Macdonald G, Bennett C, Dennis J, Coren E, Patterson J, Astin M, Abbott J
School of Sociology, Social Policy and Social Work, Director of Education, Queen's University Belfast, 6 College Park, Belfast, Northern Ireland, UK, BT7 1LP.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD006723. doi: 10.1002/14651858.CD006723.
Babies born to socio-economically disadvantaged mothers are at higher risk of injury, abuse or neglect and health problems than babies born to more affluent mothers; disadvantaged teenage mothers are at particular risk of adverse outcomes. Home-visiting programs are thought to improve outcomes for both mothers and children, largely through advice and support.
To assess the effectiveness of home-visiting programmes for women who have recently given birth and who are socially or economically disadvantaged.
The following electronic databases were searched: CENTRAL (2006, Issue 3); MEDLINE (1966 to March 2006); EMBASE (1980 to week 12 2006); CINAHL (1982 to March week 4 2006); PsycINFO (1872 to March week 4 2006); ASSIA (1987 to March 2006); LILACS (1982 to March 2006); and Sociological Abstracts (1963 to March 2006). Grey literature was also be searched using ZETOC (1993 to March 2006); Dissertation Abstracts International (late 1960s to 2006); and SIGLE (1980 to March 2006). Communication with published authors about ongoing or unpublished research was also undertaken.
Included studies were randomised controlled trials investigating the efficacy of home visiting directed at teenage mothers.
Titles and abstracts identified in the search were independently assessed for eligibility by two review authors (EC and JP or CB). Data were extracted and entered into RevMan (EC, JP and CB), synthesised and presented in both written and graphical form (forest plots). Outcomes included in this review were established at the protocol stage by an international steering group. The review did not report on all outcomes reported in included studies.
Five studies with 1838 participants were included in this review. Data from single studies provided support for the effectiveness of home visiting on some outcomes, but the evidence overall provided only limited support for the effectiveness of home visiting as a means of improving the range of maternal and child outcomes considered in this review.
AUTHORS' CONCLUSIONS: This review suggests there is only limited evidence that home-visiting programmes of the kind described in this review can impact positively on the quality of parenting of teenage mothers or on child development outcomes for their offspring. For reasons discussed in the review, this does not amount to a conclusion that home-visiting programmes are ineffective but indicates a need to think carefully about the problems that home visiting might influence and about improvements in the conduct and reporting of outcome studies in this area.
社会经济地位不利的母亲所生婴儿，比起富裕母亲所生婴儿，遭受伤害、虐待或忽视以及出现健康问题的风险更高；处于不利地位的青少年母亲出现不良后果的风险尤其高。家庭访视项目被认为能改善母亲和孩子的状况，主要是通过提供建议和支持。
评估针对近期分娩且社会或经济地位不利的女性的家庭访视项目的有效性。
检索了以下电子数据库：Cochrane系统评价数据库（2006年第3期）；医学索引数据库（1966年至2006年3月）；荷兰医学文摘数据库（1980年至2006年第12周）；护理学与健康领域数据库（1982年至2006年第4周）；心理学文摘数据库（1872年至2006年第4周）；亚洲社会科学索引数据库（1987年至2006年3月）；拉丁美洲及加勒比卫生科学数据库（1982年至2006年3月）；社会学文摘数据库（1963年至2006年3月）。还使用ZETOC（1993年至2006年3月）、国际学位论文摘要数据库（20世纪60年代末至2006年）和灰色文献数据库（1980年至2006年3月）检索了灰色文献。还与已发表文章的作者就正在进行或未发表研究进行了沟通。
纳入的研究为随机对照试验，调查针对青少年母亲的家庭访视的效果。
两名综述作者（EC和JP或CB）独立评估检索到标题和摘要的合格性。提取数据并录入RevMan软件（EC、JP和CB），进行综合并以书面和图表形式（森林图）呈现。本综述纳入的结局在方案阶段由一个国际指导小组确定。本综述未报告纳入研究中报告的所有结局。
本综述纳入了5项研究，共1838名参与者。单项研究的数据为家庭访视对某些结局的有效性提供了支持，但总体证据仅为家庭访视作为改善本综述中所考虑的一系列母婴结局的手段的有效性提供了有限支持。
本综述表明，仅有有限的证据表明本综述中所描述的家庭访视项目能对青少年母亲的育儿质量或其子女的发育结局产生积极影响。出于本综述中讨论的原因，这并不等同于得出家庭访视项目无效的结论，但表明需要仔细思考家庭访视可能影响的问题以及该领域结局研究的实施和报告方面的改进。
