Study Details | Pathways to Work

28418-Study of the Nurse-F

Study quality: High

High

Reason for the rating: This study received a high study quality rating because it is a low-attrition randomized controlled trial with no known issues that suggest the findings cannot be attributed to the intervention.

Intervention: Prenatal and Infancy Home Visiting by Nurses

Population and employment barriers:

Parents, Sex (Female)

Services provided:

Health services (Physical health services)

Setting: Urban only

Study design

Design:

Randomized controlled trial

Study group formation:

This study was a randomized controlled trial. The study aimed to enroll unmarried women who had low incomes. To be eligible to participate, a woman had to be at least 29 weeks pregnant, have had no previous live births, and have no chronic illnesses that might influence the health and development of the fetus. In addition, the mothers had to meet at least two of the following socioeconomic risk factors: be unmarried, have less than 12 years of education, or be unemployed. A total of 1,290 women who received services from the obstetrical clinic at the Regional Medical Center in Memphis met the eligibility criteria and were invited to participate. After completing informed consent, the women were randomly assigned to an intervention or comparison condition. After this, they were eligible to begin receiving assigned services. Participants enrolled from June 1990 to August 1991. A total of 1,139 women completed informed consent and were randomized to one of several intervention or comparison conditions. The two groups followed in the study contained 743 participants, including 228 participants in the intervention condition and 515 in the comparison condition.

Time period of study:

The intervention was studied for 12 years.

Primary outcome domains examined:

Increase short-term employment, Increase long-term employment, Decrease short-term benefit receipt, Decrease long-term benefit receipt

Other outcome domains examined:

Maternal outcomes: socioeconomic status; relationship with biological father; intimate partner violence; role impairment due to alcohol or other drug use; moderate/heavy alcohol use; marijuana use; incarceration; arrests; symptoms of psychological distress, borderline or clinical; duration of current partner relationship; months between first and second children; cumulative subsequent births; maternal mastery; child foster care placements; spontaneous and therapeutic abortions; still births; low birth-weight newborns; and neonatal intensive care unit admissions. Child outcomes: attended Head Start, preschool, day care, or any early intervention; academic engagement; classroom social skills; mental processing composite; receptive vocabulary; internalizing behaviors; externalizing behaviors; GPA; reading and math achievement tests; conduct grades; antisocial behavior; academically focused behavior; peer affiliation; conduct failures; depressive and anxiety disorders; disruptive behavior disorders; grade retention; and special education placement.

Study funded by:

The study was supported by grants from the National Institute of Mental Health at the National Institutes of Health and by the Office of Juvenile Justice and Delinquency Prevention at the U.S. Department of Justice.

Results

View table help Need more context or definitions for the table below? View the table help to get insight into terms, measures, and definitions.

Scroll to the right to view the rest of the table columns

Outcome domain	Measure	Timing	Study quality by finding	Comparison group mean	Intervention group mean	Impact	Units	Sample size
Increase short-term employment	Number of months employed, annual	Year 1	High	1.70	2.20	0.50	Months	682
Increase long-term employment	Number of months employed, follow-up period	Months 0–54	High	18.84	19.89	1.05	Months	646
Decrease short-term benefit receipt	Average months received AFDC/TANF, follow-up period	Year 1	High	7.60	7.30	-0.30	Months	656
Decrease long-term benefit receipt	Average months received AFDC/TANF, follow-up period	Years 1–5	High	36.19	32.55	-3.64	Months	656
Decrease long-term benefit receipt	Average months received Food Stamps/SNAP, follow-up period	Years 1–5	High	45.04	41.57	-3.47	Months	656
Decrease long-term benefit receipt	Average months received Medicaid, follow-up period	Months 0–54	High	41.08	39.59	-1.49	Months	646
Decrease long-term benefit receipt	Average months received WIC, follow-up period	Months 0–54	High	23.33	21.51	-1.82	Months	646

Short-term outcomes are those measured 18 months or fewer after participants are first offered services. Long-term outcomes are those measured between 18 months and 5 years after participants are first offered services. Very long-term outcomes are those measured 5 years or more after participants are first offered services.

Findings quality key:

High
Moderate

Study quality terms?

The findings quality describe our confidence that a given study’s finding is because of the intervention. We do not display findings that rate low.

Findings key:

A moderate-to-large favorable finding that is unlikely to be due to chance
A moderate-to-large favorable finding that might to be due to chance
A small favorable finding that is unlikely to be due to chance
A small favorable finding that might be due to chance
A favorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
A favorable finding that might be due to chance, but we cannot determine the standardized effect size
A moderate-to-large unfavorable finding that is unlikely to be due to chance
A moderate-to-large unfavorable finding that might to be due to chance
A small unfavorable finding that is unlikely to be due to chance
A small unfavorable finding that might be due to chance
An unfavorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
An unfavorable finding that might be due to chance, but we cannot determine the standardized effect size
A finding that is unlikely to be due to chance, but we cannot determine the standardized effect size or direction
A finding of no effect that might be due to chance

Favorable findings are impacts in a direction that is socially desirable. Statistical significance indicates the likelihood that a study finding is due to the intervention, rather than due to chance. Findings are described as moderate-to-large if the intervention produced a sufficiently large change in the outcome. An impact receives this designation if the standardized effect size is equal to or greater than 0.25 or equal to or less than -0.25.

Sample characteristics

All participants were women who were at least 29 weeks pregnant and expecting their first child to be born at of the start of the study. About 9 percent of participants were White, and less than 2 percent were married at the start of the program. The average age at enrollment was 18, and participants had, on average, about 10 years of education.

Age

Mean age

18 years

Sex

Female

100%

Participant race and ethnicity

Black or African American	92%
White, not Hispanic	9%

The race and ethnicity categories may sum to more than 100 percent if the authors reported race and ethnicity separately; in these cases, we report the category White, rather than White, not Hispanic.

Family status

Married	2%
Parents	100%

Intervention implementation

Implementing organization:

Memphis/Shelby County Health Department

Program history:

A trial of the program was conducted in Elmira, NY, a semirural area. This study is a replication of the trial in an urban area with a minority population.

Intervention services:

The Prenatal and Infancy Home Visiting by Nurses program provided intensive nurse home visiting services to first-time mothers who had sociodemographic risk factors, including being unmarried, having less than 12 years of education, or being unemployed. Home visits focused on improving health-related behaviors and parenting, as well as developing personal goals related to educational attainment and employment. These services took place during the mother's pregnancy, as well as at one postpartum visit before the mother left the hospital, one postpartum visit at home, and continued visits until the child was 24 months old. Mothers also received free transportation to and from scheduled prenatal care appointments. After the child was born, the children received developmental screening and referral services when they were 6, 12, and 24 months old.

Mandatory services:

None

Comparison services:

The comparison group received free transportation to and from scheduled prenatal care appointments. After the child was born, the group received developmental screening and referral services when the child was 6, 12, and 24 months old.

Service receipt duration:

Participants received services during their pregnancy and through the child's second birthday.

Intervention funding:

Not described.

Study publications

Kitzman, Harriet, David L. Olds, Charles R. Henderson, Carole Hanks, Robert Cole, Robert Tatelbaum, Kenneth M. McConnochie, Kimberly Sidora, Dennis W. Luckey, David Shaver, Kay Engelhardt, David James, and Kathryn Barnard (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: A randomized controlled trial, JAMA 278(8): 644-652.

Kitzman, Harriet, David L. Olds, Kimberly Sidora, Charles R. Henderson, Carole Hanks, Robert Cole, Dennis W. Luckey, Jessica Bondy, Kimberly Cole, and Judith Glazner (2000). Enduring effects of nurse home visitation on maternal life course: A 3-year follow-up of a randomized trial, JAMA 283(15): 1983-1989.

Olds, David L., Harriet Kitzman, Carole Hanks, Robert Cole, Elizabeth Anson, Kimberly Sidora-Arcoleo, Dennis W. Luckey, Charles R. Henderson, John Holmberg, Robin A. Tutt, Amanda J. Stevenson, and Jessica Bondy (2007). Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial, Pediatrics 120(4). Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839449/

Olds, David L., Harriet Kitzman, Robert Cole, JoAnn Robinson, Kimberly Sidora, Dennis W. Luckey, Charles R. Henderson, Carole Hanks, Jessica Bondy, and John Holmberg (2004). Effects of nurse home-visiting on maternal life course and child development: Age 6 follow-up results of a randomized trial, Pediatrics 114(6): 1550-1559.

Olds, David. L., Harriet J. Kitzman, Robert E. Cole, Carole A. Hanks, Kimberly J. Arcoleo, Elizabeth A. Anson, Dennis W. Luckey, Michael D. Knudtson, R. Charles, and Jessica Bondy (2010). Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: Follow-up of a randomized trial among children at age 12 years, Archives of Pediatrics & Adolescent Medicine 164(5): 419-424. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249758/pdf/nihms344055.pdf

View the glossary for more information about these and other terms used on this page.

The Pathways Clearinghouse refers to interventions by the names used in study reports or manuscripts. Some intervention names may use language that is not consistent with our style guide, preferences, or the terminology we use to describe populations.

Study of Prenatal and Infancy Home Visiting by Nurses