollout.DiscussionThis trial will assess the feasibility and impact of parenting programs rolled out at medium scale. The results from the trial should create evidence urgently needed for guiding Brazil’s national Criança Feliz program as well as similar efforts in other countries.Trial registrationClinicalTrials.gov, ID: NCT03386747. Registered on 13 December 2017. All items of the World Health Organization Trial Registration Data Set are available in this record.

Promoting family integrated early child development (during first 1000 days) in urban slums of India (fine child 3-3-1000): Study protocol.

This project tests a novel, targeted home visitation programme for child development targeted behaviour change during the first 1,000days for families in Delhi urban slums. The first 1,000days have highest brain development potential and is dependent on the available nutrition, health, social and cognitive stimulus. Over 1.3 million children are born annually in the slums of India and are at risk of limited development potential. The children in urban slums at multiplicity of adversities at family, society and environmental levels. No tools are available for the community health functionaries to support the families to promote child development. This cohort study targets provision of behaviour change interventions targeted at three groups (pregnant women, infants and children in year 2) to document the impact on child development. This implementation project delivers nutrition, health and child stimulation integrated services for the families through existing government community health workers and nurses. These workers shall train the families using audio-visual messages in tablets and demonstration kits for practice through quarterly home visits. Data on health, nutrition and child development shall be collected at baseline, midterm and after one year. The data from these participants shall be compared with data from recently delivered women, children aged 13months and 25months without intervention to document the impact. The successful implementation of the project has potential for future integration of the child development components into the existing programme at scale. The learning from this project shall be useful for India and other developing countries. The first 1,000days are critical period in human brain development and cognitive function acquisition potential, which is dependent on the available nutrition, health, social and cognitive stimulus. The development potential in children born and living in the slums, who are exposed to various adversities, can be mitigated through appropriate family-level practices with support from the community health workers and Nurses. This study is documenting the feasibility and impact of home visit linked coaching of families for improving child development status during the first 1,000days in three sums of Delhi, India.

Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes

BackgroundSugira Muryango is a father-engaged early child development and violence-prevention home-visiting programme delivered by trained lay workers. This cluster-randomised trial evaluates whether families living in extreme poverty (Ubudehe 1, the poorest category in the Government of Rwanda’s wealth ranking) who receive Sugira Muryango in combination with a government-provided social protection programme demonstrate greater responsive, positive caregiving, nutrition, care seeking, hygiene, and father involvement compared with control families receiving usual care (UC).MethodsUsing detailed maps, we grouped closely spaced villages into 284 geographic clusters stratified by the type of social protection programmes operating in the village clusters; 198 clusters met all enrolment criteria. Sugira Muryango was delivered to n = 541 families in 100 treatment clusters with children aged 6–36 months living in extreme poverty. We assessed changes in outcomes in intervention and n = 508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate clustering.ResultsFamilies receiving Sugira Muryango improved on core outcomes of parent-child relationships assessed using the Home Observation for Measurement of the Environment (Cohen’s d = 0.87, 95% CI: 0.74, 0.99) and the Observation of Mother-Child Interaction (Cohen’s d = 0.29, 95% CI: 0.17, 0.41). We also saw reductions in harsh discipline on items from the UNICEF MICS (OR = 0.30: 95% CI: 0.19, 0.47) and in violent victimisation of female caregivers by their partners (OR = 0.49, 95% CI: 0.24, 1.00) compared with UC. Moreover, children in families receiving SM had a 0.45 higher increase in food groups consumed in the past 24 h (Cohen’s d = 0.35, 95% CI: 0.22, 0.47), increased care seeking for diarrhoea (OR = 4.43, 95% CI: 1.95, 10.10) and fever (OR = 3.28, 95% CI: 1.82, 5.89), and improved hygiene behaviours such as proper treatment of water (OR = 3.39, 95% CI: 2.16, 5.30) compared with UC. Finally, Sugira Muryango was associated with decreased caregiver depression and anxiety (OR = 0.58, 95% CI: 0.38, 0.88).ConclusionsSugira Muryango led to improvements in caregiver behaviours linked to child development and health as well as reductions in violence.Trial registrationClinicalTrials.gov number NCT02510313.

Locally Identified Priorities for Continuous Quality Improvement (CQI) During Early Implementation of an Evidence-Based Early Childhood Home Visiting Program.

The 2010 Affordable Care Act provided for evidence-based home visiting and an accompanying continuous quality improvement (CQI) process in all states and territories. This is an organizational-level study of one state's qualitative approach to CQI during early implementation, when data system infrastructure and local agency capacity were still developing. We examined the CQI topics created by local agencies and operationalized through a qualitative, strength-based CQI process. During the first 18 months, state and local site teams (n = 21) participated in 150 CQI teleconferences. We used qualitative content analysis of teleconference notes to identify issues important to sites and that could be addressed through a qualitative CQI process. Seven categories of CQI topics emerged: participant enrollment and retention; administrative infrastructure and capacity; programmatic resources and practices; community advisory boards; home visitor skill development; systems integration and strategic partnerships; and hiring home visiting staff. Sites added local nuances to frame and address CQI topics. When local sites identify their own CQI topics in early implementation, they addressed program need at multiple levels of influence. A few sites addressed individually focused topics traditional to CQI. Most often, sites engaged with institution- or community-focused topics atypical for CQI but nonetheless essential to launching a program: building skills and capacity for administrative and program implementation, and engaging with the local system of services. Oversight agencies should be prepared to address program, organization, partner or system level issues through CQI to foster program establishment. A site-centered, strength-based approach can support programs even when quantitative data are limited.

Evaluating the real-world implementation of the Family Nurse Partnership in England: protocol for a data linkage study

IntroductionAlmost 20 000 babies are born to teenage mothers each year in England, with poorer outcomes for mothers and babies than among older mothers. A nurse home visitation programme in...

Addressing maternal mental health to increase participation in home visiting

Maternal depression poses a significant threat to the healthy development of young children and is associated with increased child behavior problems and poorer cognitive development. Home visiting programs provide critical support for children and families during early childhood, but further research is needed to examine how programs address maternal depression and whether referral to outside mental health services impacts parental participation in home visiting. This study aimed to examine rates of depression among mothers in the national Parent as Teachers (PAT) home-visiting program, whether various high needs characteristics were associated with elevated depressive symptoms, and whether depressive symptomology and initiation of outside mental health treatment were associated with attendance and retention in services, particularly after considering important family risk factors. Data from all participating affiliates was collected nationally. Measures included family demographics, high needs characteristics, rates of depression screening, initiation of maternal mental health services, and PAT program attendance and retention. Several high needs characteristics were strongly associated with maternal depressive symptoms, including intimate partner violence exposure, parental substance abuse, and parental disability. Results also showed that mothers who screened in either the probable Major Depressive Disorder or subclinical depression range on the Edinburgh Postnatal Depression Scale were enrolled for fewer months in PAT. However, depressed mothers who accessed outside mental health services stayed enrolled for more months than mothers who did not access services. Results demonstrate that mothers with higher depressive symptoms, including those in the subclinical range, have a harder time participating in home-visiting services, even though they may need the support the most. However, when PAT home-visitors address maternal mental health and mothers initiate treatment, mothers appear to be better equipped to participate in home visiting.

Intention to Engage in Maternal and Child Health Home Visiting

ABSTRACT Home visiting (HV) programs have the potential to improve maternal and child health. As federal and state initiatives expand the reach of these programs, understanding what factors enhance uptake and retention of the services becomes increasingly important. This qualitative study used a Reasoned Action Model (RAM) and a cultural lens to explore factors influencing the engagement of women with low-income in HV programs. We conducted 21 semi-structured interviews in both English and Spanish in a prenatal clinic in an urban public health department. The constructs most salient for participants were emotions and affect, behavioral beliefs, and self-efficacy. In the context of an urban public health prenatal clinic, HV marketing and outreach should highlight convenience and social support, as well as clearly communicate program content and intent. In practice, HV programs must be flexible to work around work and home schedules; marketing and outreach should emphasize that flexibility.

Collaborative Home-Visit Program for Young Children With Motor Delays in Rural Taiwan: A Pilot Randomized Controlled Trial.

Caregiver engagement and collaborative team early childhood intervention (ECI) services are international trends; however, relevant evidence of collaborative home-visiting ECI in rural areas is as yet undetermined. The study aimed to investigate the effectiveness of a collaborative ECI program in a rural area of Taiwan. The study was a pilot randomized control led trial. Children aged 6 to 33months experiencing motor delays and their caregivers were enrolled in Taitung, Taiwan. Using stratified randomization, 24 participants were allocated to either experimental or control groups, and both received 5 home visits within 3months. The experimental group received ECI services based on the International Classification of Functioning, Disability and Health framework and family-centered approaches. The control group received regular home visits by local social workers. Child outcomes included Pediatric Evaluation of Disability Inventory Chinese Version and Peabody Developmental Motor Scale, 2nd edition. Family outcomes included the Disability-Adapted Infant-Toddler version of Home Observation for Measurement, and Chinese versions of the Knowledge of Infant Development Inventory and Parental Stress Index-Short Form. A tester blinded to the study conducted assessments at baseline, postintervention, and 3-month follow-up. Two-way mixed analysis of variance was used with α=.05 (2-tailed). The experimental group improved scores on the Disability-Adapted Infant-Toddler version of Home Observation for Measurement significantly more than the control group with an effect size of 0.64 at follow-up. In other outcomes, both groups showed no significant differences. The follow-up rate was 69%, and adherence to the ECI program was acceptable. A limitation of the study was the heterogeneity of the sample. This pilot study revealed possible effectiveness in implementing collaborative ECI programs based on family-centered approaches and the International Classification of Functioning, Disability and Health in rural areas. Larger field studies are needed to confirm our findings.

Factors Contributing to Low Tuberculosis Case Detection in West Akim Municipality of the Eastern Region of Ghana: A Community and Health Facility Based Study

This research has a keen interest into assessing health and community related factors that contribute and influences low TB case detection rate in the West Akim Municipality of the Eastern region of Ghana. Data was collected from a target group of community members and health workers using a well-structured questionnaire. Data from the field was collected using Epi Info 7 and then, exported to Microsoft Excel and finally transferred to SPSS version 24 for the analysis. Some statistical techniques such as descriptive statistics, reliability of scale, t-test of independence, chi-square and analysis of variance was used to obtain results from the data analysis. Community related factors that has been identified as possible contributors to low TB detection rate are as follows, the availability of alternative means of health care (traditional healers, prayer camps, and herbs to manage suspected cases of TB. This turns to keep people away from the health facilities. The long time (2 days) it takes for an individual to get tested and to receive his/her tested results (time of diagnostics). The high levels of experienced stigma associated with psychological distress on suspected people with TB and on friends and relatives living with TB patients. the low knowledge of TB among some reasonable number of community members. The study also identified the possible health related factors influencing low TB case detection rate such as, Low TB trained personals and low TB education during health talks in creating awareness that TB is preventable, curable and treatable and that suspected people with TB (cough for more than two weeks) should seek medical attention. Community health nurses not including TB screening as part of their home visitation program and low level of contact tracing could also contribute to the low case detection rate. The highly inadequate number Gene Xpert machines, DOT centres and laboratories for the diagnostics of TB. The study also found that, TB stigma even existed among health care providers against suspected patients. This negatively influence the health seeking behavior among suspected patients. This study became necessary to generate information for the Ghana national TB control Programme for appropriate remedial actions to be taken to forestall any catastrophe that may result from undetected and untreated TB cases in the West Akim municipality. Keywords: Gene Xpert machines, DOT Centres, Stigmatization, Psychological Distress, TB screening, Low TB Case Detection. DOI: 10.7176/JHMN/72-11 Publication date: March 31 st 2020

Transitional Care Home Visits: Outcomes Among Underserved Patients in a Heart Failure Clinic

Background Heart failure (HF) is a complex disease with a 59% five-year mortality rate, and significantly impacts quality of life (QOL). The prevalence of depression in patients with HF is three times higher than the general population. To compound these issues, underserved individuals often lack access to health care resources resulting in poorer outcomes and delayed treatments. Evidence supports the home visit (HV) approach to HF management as a method to promote positive outcomes and improved QOL. Yet, little is known regarding HV in this vulnerable population, specifically the outcomes associated with the timing of HV. Purpose The purpose of this quality improvement project was to evaluate if transitional care HV completed 14 days after hospital discharge impacted depression and functional status in underserved patients with HF over six months. Methods The setting was a nurse-led outpatient clinic. The two-year retrospective review included 45 participants who received a HV 14 days after hospital discharge. Demographic and clinical data collected included age, gender, race, ethnicity, and New York Heart Association (NYHA) class. Depression was measured by the Patient Health Questionnaire (PHQ)-9 survey. Functional status was operationalized using the Short Form (SF)-22 survey. Comparison of outcomes were measured at baseline and at three and six months. Descriptive statistics, t-test, and chi-square test were used to determine if any statistically significant differences existed between the groups. Results Statistically, no significant differences were observed in the demographic and clinical characteristics between the groups. The sample was predominantly African American (82%), mean age 50 years, and 55% males. Regarding NYHA class symptoms, 44% of all participants reported class III at baseline. At three months, 40% of all participants reported class I. By six months, 79% of participants in the HV 14 days reported class I. Only 1-3% of all participants described class IV throughout the six months. Mean PHQ-9 scores varied between the groups, but no statistically significant differences were observed by six months (HV 14 days = 5.62). T-test analysis did show statistically significant differences between the mean SF-22 physical health scores of the groups (43.3 versus 64.8), in which participants in the HV >14 days group showed improved scores by six months. Conclusions Project results showed that overall, HV timing did not significantly impact the health outcomes of underserved patients with HF over six months. Nevertheless, the results were clinically significant, as the home visitation program allowed clinicians and patients to benefit in ways that are not easily measured through surveys and statistical analyses. Home visiting provided an opportunity to strengthen the clinician-patient relationship. Clinicians were able to assess patient needs in the home environment and identify resources that benefited patients long-term. Lastly, the one statistically significant finding in the HV >14 day group suggests that there might be a learning period associated with more interaction with the healthcare team.

Eliminating Patient Identified Barriers to Decrease Medicaid Inpatient Admission Rates and Improve Quality of Care.

The goal of this study was to decrease admission and readmission rate for the 2296 Medicaid patients in our clinic. Our focus was to eliminate patient identified barriers to care that led to decreased quality of care. The identified barriers for our clinic included distance to care, poor same-day access, communication, and fragmented care. A team-based, collaborative approach using members from all aspects of patient care. An initial survey identified which barriers to care our patients felt obstructed their care. With this data, along with a national literature review, our team used biweekly quality team meetings with LEAN methodology and Plan-Do-Study-Act cycles to create a 4-phase quality improvement project. A home-visit program to decrease distance to care, walk-in clinic to improve same-day access, strengthened collaboration with outside care managers and clinic staff to improve communication, and the introduction of an in-house phlebotomist to improve fragmented care were created and studied between June 2015 and December 2018. Admission rate, avoidable readmission rate, as well as other quality of care measurements were assessed with electronic medical record reports and through North Carolina Medicaid data reports. Overall Medicaid admissions decreased 32.7% from starting numbers, 40.2% below expected benchmarks. Avoidable readmissions decreased 41.8%, 53.8% below the expected benchmark. Improvements in same-day access numbers and lab completion rate were also seen. The team-based approach to eliminating patient-identified barriers decreased both admissions and avoidable readmissions for our Medicaid patients. It also improved quality-of-care measures. This approach has been shown to be beneficial at our clinic and can easily be replicated in other settings.

Child Birth Order as a Moderator of Intervention Effectiveness for the Early Childhood Version of the Family Check-Up.

Child birth order (CBO) in the family has received little attention in the field of prevention science. CBO is relevant to early interventionists from a public health perspective, as the most widely disseminated home-visiting program has traditionally targeted mothers and their first-born children. The current paper revisits a previous publication by Shaw et al. (2009) on the effectiveness of the Family Check-Up (FCU) to evaluate CBO (firstborn vs. middle vs. youngest) as a moderator of treatment effects of the FCU in relation to improvements in parenting, maternal depressive symptoms, and child outcomes from ages 2 to 4 in a sample of low-income, ethnically diverse families (N = 709) with multiple children. Results suggest that the FCU elicited improvements in observed parenting from ages 2 to 3 primarily for target children who were the youngest or middle children, but not for firstborns. Findings are discussed in the context of implications for prevention science research, dissemination, and public policy.

Education and employment outcomes in clients of the Nurse-Family Partnership.

Nurse-Family Partnership (NFP) is an evidence-based home visitation program designed for low-income, first-time mothers to support pregnancy, child development, and maternal self-sufficiency. This study examined educational and employment outcomes among NFP clients compared to a reference sample. Entropy balancing and a difference-in-difference design were used to compare the two samples of women from 2007 to 2016. There were 127,427 women in the NFP sample, and 787 women in the reference cohort. Educational outcomes included high school completion and employment outcomes consisted of employment status. Across a one-year interval, NFP mothers with less than a high school diploma or general education diploma (GED) at baseline showed a 9.5 percentage point increase in diploma or GED attainment compared to the reference mothers [95% CI: 0.015-0.180]. Similarly, mothers enrolled in NFP who were not employed at baseline showed a 7.8 percentage point increase in employment compared to the reference mothers [95% CI: 0.003-0.150]. The findings in this study show positive results for NFP mothers attaining high school completion and employment compared to mothers in the reference group. Such findings are of importance with regard to progression toward economic self-sufficiency and corresponding reduction of health disparities.

Háblame Bebé: A phone application intervention to support Hispanic children's early language environments and bilingualism.

The early language environments of low-income Hispanic children can be negatively affected when their Spanish-speaking caregivers face racism, assimilation pressure, and/or misinformed advice based on English-only ideologies. This article reports on the design and efficacy of Háblame Bebé, a language-promoting phone application that encourages low-income Hispanic mothers to talk more to their children in their native Spanish with the goals of (1) improving their children's early language environment, (2) promoting bilingualism, and (3) monitoring developmental milestones. The app was designed and tested across three phases as mandated by the US HRSA Bridging the Word Gap Challenge. In Phase I, we developed a curriculum that promotes high-quality language interactions in Spanish and designed the app components. In Phase II, we tested the app with 20 Hispanic mothers (half high school-educated, half college-educated) in a pretest-posttest design in which we examined their language interactions before and after two months of using the app. Preliminary results indicated that mother-child verbal interactions increased, but not always in their native Spanish, and the difference was not statistically significant. Focus group data revealed that many of the mothers had experienced linguistic racism and that tropes surrounding Spanish-speaking identity in the USA needed to be explicitly addressed within the intervention. In Phase III, a sociolinguistic pride component was added and the app was again tested with 12 additional Hispanic mothers (all high school-educated only). This time, a statistically significant increase in mother-child verbal interactions was found. Mothers also reported feeling prouder to use Spanish with their children. These results suggest that Háblame Bebé may be a viable means to reach low-income Hispanic caregivers who face obstacles in accessing health information and/or home-visiting programs for their children.

Development and Effects of a Depression Management Program Based on Reminiscence Therapy for the Elderly Living Alone - Individual Home Visit Programs -

The purpose of this study is to develop and apply a program to manage the depression of elderly people who live alone, which is now considered as a national and social crisis in South Korea. This study uses a similar experimental and retrospective before-and-after design with non-equivalent controls for a depression management program for the elderly who live alone. The experimental group who participated in the depression management program showed higher self-esteem and lower depression and suicide tendency scores than the control group who did not participate in the program. The depression management program was found to be an effective intervention that improves self-esteem and reduces depression and suicidal inclination among the elderly living alone. Since the effect was measured immediately after the experimental treatment, it is suggested that a long-term follow-up

Maternal Engagement in a Home Visiting Program as a Function of Fathers' Formal and Informal Participation.

Home visiting programs support new and expecting parents by strengthening parenting practices, improving parental and child health and well-being, and preventing child maltreatment. Participant retention is often a challenge for home visitation, particularly for young families, potentially reducing program impact. Father engagement in services may be one avenue for supporting continued program take-up for young parents. The current study examined associations between fathers' formal and informal participation in an infant home visiting program and mothers' take-up of home visits and whether these associations differed depending on mothers' relationship status at enrollment or timing of enrollment. Results showed that fathers' participation in home visiting supported maternal retention, particularly when fathers were formally enrolled. These associations depended on mothers' relationship status at enrollment but not on whether they enrolled pre- or postnatally. These findings have direct implications for home visiting programs, both in supporting maternal retention and in informing the recruitment and engagement of fathers.

Effectiveness of using an educational video simulating the anatomical mechanism of shaking and smothering in a home-visit program to prevent self-reported infant abuse: A population-based quasi-experimental study in Japan

BackgroundA video that simulates the anatomical mechanism of shaking the infant head, which may have a stronger impact on the viewer, and a tool to prevent self-reported smothering in response to crying, has never been investigated. ObjectiveTo investigate whether watching an educational video at home visit at 2 months postpartum on infant crying and the dangers of shaking and smothering reduces self-reported shaking and smothering behaviors at 4 months postpartum. MethodIn a quasi-experimental study in A city in Japan, the video intervention was implemented at home visits by a midwife, public health nurse or trained volunteers when babies were 2 months old. At the 4-month health checkup, participants received a questionnaire about the video, self-reported shaking and smothering behaviors and other covariates. The impacts of watching the video and self-reported shaking or smothering were analyzed using multiple logistic regression. ResultsIn total, 5961 caregivers provided valid response for this study (valid response rate: 73.8 %). In the adjusted model, those who watched the video were 74 % less likely to shake their infants (odds ratio (OR): 0.36, 95 % confidence interval (CI): 0.21–0.64), 43 % were less likely to smother their infants (OR: 0.57, 95 % CI: 0.37–0.89), 52 % were less likely to shake or smother (OR: 0.48, 95 % CI: 0.33–0.69) their infants. ConclusionThe educational video on infant crying and the dangers of shaking and smothering, with anatomical mechanism of shaking, may halve the risk of self-reported shaking and smothering at 4 months of age.

A Community Health Worker Home Visit Program: Facilitators and Barriers of Program Implementation.

Home visit programs have long been used as a means of intervention specifically among vulnerable, at-risk populations including: chronically ill, impoverished, rural, or homebound individuals. Understanding barriers and facilitators to the implementation of home visit programs is essential to inform these efforts. Home visit programs led by community health workers (CHWs) are becoming more common and pose specific challenges. The Ohio Infant Mortality Reduction Initiative is a home visit program led by CHWs with the purpose of reducing infant mortality among high-risk populations. The intervention included health education, referrals to health services, and provision of supplies and social support to expectant mothers. This study examined qualitative interviews with program managers and administrators to describe facilitators and barriers associated with this home visit program from a managerial perspective. Findings highlight the importance of initial and ongoing CHW training, appropriate caseloads, effective communication, and adequate funding, which can inform future CHW programs.

The Role of State Context in Promoting Service Coordination in Maternal, Infant, and Early Childhood Home Visiting Programs.

The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program provides funding to states to promote health and development of at-risk expectant families and families with young children. MIECHV programs are required to coordinate services within a larger system of care; yet, little is known about state-level factors that support coordination. This study examined state-level supports and barriers for coordination of home visiting with other entities within the early childhood system of care. A Web-based survey was distributed in 2016 via e-mail to MIECHV administrators in all 50 states, 5 US territories, and the District of Columbia. The survey elicited information on 5 domains shown by theory and prior research to support coordination: MIECHV leadership, state leadership, shared goals across sectors, data systems, and finance. Respondents also rated their perceptions of state-level coordination. Forty-two (75%) of the MIECHV administrators participated in the survey. States and territories varied widely within and across the 5 domains of support for coordination. MIECHV leadership was an area of relative strength, whereas data systems and finance showed the most room for improvement. State leadership and shared goals were associated with stronger perceptions of state-level coordination. The findings indicate opportunities for shared learning among states to enhance coordination infrastructure. Such efforts should include multiple stakeholder perspectives and consideration of local and organizational contexts. This work could be facilitated using the service coordination toolkit developed as part of this project.