Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis.
OBJECTIVE
To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment.


METHODS
Systematic review of the literature of randomised controlled trials and quasi-experimental studies evaluating home visiting programmes involving at least one postnatal visit.


METHODS
Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes.


RESULTS
Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures.


CONCLUSIONS
Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.
Kendrick
D
D
Division of General Practice, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK. denise.kendrick@nottingham.ac.uk
Elkan
R
R
Hewitt
M
M
Dewey
M
M
Blair
M
M
Robinson
J
J
Williams
D
D
Brummell
K
K
D002648:Child; D002662:Child Health Services / Q000592:standards; D002669:Child Welfare; D002675:Child, Preschool; D003152:Community Health Nursing / Q000592:standards; D006699:Home Care Services / Q000592:standards; D006792:House Calls; D006801:Humans; D015201:Meta-Analysis as Topic; D017063:Outcome Assessment, Health Care; D016487:Parenting; D011379:Prognosis; D015397:Program Evaluation; D011788:Quality of Life; D006113:United Kingdom