Cavallaro Francesca L, Gilbert Ruth, Wijlaars Linda, Kennedy Eilis, Swarbrick Ailsa, van der Meulen Jan, Harron Katie
Great Ormond Street Institute of Child Health, University College London, London, UK.
Children, Young Adults and Families Directorate, Tavistock and Portman NHS Foundation Trust, London, UK.
BMJ Open. 2020 May 18;10(5):e038530. doi: 10.1136/bmjopen-2020-038530.
Almost 20 000 babies are born to teenage mothers each year in England, with poorer outcomes for mothers and babies than among older mothers. A nurse home visitation programme in the USA was found to improve a wide range of outcomes for young mothers and their children. However, a randomised controlled trial in England found no effect on short-term primary outcomes, although cognitive development up to age 2 showed improvement. Our study will use linked routinely collected health, education and social care data to evaluate the real-world effects of the Family Nurse Partnership (FNP) on child outcomes up to age 7, with a focus on identifying whether the FNP works better for particular groups of families, thereby informing programme targeting and resource allocation.
We will construct a retrospective cohort of all women aged 13-24 years giving birth in English NHS hospitals between 2010 and 2017, linking information on mothers and children from FNP programme data, Hospital Episodes Statistics and the National Pupil Database. To assess the effectiveness of FNP, we will compare outcomes for eligible mothers ever and never enrolled in FNP, and their children, using two analysis strategies to adjust for measured confounding: propensity score matching and analyses adjusting for maternal characteristics up to enrolment/28 weeks gestation. Outcomes of interest include early childhood development, childhood unplanned hospital admissions for injury or maltreatment-related diagnoses and children in care. Subgroup analyses will determine whether the effect of FNP varied according to maternal characteristics (eg, age and education).
The Nottingham Research Ethics Committee approved this study. Mothers participating in FNP were supportive of our planned research. Results will inform policy-makers for targeting home visiting programmes. Methodological findings on the accuracy and reliability of cross-sectoral data linkage will be of interest to researchers.
在英格兰，每年有近2万名少女妈妈生育宝宝，与年龄较大的妈妈相比，少女妈妈及其宝宝的结局更差。美国的一项护士家访计划被发现能改善年轻妈妈及其孩子的一系列结局。然而，英格兰的一项随机对照试验发现，该计划对短期主要结局没有影响，不过2岁前的认知发展有所改善。我们的研究将使用常规收集的健康、教育和社会护理关联数据，评估家庭护士伙伴关系（FNP）对7岁以下儿童结局的实际影响，重点是确定FNP是否对特定群体的家庭效果更好，从而为项目目标设定和资源分配提供依据。
我们将构建一个回顾性队列，纳入2010年至2017年间在英格兰国民保健服务（NHS）医院分娩的所有13至24岁女性，将FNP项目数据、医院事件统计数据和全国学生数据库中的母婴信息进行关联。为评估FNP的有效性，我们将比较曾参与和从未参与FNP的符合条件的母亲及其孩子的结局，使用两种分析策略来调整测量到的混杂因素：倾向得分匹配和根据母亲在登记/妊娠28周前的特征进行调整的分析。感兴趣的结局包括幼儿发育、因受伤或虐待相关诊断而导致的儿童意外住院以及受照料儿童。亚组分析将确定FNP的效果是否因母亲特征（如年龄和教育程度）而异。
诺丁汉研究伦理委员会批准了本研究。参与FNP的母亲支持我们的计划研究。研究结果将为政策制定者制定家访计划提供参考。跨部门数据关联的准确性和可靠性方面的方法学研究结果将引起研究人员的兴趣。
