Home-visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial.
OBJECTIVE
To assess the impact of a paraprofessional-delivered home-visiting intervention to promote child care knowledge, skills, and involvement among pregnant American Indian adolescents.


METHODS
Randomized controlled trial comparing a family-strengthening intervention with a breastfeeding education program.


METHODS
One Apache and 3 Navajo communities.


METHODS
Fifty-three pregnant American Indian adolescents were randomly assigned to intervention (n = 28) or control (n = 25) groups. Follow-up data were available for 19 intervention and 22 control participants. Intervention Paraprofessionals delivered 41 prenatal and infant care lessons in participants' homes from 28 weeks' gestation to 6 months post partum.


METHODS
Child care knowledge, skills, and involvement.


RESULTS
Mothers in the intervention compared with the control group had significantly higher parent knowledge scores at 2 months (adjusted mean difference [AMD], +14.9 [95% confidence interval (CI), +7.5 to +22.4]) and 6 months post partum (AMD, +15.3 [95% CI, +5.9 to +24.7]). Intervention group mothers scored significantly higher on maternal involvement scales at 2 months post partum (AMD, +1.5 [95% CI, -0.02 to +3.02]), and scores approached significance at 6 months post partum (AMD, +1.1 [95% CI, -0.06 to +2.2]). No between-group differences were found for child care skills.


CONCLUSIONS
A paraprofessional-delivered, family-strengthening home-visiting program significantly increased mothers' child care knowledge and involvement. A longer and larger trial is needed to understand the intervention's potential to improve adolescent parenting and related child outcomes in American Indian communities.
Barlow
Allison
A
Johns Hopkins Center for American Indian Health, 621 N. Washington Street, Baltimore, MD 21205, USA. abarlow@jhsph.edu
Varipatis-Baker
Elena
E
Speakman
Kristen
K
Ginsburg
Golda
G
Friberg
Ingrid
I
Goklish
Novalene
N
Cowboy
Brandii
B
Fields
Pauline
P
Hastings
Ranelda
R
Pan
William
W
Reid
Raymond
R
Santosham
Mathuram
M
Walkup
John
J
D000293:Adolescent; D003150:Community Health Workers; D005260:Female; D006699:Home Care Services; D006801:Humans; D007198:Indians, North American; D007223:Infant; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D009035:Mothers / Q000193:education*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy