The effectiveness of home visiting as a delivery strategy for public health nursing interventions to clients in the prenatal and postnatal period: a systematic review

Abstract

The purpose of this systematic overview was to assess the evidence for the effectiveness of public health nursing interventions when carried out by the strategy of home visiting of clients in the pre-and postnatal period. This is an update of a larger overview first collecting literature to 1993, then updated to the end of 1995, and now updated to 1998. The search of published and unpublished literature related to home visiting resulted in retrieval of a total of 211 articles, including 149 articles relevant to all age groups and including all interventions implemented by various professional and nonprofessional groups, where the intervention was considered to be within the scope of practice of public health nursing in Ontario. When the relevance was limited to interventions where the intervenor was known to be a nurse, and the clients were in the pre-or postnatal period, there were 20 articles with quality ratings of 'strong' or 'moderate' included in this update for the systematic review, and 8 additional articles in this update. There were no reported negative effects of home visiting in the 12 strong articles. Positive outcomes included improvement in children's mental development, mental health and physical growth, reduction in the mother's depression, improvement in maternal employment, education, nutrition and other health habits, and government cost saving. There is no proven impact on low birth weight, gestational age or neonatal morbidity or mortality, although the studies had inadequate sample sizes to demonstrate a difference in such relatively rare occurrences. As a delivery strategy, nurses visiting pre-and postnatal clients in the home can produce significant benefit, particularly with interventions of high intensity and with clients who are considered to be 'at risk' due to factors such as low income and low educational achievement.

Public health care nurses’ views of mothers’ mental health in paediatric healthcare services: a qualitative study

“…Others (e.g., Ciliska et al, 2001) have verified the beneficial effects of home visits. It is worth nothing that in the Swedish context only one home visit is generally conducted, and the main contacts between mother and nurse take place at the clinic.…”

Measuring Dosage: A Key Factor When Assessing the Relationship Between Prenatal Case Management and Birth Outcomes

“…Many of these studies have shown significant benefits for participants in mental health, substance use, employment attainment, parenting skills, and educational attainment (2–9). Unfortunately, studies examining outcomes such as low birthweight (LBW) and preterm birth (PTB) have shown little or no benefit from PCM participation (4,9,10). Studies that do show a significant improvement in birth outcomes seem to detect differences only in the extremes of the outcomes, very PTB (<34 weeks) and very LBW (<1500 g) (4,11).…”

“…Studies that do show a significant improvement in birth outcomes seem to detect differences only in the extremes of the outcomes, very PTB (<34 weeks) and very LBW (<1500 g) (4,11). Critiques of previous studies of PCM suggest that the failure to detect an effect may be due to a lack of statistical power resulting from a small sample size, (6,10,12) selection bias, (9,12) or failure to assess PCM dosage (6,10,13–15). …”

“…Since health and social needs differ among women, the intervention breadth, amount of time spent with a CM, and duration of enrollment in PCM is unique to each woman (15). Most studies evaluating the relationship between PCM and pregnancy outcomes have only assessed the effect of participation as a dichotomous exposure, giving no consideration to variations in intervention intensity, and the content of individualized care plans (10,14,15,17). This simple dichotomy fails to describe the amount of effort expended by both the CM and the enrolled woman to reach the targeted outcomes.…”

“…Unfortunately, RCTs are expensive and may not be ethically feasible for high-risk pregnant women. Although some RCTs have been conducted in studies of PCM, most suffer from small sample sizes and lack of power to detect differences for rare outcomes (i.e., LBW and PTB) (10,17). The majority of PCM studies investigating pregnancy outcomes have been observational.…”