Caldera Debra, Burrell Lori, Rodriguez Kira, Crowne Sarah Shea, Rohde Charles, Duggan Anne
Alaska State Department of Health and Scial Services, Anchorage, AK, USA.
Child Abuse Negl. 2007 Aug;31(8):829-52. doi: 10.1016/j.chiabu.2007.02.008. Epub 2007 Sep 5.
To assess the impact of a voluntary, paraprofessional home visiting program on promoting child health and development and maternal parenting knowledge, attitudes, and behaviors.
This collaborative, experimental study of 6 Healthy Families Alaska (HFAK) programs enrolled 325 families from 1/00 to 7/01, randomly assigned them to HFAK and control groups, interviewed mothers at baseline, and followed families until children were 2 years old (85% follow-up). Child outcomes included health care use, development and behavior. Parent outcomes included knowledge of infant development, parenting attitudes, quality of the home environment, and parent-child interaction. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure knowledge, perceived effectiveness and perceived training adequacy.
There was no overall impact on child health, but HFAK group children had more favorable developmental and behavioral outcomes. HFAK and control mothers had similar parenting outcomes except that HFAK mothers had greater parenting self-efficacy (35.1 vs. 34.6 based on the Teti Self-Efficacy Scale, p<.05). Fewer HFAK families had a poor home environment for learning (20% vs. 31%, p<.001). HFAK families were more likely to use center-based parenting services (48% vs. 39%, p<.05). The impact was greater for families with lower baseline risk (Family Stress Checklist scores<45). There was little evidence of efficacy for families with a higher dose of service.
The program promoted child development and reduced problem behaviors at 2 years. Impact could be strengthened by improving home visitor effectiveness in promoting effective parenting. Future research is needed to determine whether short-term benefits are sustained.
评估一项由非专业人员自愿参与的家访项目对促进儿童健康与发展以及母亲育儿知识、态度和行为的影响。
这项针对6个阿拉斯加健康家庭（HFAK）项目的合作性实验研究，在2000年1月至2001年7月期间招募了325个家庭，将他们随机分为HFAK组和对照组，在基线时对母亲进行访谈，并跟踪这些家庭直至孩子2岁（随访率85%）。儿童结局包括医疗保健利用情况、发育和行为。家长结局包括婴儿发育知识、育儿态度、家庭环境质量和亲子互动。对HFAK记录进行审查以衡量家访服务。对家访人员进行调查以衡量其知识、感知到的有效性和感知到的培训充足性。
对儿童健康没有总体影响，但HFAK组儿童在发育和行为结局方面更有利。HFAK组和对照组母亲的育儿结局相似，只是HFAK组母亲的育儿自我效能感更强（根据泰蒂自我效能感量表，分别为35.1和34.6，p<0.05）。HFAK组中家庭学习环境差的家庭较少（20%对31%，p<0.001）。HFAK组家庭更有可能使用基于中心的育儿服务（48%对39%，p<0.05）。对于基线风险较低（家庭压力清单得分<45）的家庭，影响更大。几乎没有证据表明服务剂量较高的家庭有效果。
该项目促进了儿童发育并减少了2岁时的问题行为。通过提高家访人员促进有效育儿的效果，可以增强影响。需要进一步研究以确定短期益处是否能持续。
