Effects of home visits to vulnerable young families

Nurses' home visits to new parents have been replaced in many high-need communities by nonprofessional visits without clear evidence of effectiveness. Previous reviews of home visiting research have combined nurse and non-nurse interventions and have pooled studies from the US, where home visiting is mainly limited to low-income families, with those from nations where home visiting is a universal service. This integrative review was focused on nurse-delivered interventions in the US and Canada to identify the nursing-specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim.

The sample consisted of 20 experimental and quasi-experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity.

Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described.

Maternal outcomes, maternal-infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well-child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well-educated nurses, and were focused on building a trusting relationship and coaching maternal-infant interaction. Social ecology theory was partially supported.

Future nurse home-visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse-delivered interventions for vulnerable families.