Tough Suzanne C, Johnston David W, Siever Jodi E, Jorgenson Gayleen, Slocombe Linda, Lane Carolyn, Clarke Margaret
Department of Paediatrics, University of Calgary, Canada.
Birth. 2006 Sep;33(3):183-94. doi: 10.1111/j.1523-536X.2006.00103.x.
The addition of supplementary prenatal support may improve the health and well-being of high-risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community-based population of pregnant women.
Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling).
Overall, those in the nurse intervention group were more likely to attend an "Early Bird" prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy-related topics but had little impact on resource use for mental health and poverty-related needs. Among those with added support, resource use among low-risk women was generally greater than among high-risk women.
Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community-based resources. This finding was true even for high-risk women, although this intervention did not reduce the difference in resource use between high- and low-risk women.
增加产前辅助支持可能会改善高危妇女及其家庭的健康和福祉。这项随机对照试验的目的是研究产前辅助护理对社区孕妇群体资源利用情况的影响。
来自三家城市产科诊所的孕妇被随机分为三组：（a）接受当前医生护理标准；（b）接受当前护理标准并加上护士咨询；（c）在（b）的基础上加上家访员咨询。参与者为1352名妇女，她们接受了3次电话访谈。主要结果是资源利用情况（如参加产前课程、接受营养咨询）。
总体而言，护士干预组的妇女更有可能参加“早鸟”产前课程和育儿课程，并使用营养咨询服务以及寻求儿童保育协助机构的帮助。获得额外护理和家访支持的妇女更有可能使用书面资源指南、营养咨询服务以及寻求儿童保育协助机构的帮助。在高危妇女（如存在语言障碍、产妇年龄小、低收入）中，护士干预显著增加了早期产前课程的使用率，而护士和家访员干预则显著增加了书面资源指南和营养咨询服务的使用率。该干预措施大幅增加了在众多与怀孕相关主题上所获取的信息量，但对心理健康和贫困相关需求的资源利用影响甚微。在获得额外支持的人群中，低危妇女的资源利用情况总体上高于高危妇女。
护士或护士与家访员提供的额外支持能够成功满足信息需求，并增加妇女利用现有社区资源的可能性。即使对于高危妇女也是如此，尽管该干预措施并未缩小高危与低危妇女在资源利用方面的差距。
