The effect of health visitors' postpartum home visit frequency on first-time mothers: cluster randomised trial.
BACKGROUND
Postpartum home visiting by nurses can benefit higher-risk families. Yet, little is known about the effects of universal services which provide care for all families including those at lowest risk (e.g., provision by health visitors-United Kingdom specialist community public health nurses).


OBJECTIVE
It was to determine the effect of frequency of health visitors' home visits on 'low-risk' first-time families' outcomes to 8 weeks postpartum and 7 months follow-up.


METHODS
A cluster randomised controlled trial.


METHODS
Within one health and social care managerial area in Northern Ireland.


METHODS
First-time 'low risk' mothers who had given birth during 2002-2004 and were visited by a health visitor who had agreed to take part in the study, were invited to participate. In total, n=39 health visitors were allocated to 'intervention' and n=41 to 'control'. Of n=295 'low-risk' first-time mothers who agreed to take part, n=136 with intervention health visitors were offered six home visits 2-8 weeks postpartum and n=159 within the control group were offered one planned visit.


METHODS
Self-completed measures of parenting, maternal wellbeing and service use were gathered pre-intervention, 8 weeks and 7 months postpartum. The main outcome was the Edinburgh Postnatal Depression Scale (EPDS). At 8 weeks and 7 months postpartum, n=129 and n=115 intervention mothers, also n=151 and n=141 control mothers completed outcome measures.


RESULTS
An intention to treat analysis was performed using multilevel modelling analysis which statistically controlled for pre-home visit outcomes, clinic attendance and antenatal contact. The intervention had no impact on most outcomes, however, it was associated with an increased EPDS score (after adjustment: 0.16, 2.36 95% CI) at 8 weeks (before accounting for outliers) but not at 7 months (-0.62, 1.65 95% CI). Intervention mothers had higher service satisfaction (7.7, 21.28, 95% CI 8 weeks; 4.69, 22.71, 7 months) and were less likely to have used emergency medical services for their infants to 8 weeks (OR: 0.15, 0.85, 95% CI).


CONCLUSIONS
Weekly postpartum visits to 'low-risk' mothers had variable effects, therefore, practitioners and researchers should consider further development and application of effective, evidence based home visiting content.
School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, United Kingdom. j.christie@qub.ac.uk
Janice
J
Christie
Brendan
B
Bunting
D003152:Community Health Nursing; D005260:Female; D006792:House Calls; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy