Regular home visits by a nurse-health advocate team can improve maternal and infant outcomes for low-income, minority families, according to a study supported by the Agency for Healthcare Research and Quality (HS07624). However, to be effective, these programs must be culturally sensitive, intensive, and adequately staffed and financed, notes Kathleen F. Norr, Ph.D., of the University of Illinois at Chicago.
Dr. Norr and her colleagues recruited 406 black and 186 Mexican-American low-income pregnant women from two university-associated prenatal clinics in Chicago. They randomly assigned them to the Chicago REACH-Futures Program or to a control group and interviewed the women during the last trimester of pregnancy and at 2, 6, and 12 months after delivery to assess maternal and infant outcomes.
Each REACH team of one nurse and two trained community workers followed a caseload of 150 families. The community workers, who were familiar with the social realities of the family's community, contacted the families once a month or more often if necessary. They assessed maternal concerns and problems, upcoming developmental changes, and appropriate parenting, as well as home safety, infant health status, growth and nutrition, signs of illness and appropriate responses, and preventive care received and needed. The nurse accompanied the advocate at 1, 6, and 12 months and conducted infant health and developmental screening. The home visits did not replace regular well-child visits.
Many of the mothers were depressed and faced an average of nearly four difficult life circumstances, such as an abusive partner or an inability to pay bills. The effects of the REACH program varied by race/ethnicity. For blacks, the program was associated with better maternal documentation of infant immunizations, more developmentally appropriate parenting expectations, and higher 12-month infant mental development scores. For Mexican Americans, the program improved the women's daily living skills (such as money management or riding the bus) and scores on providing appropriate play materials. One explanation for comparatively few program effects was maternal depression and the extreme economic and environmental deprivation faced by families in the study.
See "Maternal and infant outcomes at one year for a nurse-health advocate home visiting program serving African Americans and Mexican Americans," by Dr. Norr, Kathleen S. Crittenden, Ph.D., Evelyn L. Lehrer, Ph.D., and others, in Public Health Nursing 20(3), pp. 190-203, 2003.