title: An equivalence evaluation of a nurse-moderated group-based internet support program for new mothers versus standard care: a pragmatic preference randomised controlled trial.
abstract: BACKGROUND
  All mothers in South Australia are offered a clinic or home-visit by a Child and Family Health community nurse in the initial postnatal weeks. Subsequent support is available on request from staff in community clinics and from a telephone helpline. The aim of the present study is to compare equivalence of a single clinic-based appointment plus a nurse-moderated group-based internet intervention when infants were aged 0-6 months versus a single home-visit together with subsequent standard services (the latter support was available to mothers in both study groups).
  
  
  METHODS
  The evaluation utilised a pragmatic preference randomised trial comparing the equivalence of outcomes for mothers and infants across the two study groups. Eligible mothers were those whose services were provided by nurses working in one of six community clinics in the metropolitan region of Adelaide. Mothers were excluded if they did not have internet access, required an interpreter, or their nurse clinician recommended that they not participate due to issues such as domestic violence or substance abuse. Randomisation was based on the service identification number sequentially assigned to infants when referred to the Child and Family Health Services from birthing units (this was done by administrative staff who had no involvement in recruiting mothers, delivering the intervention, or analyzing results for the study). Consistent with design and power calculations, 819 mothers were recruited to the trial. The primary outcomes for the trial are parents' sense of competence and self-efficacy measured using standard self-report questionnaires. Secondary outcomes include the quality of mother-infant relationships, maternal social support, role satisfaction and maternal mental health, infant social-emotional and language development, and patterns of service utilisation. Maternal and infant outcomes will be evaluated using age-appropriate questionnaires when infants are aged <2 months (pre-intervention), 9, 15, and 21 months.
  
  
  CONCLUSIONS
  We know of no previous study that has evaluated an intervention that combines the capacity of nurse and internet-based services to improve outcomes for mothers and infants. The knowledge gained from this study will inform the design and conduct of community-based postnatal mother and child support programs.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12613000204741.
authors.affiliation: School of Population Health, University of Adelaide, Adelaide, Australia. alyssa.sawyer@adelaide.edu.au.
authors.forename: Alyssa C P
authors.initials: AC
authors.lastname: Sawyer
authors.forename: John
authors.initials: J
authors.lastname: Lynch
authors.forename: Kerrie
authors.initials: K
authors.lastname: Bowering
authors.forename: Debra
authors.initials: D
authors.lastname: Jeffs
authors.forename: Jenny
authors.initials: J
authors.lastname: Clark
authors.forename: Christine
authors.initials: C
authors.lastname: Mpundu-Kaambwa
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sawyer
mesh_terms: D001315:Australia; D002657:Child Development; D003142:Communication; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020407:Internet; D016389:Maternal-Child Nursing; D009034:Mother-Child Relations; D009035:Mothers; D009769:Object Attachment; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic / Q000379:methods*; D010371:Pediatric Nursing; D012944:Social Support; D011795:Surveys and Questionnaires