Home visiting by paraprofessionals and by nurses: a randomized, controlled trial

Area of Science:

• Maternal and Child Health
• Public Health Interventions
• Behavioral Science

Background:

• Home visiting programs aim to improve maternal and child health.
• Effectiveness can vary based on the type of professional providing the service.
• Previous research suggests nurse-led programs are effective.

Purpose of the Study:

• To compare the effectiveness of home visiting by paraprofessionals versus nurses.
• To assess outcomes when both visitor types use a proven program model.
• To determine the impact on maternal health, child development, and family well-being.

Main Methods:

• Randomized controlled trial in Denver, Colorado.
• Included 735 pregnant women randomized to control, paraprofessional, or nurse conditions.
• Outcomes measured included maternal cotinine levels, subsequent pregnancies, child development, and interaction quality.

Main Results:

• Nurses significantly reduced maternal smoking, subsequent pregnancies, and improved mother-infant interaction and child development.
• Paraprofessionals showed limited effects, primarily in mother-infant interaction for mothers with low psychological resources.
• Nurse-led interventions demonstrated statistically significant improvements across a broad range of maternal and child health indicators.

Conclusions:

• Nurse-led home visiting programs are highly effective in improving maternal and child health outcomes.
• Paraprofessionals, while trained in the same model, yielded smaller, often non-significant effects.
• The findings underscore the significant impact of skilled nursing in early intervention programs.