Replicating Evidence-Based Practices with Flexibility for Perinatal Home Visiting by Paraprofessionals.

ABSTRACT: Introduction Strategies are needed to improve the efficacy of paraprofessional home visitors for pregnant women in the United States. This study evaluates the maternal and child outcomes when evidence-based practices (EBP) are replicated with flexibility, rather than fidelity to a manualized intervention. Methods Pregnant mothers (N?=?203) in five clinics were recruited in the waiting rooms and randomized to standard clinic care as the control condition (n?=?104) or standard care plus home visiting (n?=?99). Home visitors (n?=?9) were selected, trained in foundational skills common to EBP and four problem domains (weight control, breastfeeding, daily habits, and depression). Independent interviewers assessed targeted outcomes at birth (82%) and 6 months later (83%). RESULTS:Home visitors, called Mentor Mothers [MM], made an average of 14.9 home visits or telephone contacts (SD?=?9; total contacts?=?1491) addressing maternal daily habits, breastfeeding, and depression. Intervention and control mothers were similar in weight, Body Mass Index (BMI), depression and social support at baseline and 6 months later. The percentage of low birth weight babies was similar; intervention infants' growth (weight/height Z score) tended to be significantly better compared to the control condition. DISCUSSION:There are many explanations for the failure to find significant benefits: insufficient statistical power; the benefits of repeated assessments by warm, supportive peers to improve outcomes; or the failure of EBP and the need to maintain replication with fidelity. All study mothers had better outcomes than documented among comparable published samples of low-income, Latina and Korean-American mothers in Los Angeles, CA. ClinicalTrials.gov registration NCT01687634.

SUBMITTER: Rotheram-Fuller EJ 

PROVIDER: S-EPMC5671538 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature