Home visits by nurses to young women who are pregnant improve the lives not only of the children but also the mothers and their partners as well, a study published in the April 19 issue of the Journal of the American Medical Association has found. The positive effects last for years.
The program, developed by researchers at the University of Rochester and the Colorado Health Sciences Center, is one of only a handful of programs that have been shown to promote self sufficiency among young, struggling families. Compared to families who did not receive prenatal and infancy home visits by nurses, families who were visited spent fewer months on welfare and food stamps. Mothers in these families also had fewer subsequent pregnancies and longer intervals between the birth of their first and second child. And their family structure was more stable, with women's partners more involved in the raising of the child and more likely to be employed.
The latest study of 1,139 young mothers was done in Memphis, Tenn., in the early 1990s. The majority of participants were African-American, and most were 18 or younger. Most were unmarried, had not graduated from high school, and were unemployed. One group received standard care; nurses visited women in the other group in their homes during pregnancy and for two years after the birth of their first child. Researchers then tracked the participants for three years after the program ended.
"The investment that society can make at this critical stage in a woman's life pays off over the long run in many ways having to do not only with care of the children but also with the woman's potential for economic self-sufficiency and the stability in her relationships," says Harriet Kitzman, R.N., Ph.D., the Loretta Ford Professor of Nursing at the University of Rochester School of Nursing.
The nurse visitation program was developed more than 20 years ago by developmental psychologist David Olds, Ph.D., formerly on the University of Rochester faculty and now at the University of Colorado Health Sciences Center, and other University of Rochester faculty members. Working as a pediatric nurse practitioner in the late 1960s, Kitzman actively engaged in home nursing visits and noticed the difference in the lives of the families she visited. She hooked up with Olds, who was conducting a study of home visits in Elmira, a small city in a rural area in southern New York State, to conduct a study that has been underway for nearly 20 years. Those results from a very different socio-cultural group, announced previously, mirror the latest findings. In addition, the team has tracked children from the Elmira study for 15 years and has found that children in families who were visited by nurses are less likely to use drugs, have fewer run-ins with the law, have fewer injuries, and are less likely to engage in irresponsible sexual behavior.
"There's a universal desire on the parts of mothers to protect their children and create optimal opportunities for them," Kitzman says. "Regardless of whether you're talking about rural white women or urban black women, mothers want the best for their children. This program helps women develop the resources to achieve that, so it's not surprising that the findings replicate from one site to another."
As a result of the studies, 130 communities around the country now use the nurse visitation program developed by Olds and Kitzman. A center that trains health officials to use the program is based at the University of Colorado and is funded by the Robert Wood Johnson Foundation.
The visits are geared toward young first-time mothers without many resources. The women may have dropped out of school, may not have the support of a spouse or partner, and often haven't developed a means to provide for their child. "While the women have observed mothering before, this is their first experience as parents, and they are open to learning more about what infants need for optimal development," Kitzman says.
The starting point for most of the nurse visits was the health of the baby. The nurses and mothers talked about how to read the subtle cues that babies give off, how to look for signs of illness, what to expect at certain ages, and the risks of habits like smoking and drinking.
"The nurses provide information about the health aspects of pregnancy, and that provides an entry point to a number of other issues. The topic of health provides an easy entry for the nurse and mother to work on other stresses the woman and her family are experiencing."
Building on the bond of trust centered on the baby's welfare, conversations typically branched out into other areas. Continuing their education, housing needs, employment opportunities, the availability of other resources, and the involvement of the women's partners and other family members in caring for the child were among the topics of most visits.
"Many visits really came to center on helping the women envision the future and to set goals for themselves," says Kitzman. "The nurse became the person to help the mother see the opportunities, and to develop the resources and skills to take advantage of them."
Kitzman and Olds were joined on the study by several other authors from Rochester, Colorado, Cornell University, and the Baylor School of Nursing. Other authors from Rochester include Robert Cole, Ph.D., associate professor of nursing and of psychiatry, and research associate Kimberly Sidora, M.P.H. The study was funded by the Department of Health and Human Services, the Carnegie Corporation of New York, and the Robert Wood Johnson Foundation.
Journal
JAMA