Sawyer Michael G, Pfeiffer Sara, Sawyer Alyssa, Bowering Kerrie, Jeffs Debra, Lynch John
Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia; Research and Evaluation Unit, Women's and Children's Health Network, North Adelaide, South Australia, Australia.
J Paediatr Child Health. 2014 Dec;50(12):1013-22. doi: 10.1111/jpc.12679. Epub 2014 Jun 23.
To evaluate the effectiveness of a 2-year post-natal home-visiting programme delivered by nurses to socially disadvantaged mothers in rural regions of South Australia.
The intervention group consisted of 225 mothers who lived in rural regions and enrolled in the programme between 2010 and 2012. The comparison group consisted of 239 mothers who lived in rural areas between 2008 and 2009 when the programme was not yet available. All participants were eligible for enrolment in the home-visiting programme. Participants in both groups were assessed at baseline (mean child age = 15.2 weeks, SD = 2.4), prior to programme enrolment, and again when children were aged 9, 18 and 24 months. Outcomes were evaluated using the Parent Stress Index, Kessler Psychological Distress Scale, Ages and Stages Questionnaire, Child Behaviour Checklist, and MacArthur Communicative Developmental Inventory.
During the follow-up period, there was little difference in the pattern of scores across the two groups. Mixed models adjusting for baseline differences between the groups did not identify any significant Group × Time interactions. This suggests that the linear trajectories of scores on outcomes did not differ significantly between the two groups.
Findings suggest that the home-visiting programme did not have a measurable effect on maternal or child outcomes. However, the programme was relatively early in its rollout, and the greater challenges of recruitment, training and support, along with rural nurses' broader responsibilities for delivering other maternal and child health services, may explain why effects seen in the metropolitan area were not evident in rural regions.
评估护士为南澳大利亚农村地区社会弱势母亲提供的为期两年的产后家访计划的有效性。
干预组由225名居住在农村地区且于2010年至2012年期间参加该计划的母亲组成。对照组由239名在2008年至2009年该计划尚未实施时居住在农村地区的母亲组成。所有参与者均有资格参加家访计划。两组参与者在基线时（平均儿童年龄=15.2周，标准差=2.4）、参加计划前以及儿童9个月、18个月和24个月大时再次接受评估。使用父母压力指数、凯斯勒心理困扰量表、年龄与阶段问卷、儿童行为检查表和麦克阿瑟沟通发展量表对结果进行评估。
在随访期间，两组的得分模式差异不大。对两组之间的基线差异进行调整的混合模型未发现任何显著的组×时间交互作用。这表明两组在结果得分的线性轨迹上没有显著差异。
研究结果表明，家访计划对母亲或儿童的结果没有可测量的影响。然而，该计划推出时间相对较早，招募、培训和支持方面的更大挑战，以及农村护士在提供其他母婴健康服务方面更广泛的职责，可能解释了为什么在大都市地区看到的效果在农村地区不明显。
