A Nurse Home Visiting Program for Pregnant Adolescents: A Randomized Controlled Trial

Abstract Objective To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life.Methods We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse HVP for adolescent mothers living in a poor urban area of São Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Laços (intervention group, n = 40) or healthcare as usual (control group, n = 40) groups. Primeiros Laços is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child’s age of 24 months. Participants were assessed by blind interviewers at 8–16 weeks of pregnancy (baseline), 30 weeks of pregnancy, 3, 6, and 12 months of child’s age. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment (HOME). Generalized estimating equation (GEE) models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen’s d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818.Results Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient = 0.89, 95% CI [0.18, 1.61], p = 0.014), maternal emotional/verbal responsivity (coefficient = 0.97, 95% CI [0.37, 1.58], p = 0.002), and opportunities for variety in daily stimulation (coefficient = 0.37, 95% CI [0.09, 0.66], p = 0.009). Standardized effect sizes of the intervention were small to moderate.Conclusions Primeiros Laços is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers.

Download Full-text

A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents

Scientific Reports ◽

10.1038/s41598-021-93938-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daniel Fatori ◽

Pedro Fonseca Zuccolo ◽

Elizabeth Shephard ◽

Helena Brentani ◽

Alicia Matijasevich ◽

...

Keyword(s):

Child Development ◽

Home Environment ◽

Adolescent Mothers ◽

Home Visiting ◽

Controlled Trial ◽

Effect Sizes ◽

Randomized Controlled ◽

Nurse Home Visiting ◽

Standardized Effect Sizes ◽

Home Visiting Program

AbstractTo test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life. We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse HVP for adolescent mothers living in a poor urban area of São Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Laços (intervention group, n = 40) or healthcare as usual (control group, n = 40). Primeiros Laços is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child’s age of 24 months. Participants were assessed by blind interviewers at 8–16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and 3, 6, 12, and 24 months of child’s age. We assessed oscillatory power in the mid-range alpha frequency via electroencephalography when the children were aged 6 months. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment. Generalized estimating equation models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen’s d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818. Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient = 0.89, 95% CI [0.18, 1.61], p = 0.014), maternal emotional/verbal responsivity (coefficient = 0.97, 95% CI [0.37, 1.58], p = 0.002), and opportunities for variety in daily stimulation (coefficient = 0.37, 95% CI [0.09, 0.66], p = 0.009). Standardized effect sizes of the intervention were small to moderate. Primeiros Laços is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers. However, considering the limitations of our study, future studies should be conducted to assess Primeiros Laços potential to benefit this population.Clinical Trial Registration: The study was registered at clinicaltrial.gov (Registration date: 21/06/2016 and Registration number: NCT02807818).

Download Full-text

Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial

JMIR mhealth and uhealth ◽

10.2196/13686 ◽

2020 ◽

Vol 8 (7) ◽

pp. e13686

Author(s):

Daniel Fatori ◽

Adriana Argeu ◽

Helena Brentani ◽

Anna Chiesa ◽

Lislaine Fracolli ◽

...

Keyword(s):

Adolescent Mothers ◽

Home Visiting ◽

Controlled Trial ◽

Compliance Rate ◽

Well Being ◽

Control Group ◽

Pregnant Adolescents ◽

Maternal Parenting ◽

Randomized Controlled ◽

Nurse Home Visiting

Background Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818

Download Full-text

Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial (Preprint)

10.2196/preprints.13686 ◽

2019 ◽

Author(s):

Daniel Fatori ◽

Adriana Argeu ◽

Helena Brentani ◽

Anna Chiesa ◽

Lislaine Fracolli ◽

...

Keyword(s):

Adolescent Mothers ◽

Home Visiting ◽

Controlled Trial ◽

Compliance Rate ◽

Well Being ◽

Control Group ◽

Pregnant Adolescents ◽

Maternal Parenting ◽

Randomized Controlled ◽

Nurse Home Visiting

BACKGROUND Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. OBJECTIVE Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. METHODS We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. RESULTS We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). CONCLUSIONS The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. CLINICALTRIAL ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818

Download Full-text

Promoting mother‐infant relationships and underlying neural correlates: Results from a randomized controlled trial of a home‐visiting program for adolescent mothers in Brazil

Developmental Science ◽

10.1111/desc.13113 ◽

2021 ◽

Author(s):

Fernanda Speggiorin Pereira Alarcão ◽

Elizabeth Shephard ◽

Daniel Fatori ◽

Renata Amável ◽

Anna Chiesa ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Adolescent Mothers ◽

Home Visiting ◽

Controlled Trial ◽

Neural Correlates ◽

Randomized Controlled ◽

Home Visiting Program

Download Full-text

Improving Adolescent Parenting: Results From a Randomized Controlled Trial of a Home Visiting Program for Young Families

American Journal of Public Health ◽

10.2105/ajph.2015.302919 ◽

2016 ◽

Vol 106 (2) ◽

pp. 342-349 ◽

Cited By ~ 25

Author(s):

Francine Jacobs ◽

M. Ann Easterbrooks ◽

Jessica Goldberg ◽

Jayanthi Mistry ◽

Erin Bumgarner ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Home Visiting ◽

Controlled Trial ◽

Adolescent Parenting ◽

Randomized Controlled ◽

Home Visiting Program

Download Full-text

Healthy Start Home Visiting Program—School-Based Model: Cluster Randomized Controlled Trial

Research on Social Work Practice ◽

10.1177/1049731518786578 ◽

2018 ◽

Vol 29 (6) ◽

pp. 628-643 ◽

Cited By ~ 2

Author(s):

Cynthia Leung ◽

Sandra Tsang ◽

Kitty Heung ◽

Mia Tam

Keyword(s):

Randomized Controlled Trial ◽

Home Visiting ◽

Controlled Trial ◽

Healthy Start ◽

Control Groups ◽

Randomized Controlled ◽

Children's Behavior ◽

School Based ◽

Home Visiting Program ◽

Cluster Randomized

Objective: This study evaluated the effectiveness of the Healthy Start Home Visiting Program—School-Based Model (HSS), using a cluster randomized controlled trial design. Methods: Participants included 224 parents from 20 preschools randomized into intervention and wait-list control groups at the preschool level. Furthermore, 105 parents from the participating preschools were trained as parent ambassadors to assist in program delivery. They were randomized into intervention and control groups at the preschool level. Outcome measures included parent and teacher reports on children’s learning, parent report on children’s behavior and health, their own parenting, and direct assessment of children. Parent ambassadors completed measures on parenting and their children’s behavior before training and after program delivery. Results: There was significant improvement at postintervention in parenting, children’s behavior, and learning and health in the intervention group, compared with the control group. Conclusions: The results provided evidence on the effectiveness of the HSS program.

Download Full-text