Home visits versus fixed-site care by community health workers and child survival: a cluster-randomized trial, Mali.

Objective: To test the effect of proactive home visits by trained community health workers (CHWs) on child survival. Methods: We conducted a two arm, parallel, unmasked cluster-randomized trial in 137 village-clusters in rural Mali. From February 2017 to January 2020, 31 761 children enrolled at the trial start or at birth. Village-clusters received either primary care services by CHWs providing regular home visits (intervention) or by CHWs providing care at a fixed site (control). In both arms, user fees were removed and primary health centres received staffing and infrastructure improvements before trial start. Using lifetime birth histories from women aged 15-49 years surveyed annually, we estimated incidence rate ratios (IRR) for intention-to-treat and per-protocol effects on under-five mortality using Poisson regression models. Findings: Over three years, we observed 52 970 person-years (27 332 in intervention arm; 25 638 in control arm). During the trial, 909 children in the intervention arm and 827 children in the control arm died. The under-five mortality rate declined from 142.8 (95% CI: 133.3-152.9) to 56.7 (95% CI: 48.5-66.4) deaths per 1000 live births in the intervention arm; and from 154.3 (95% CI: 144.3-164.9) to 54.9 (95% CI: 45.2-64.5) deaths per 1000 live births in the control arm. Intention-to-treat (IRR: 1.02; 95% CI: 0.88-1.19) and per-protocol estimates (IRR: 1.01; 95% CI: 0.87-1.18) showed no difference between study arms. Conclusion: Though proactive home visits did not reduce under-five mortality, system-strengthening measures may have contributed to the decline in under-five mortality in both arms.

The Happy Child Program's Intersectionality: Prenatal Home Visit Frequency, Food Insecurity Risk, Symptoms of Depression, and Parental Practices in Brazilian Women Assisted during Pregnancy.

Food insecurity (FI) is a critical issue in developing countries, particularly in low-resource settings, where it can worsen women's mental health. Psychosocial factors such as low household income, limited education, multiparity, and vulnerability are linked to depressive symptoms during pregnancy. Additionally, the family environment influences parental practices, which may impact mental health. This study evaluates the association of socioeconomic factors, parental practices, FI risk, and home visit frequency with depressive symptoms in pregnant women enrolled in the Happy Child Program (Programa Criança Feliz-PCF) in the Federal District, Brazil. In this cross-sectional study, 132 pregnant women monitored by PCF from May to July 2023 were assessed using a self-administered questionnaire for socioeconomic data, the two-item Triage for Food Insecurity (TRIA) instrument for FI risk, the Scale of Parental Beliefs and Early Childhood Care Practices, and the Beck Depression Inventory-II for depressive symptoms. Most participants were multiparous (87.9%), had low income (under 200 USD/month; 80.8%), presented depressive symptoms (67.4%) and were at risk of FI (81.8%). About half demonstrated adequate parental practices (50.8%) and received four home visits per month during pregnancy (54.5%). Women who received four PCF home visits had a lower prevalence of depressive symptoms compared to those with fewer visits (PR 0.76, 95% CI 0.59-0.98). No significant association was found between FI or parental practices and depressive symptoms. These findings suggest that the PCF home-visiting program may strengthen vulnerable families, support social networks, and improve mental health during pregnancy. Additionally, the results of this study highlight the need for targeted interventions aimed at reducing food insecurity and promoting mental health during pregnancy, particularly among socially vulnerable populations. Furthermore, they reinforce the importance of expanding access to home-visiting programs as an effective strategy to improve maternal mental health and well-being, while fostering healthier prenatal environments for both mothers and their children.

Projected Cost Savings of a Community Health Worker Model for Asthma Home Visits in the Massachusetts Pediatric Medicaid Population.

Introduction: The community health worker-led asthma home visiting model (CHW model) improved asthma outcomes and reduced health care costs among Massachusetts children with asthma. We projected cost savings associated with the expansion of the CHW model among pediatric Massachusetts Medicaid (MassHealth)-eligible patients with uncontrolled asthma (≥2 asthma-related emergency department visits per year). Methods: We estimated 2019 costs associated with asthma-related hospitalizations and emergency department visits for MassHealth pediatric patients with uncontrolled asthma who also had 365 days of Medicaid eligibility in 2019. We based estimated cost savings on previously published results from a study of a comparable patient population. Results: The projected asthma-related cost savings from expansion of the CHW model were $566.58 per patient, or $774,514.86 total, for the 1,367 MassHealth-eligible children with uncontrolled asthma in our analysis. Conclusion: Expansion of the CHW model is an effective way to increase asthma services and reduce Medicaid costs for MassHealth patients, a population made up disproportionately of Black and Hispanic residents with low incomes.

Navigating Real-World Randomized Clinical Trials: The 'Parents as Teachers' Experience.

The Parents as Teachers Randomized Controlled Trial (PAT RCT) Case Study investigates the multifaceted impact of implementing the PAT RCT in Arizona, U.S.A., shedding light on both the positive and negative effects. There has been a recent focus on improving the implementation of RCTs in community settings, as this issue has not been fully addressed. This research presents a case study examining the implementation of a community-based RCT in home visitation. This study also addresses the strategies that can be employed to mitigate some of the challenges in the implementation of an RCT, offering valuable insights for future RCTs in the domain of home visiting. The PAT program, aimed at providing parent education and family engagement for children from birth to kindergarten, encompasses a range of services, including personal visits, group connections, child screenings, and community resource linkages. The Parents as Teachers Randomized Controlled Trial (PAT RCT) directly promotes health by educating parents about health and wellness as well as providing early child screenings and heath referrals, all of which enhance health outcomes through timely interventions and improved parental practices. Lessons from the study also aim to improve the implementation of future health-related RCTs, ensuring effective delivery and impactful results.

Promoting gender equity in a home visits programme: a qualitative study in Northern Nigeria.

BACKGROUND: Gender inequities remain critical determinants influencing maternal health. Harmful gender norms and gender-based violence adversely affect maternal health. Gendered division of labour, lack of access to and control of resources, and limited women's decision-making autonomy impede women's access to maternal healthcare services. We undertook a cluster randomized controlled trial of universal home visits to pregnant women and their spouses in one local government area in Bauchi State, North-Eastern Nigeria. The trial demonstrated a significant improvement in maternal and child health outcomes and male knowledge, attitudes and behaviours. This paper qualitatively evaluates gender equity in the home visits programme. METHODS: The research team explored participants' views about gender equity in the home visits programme. We conducted nine key informant interviews with policymakers and 14 gender and age-stratified focus group discussions with men and women from visited households, with women and men home visitors and supervisors, and with men and women community leaders. Analysis used an adapted conceptual framework exploring gender equity in mainstream health. A deductive thematic analysis of interviews and focus group reports looked for patterns and meanings. RESULTS: All respondents considered the home visits programme to have a positive impact on gender equity, as they perceived gender equity. Visited women and men and home visitors reported increased male support for household chores, with men doing heavy work traditionally pre-assigned to women. Men increased their support for women's maternal health by paying for healthcare and providing nutritious food. Households and community members confirmed that women no longer needed their spouses' permission to use health services for their own healthcare. Households and home visitors reported an improvement in spousal communication. They perceived a significant reduction in domestic violence, which they attributed to the changing attitudes of both women and men due to the home visits. All stakeholder groups stressed the importance of engaging male spouses in the home visits programme. CONCLUSION: The home visits programme, as implemented, contributed to gender equity.

Impact of the Korea Early Childhood Home-visiting Intervention (KECHI) on child health and development and maternal health: a randomised controlled trial protocol.

INTRODUCTION: Randomised controlled trials (RCTs) of early childhood home-visiting interventions led by nurses have been conducted mainly in Western countries, whereas such trials have been limited in non-Western cultures, including Asia. In South Korea, a national nurse home visit programme (Korea Early Childhood Home-visiting Intervention (KECHI)) was developed in 2020 and launched throughout the country. We designed a pragmatic RCT to evaluate the effectiveness of KECHI on child health and development and maternal health. METHODS AND ANALYSIS: Eligible participants will be pregnant women at <37 weeks of gestation with risk factor scores of 2 or over, who are sufficiently fluent in Korean to read and answer the questionnaire written in Korean and live in districts where the KECHI services are available. Eight hundred participants will be recruited from the general community and through the District Public Health Centres. The participants will be randomised 1:1 to KECHI plus usual care or usual care. KECHI encompasses 25-29 home visits, group activities and community service linkage. Participants will complete assessments at baseline (<37 weeks gestation), 6 weeks, 6 months, 12 months, 18 months and 24 months post partum. The six primary outcomes will be (1) home environment (assessed by Infant/Toddler Home Observation for Measurement of the Environment), (2) emergency department visits due to injuries, (3) child development (assessed using Korean Bayley Scales of Infant and Toddler Development-III), (4) breastfeeding duration, (5) maternal self-rated health and (6) community service linkage. ETHICS AND DISSEMINATION: This trial has received full ethical approval from the Institutional Review Board of the Seoul National University Hospital. Written consent will be obtained from the participants. The results will be reported at conferences, disseminated through peer-reviewed publications and used by the Korean government to expand the KECHI services. TRIAL REGISTRATION NUMBER: NCT04749888.

Development of a home visit solution with a route- and appointment planning tool for patients with severe spasticity: A participatory design study.

Objectives: This article describes how a home visit solution was developed in a co-design process between patients in treatment for severe spasticity, their caregivers and hospital nurses. The solution was developed using a participatory design approach and was based on the identified needs of the participants. Methods: We developed a home visit solution through an iterative process and a collective 'reflection-in-action' approach with patients, caregivers and healthcare professionals. Results: The study revealed the complexities of establishing new routines around home visits. The solution included a new workflow for the nurses and a new route and appointment planning tool. Conclusion: Through a participatory design approach, the users developed a home visit solution that minimised disruption to patients' daily lives and facilitated a dialogue between the nurses and the caregivers about the treatment and the patients' spasticity, which helped to adjust the treatment in line with the patient´s needs.

The effect of nursing interventions applied at home to improve rational use of medicines and awareness of elderly individuals: A randomized controlled study.

The aim of this study was to evaluate the effect of nursing interventions applied to elderly individuals to improve rational use of medicines (RUM) and awareness through home visits. It was carried out in a prospective, randomized controlled experimental design with the pretest-post-test control group. The study was completed with 74 elderly individuals aged ≥65 years living in a rural area. The intervention group received education, counselling, brochures and pill boxes through home visits to increase RUM and awareness. The study data were collected between September and December 2022 using the face-to-face interview method, the elderly identification form, the Rational Use of Medicines Scale and the Rational Drug Use Awareness Scale. After nursing interventions were applied at home, it was determined that, the mean scores of RUM and Awareness of RUM of the intervention group increased compared to the control group and that, interventions to improve RUM and awareness were effective. In line with these results, training sessions on RUM should be organized periodically for elderly individuals and home visits should be planned by nurses at regular intervals to ensure the sustainability of RUM in the home environment.

A comparison of virtual versus in-person delivery of SafeCare on parent and implementation outcomes.

BACKGROUND: Evidence-based prevention services for child abuse and neglect (CAN), typically delivered via home visiting (HV), pivoted to virtual delivery in 2020 to continue family services while adhering to the COVID-19 public health guidelines. OBJECTIVE: The study aims are to compare parent and implementation outcomes for the HV program, SafeCare©, delivered virtually versus in-person, across a 2-year period. METHODS: Three data sources were used to examine parent program engagement and skill mastery, as well as provider fidelity. Sources included: 1) quantitative service data collected as part of routine SafeCare implementation (in-person families, n = 923; virtual families, n = 1978), 2) qualitative survey data collected from SafeCare providers (n = 212) and 3) focus group data with SafeCare Providers (n = 9). RESULTS: Service data were examined using mixed models due to the nesting of the data, with all analyses controlling for time. Qualitative data from the survey and focus groups were analyzed using thematic coding. Data were triangulated from the three sources to answer the primary research question. Findings suggest that virtual delivery of SafeCare holds promise, with parents who participated virtually completing more modules at a faster pace than in-person clients. SafeCare parents demonstrated positive programmatic outcomes regardless of whether they participated in the program virtually or in-person. Provider fidelity remained high in the transition to virtual delivery. However, technology-related logistical issues and provider self-efficacy related to virtual delivery presented challenges to program success. CONCLUSIONS: The study has multiple implications for the HV field about the viability of virtual service delivery. Further research is warranted with data collected directly from parents, and a more critical analysis of what works best for whom and when to further advance the field.

Community case management to accelerate access to healthcare in Mali: a realist process evaluation nested within a cluster randomized trial.

The Proactive Community Case Management (ProCCM) trial in Mali reinforced the health system across both arms with user fee removal, professional community health workers (CHWs) and upgraded primary health centres (PHCs)-and randomized village-clusters to receive proactive home visits by CHWs (intervention) or fixed site-based services by passive CHWs (control). Across both arms, sick children's 24-hour treatment and pregnant women's four or more antenatal visits doubled, and under-5 mortality halved, over 3 years compared with baseline. In the intervention arm, proactive CHW home visits had modest effects on children's curative and women's antenatal care utilization, but no effect on under-5 mortality, compared with the control arm. We aimed to explain these results by examining implementation, mechanisms and context in both arms We conducted a process evaluation with a mixed method convergent design that included 79 in-depth interviews with providers and participants over two time-points, surveys with 195 providers and secondary analyses of clinical data. We embedded realist approaches in novel ways to test, refine and consolidate theories about how ProCCM worked, generating three context-intervention-actor-mechanism-outcome nodes that unfolded in a cascade. First, removing user fees and deploying professional CHWs in every cluster enabled participants to seek health sector care promptly and created a context of facilitated access. Second, health systems support to all CHWs and PHCs enabled equitable, respectful, quality healthcare, which motivated increased, rapid utilization. Third, proactive CHW home visits facilitated CHWs and participants to deliver and seek care, and build relationships, trust and expectations, but these mechanisms were also activated in both arms. Addressing multiple structural barriers to care, user fee removal, professional CHWs and upgraded clinics interacted with providers' and patients' agency to achieve rapid care and child survival in both arms. Proactive home visits expedited or compounded mechanisms that were activated and changed the context across arms.

The effectiveness of preventive home visits on resilience and health-related outcomes among community dwelling older adults: A systematic review.

BACKGROUND: This research aimed to assess the effectiveness of preventive home visits (PHVs) in enhancing resilience and health-related outcomes among older adults living in the community. METHODS: A comprehensive literature search was conducted in nine databases (PubMed, MEDLINE, CINAHL, Embase, Emcare, Web of Science (WOS), Scopus, PsycINFO and Cochrane Library. The search was undertaken between March 15 and 31, 2022 with subsequent updates performed on October 15, 2023 and April 10, 2024. This review also included grey literature sourced via Google, Google Scholar and backward citation searches. RESULTS: Out of 5,621 records, 20 articles were found to meet the inclusion criteria with a total of 8,035 participants involved and the mean age ranged from 74.0 to 84.4 years. Using McMaster Critical Review Form for Quantitative Studies, we ascertained that the studies included in our analysis had moderate to high levels of quality. In addition to health-related outcomes, PHV interventions were also conducted to evaluate psychological effects (16 studies) and social outcomes (seven studies). Five studies conducted financial assessment to evaluate the costs of health and social care utilisation during PHV interventions. Regarding the results of the review, seven studies showed favourable outcomes, five indicated no effect and eight had equivocal findings. Only one study assessed resilience and determined that PHV had no effect on the resilience of the subjects. CONCLUSION: This review found that the effectiveness of PHV interventions was uncertain and inconclusive. PHV interventions often prioritise health-related objectives. The incorporation of a holistic approach involving psychosocial health into PHV interventions is relatively uncommon. Due to the paucity of research on resilience as PHV outcome, we are unable to draw a conclusion on the effectiveness of PHV on resilience. Resilience should be prioritised as a psychological assessment in the future development of comprehensive PHV interventions, as it enables older adults to adapt, manage, and respond positively to adversities that may arise with age. Performing financial analysis such as costs and benefits analysis to incorporate the return on investment of PHV interventions is an added value for future research on this topic. CLINICAL TRIAL REGISTRATION: PROSPERO registration number: CRD42022296919.

Frontloading Home Physical Therapy Visits for Patients With Heart Failure: A Multi-center Randomized Controlled Trial.

Frontloading home care visits has been found to be effective in the nursing profession but has not been investigated in physical therapy (PT) practice. This study aimed to examine the impact of frontloading home PT visits on function in persons with heart failure (HF). This was a prospective multi-center randomized controlled trial with blinded raters. A total of 82 ambulatory patients with a primary diagnosis of HF discharged from an acute care facility to home care participated in the study. Subjects were randomly allocated to an experimental frontloaded group (FLG) or control group (CG) for 4 weeks. FLG visit frequencies were five sessions per week for 2 weeks, and three sessions per week for 2 weeks. The CG received two sessions per week for 4 weeks. Functional measures including the 2-minute step test (2MST), 2-minute walk test (2MWT), gait speed (GS), Timed Up and Go (TUG), and 30-second chair rise test (30-CRT) were collected at the onset of care, at the end of 2 weeks and 4 weeks. The groups were statistically similar at baseline for all measures. All subjects significantly improved scores in all functional measures over time, within-subject main effect (p < .01). Significant between-subject effects were noted for 30-CRT (p = .04). Interaction effects were noted for GS (p = .03) and TUG test (p = .02). This is the first study to report meaningful improvements in function in individuals with HF. Significant treatment effect differences between the FLG and CG were found for GS, TUG, and 30-CRT. Future studies should examine the use of a standardized intervention to validate the effectiveness of frontloading home visits on quality of life and readmission rates.

Improving medication adherence among persons with cardiovascular disease through m-health and community health worker-led interventions in Kerala; protocol for a type II effectiveness-implementation research-(SHRADDHA-ENDIRA).

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). A key reason for poor outcomes is non-adherence to medication. METHODS: The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4-5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done. DISCUSSION: The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment. TRIAL REGISTRATION: The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095.

Effects of perceived risk of COVID-19 on fear among visiting workers: Mediating role of perceived stress.

With the creation of a social distancing policy due to coronavirus disease 2019 (COVID-19), home visit workers are under mental stress as they are treated as the source of infection for COVID-19. Since door-to-door rental equipment examiners and gas inspectors must perform their duties even in the COVID-19 situation, they are being discriminated against so severely. The purpose of study was to examine the mediating role of perceived stress on the relationship between risk perception and fear. Data was collected data through labor unions among 275 home visiting workers who examine rental home appliance equipment or inspecting gas. On-line survey was conducted to assess COVID-19 risk perception, fear, perceived stress, and demographic characteristics. The data was analyzed using PROCESS Macro (Model 4). The results of the study showed that stress plays an important role in increasing COVID-19 fears when COVID-19 risk perception increases. Meanwhile, it was found that COVID-19 fear decreased when the level of perceived stress decreased. To reduce the impact of COVID-19 risk perception on COVID-19 fears, appropriate educational programs to reduce stress should be developed for home visit workers. Policymakers need to develop online or mobile Infectious disease education programs for COVID-19 risk at work and establish policies to apply legal education.

The Impact of the New Families Home Visiting Program on Depressive Symptoms Among Norwegian Fathers Postpartum: A Nonrandomized Controlled Study.

Becoming a parent is a vulnerable life transition and may affect parents' mental health. Depressive symptoms may occur in fathers, as well as mothers, during pregnancy and the postpartum period. The health service is expected to have a family perspective, aiming to support both parents. Despite this goal, mothers traditionally receive more support than fathers. Home visiting programs may provide enhanced guidance for new fathers and increased mental health support. The aim of this study was therefore to assess possible differences in level of depressive symptom in fathers receiving the New Families home visiting program compared with those receiving standard care from the Norwegian Child Health Service. A prospective nonrandomized controlled study with a parallel group design was performed. The Edinburg Postnatal Depression Scale (EPDS) was used to measure depressive symptoms in fathers (N = 197) at 28 weeks of their partners' pregnancy (T1), at 6 weeks (T2), and 3 months postpartum (T3), in the intervention and the control group. The results indicate a prevalence of depressive symptoms (EPDS score ≥ 10) in Norwegian fathers of 3.1% at T1, 3.9% at T2, and 2.2% at T3 for the full sample. No significant EPDS score differences were found between the intervention and the control group at six weeks and three months postpartum. This suggests that the intervention had no clear impact on depressive symptoms during this time-period.

Nurse-Led Care at Home Visit Versus Standard Care in Patients with Mild Acute Pancreatitis: A Retrospective Analysis.

BACKGROUNDS: Frequent hospitalization and the costs of hospitalization are the main burdens in China for patients with acute pancreatitis. Most admitted patients have mild disease conditions that do not require hospitalization. AIMS: Here, we compare some health and economic aspects of patients with mild acute pancreatitis who received nurse-led care at home visits against those who were hospitalized on follow-up. METHODS: Patients discharged from the hospital after treatment for mild acute pancreatitis received (NC cohort, n = 104) or did not receive (HN cohort, n = 141) regular home visits by nurses for treatment and care. Patients were rehospitalized by caregivers with or without help of nurse. RESULTS: Hospital readmission events occurred in both cohorts at a follow-up care time of 2 months. Compared with the time of discharge from the hospital, unwanted effects were higher in follow-up care in all patients (p < 0.001 for all). Patients in the NC cohort had less time to resolution of pain, less time to resumption of oral solid food intake, smaller number of patients with hospital readmissions, less average time of hospitalization, lower cost of care, and lower occurrence of unwanted effects than those of patients in the HN cohort during 2 months of follow-up care (p < 0.05 for all). CONCLUSIONS: Patients with mild acute pancreatitis who undergo treatment require nurse-led nontreatment intervention(s) for rehabilitation in follow-up. Nurse-led follow-up care at-home visits increase recovery, are beneficial and cost-effective, and decrease unwanted adverse effects in patients receiving treatment for mild acute pancreatitis. LEVEL OF EVIDENCE: IV. TECHNICAL EFFICACY: Stage 5.

Development of an outcome indicator framework for a universal health visiting programme using routinely collected data.

BACKGROUND: Universal health visiting has been a cornerstone of preventative healthcare for children in the United Kingdom (UK) for over 100 years. In 2016, Scotland introduced a new Universal Health Visiting Pathway (UHVP), involving a greater number of contacts with a particular emphasis on the first year, visits within the home setting, and rigorous developmental assessment conducted by a qualified Health Visitor. To evaluate the UHVP, an outcome indicator framework was developed using routine administrative data. This paper sets out the development of these indicators. METHODS: A logic model was produced with stakeholders to define the group of outcomes, before further refining and aligning of the measures through discussions with stakeholders and inspection of data. Power calculations were carried out and initial data described for the chosen indicators. RESULTS: Eighteen indicators were selected across eight outcome areas: parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents and injuries, and child protection interventions. Data quality was mixed. Coverage of reviews was high; over 90% of children received key reviews. Individual item completion was more variable: 92.2% had breastfeeding data at 6-8 weeks, whilst 63.2% had BMI recorded at 27-30 months. Prevalence also varied greatly, from 1.3% of children's names being on the Child Protection register for over six months by age three, to 93.6% having received all immunisations by age two. CONCLUSIONS: Home visiting services play a key role in ensuring children and families have the right support to enable the best start in life. As these programmes evolve, it is crucial to understand whether changes lead to improvements in child outcomes. This paper describes a set of indicators using routinely-collected data, lessening additional burden on participants, and reducing response bias which may be apparent in other forms of evaluation. Further research is needed to explore the transferability of this indicator framework to other settings.

Maternal satisfaction with postnatal home visitation services by community health nurses in Ashanti Region, Ghana: A cross-sectional correlational study.

Efforts have been made to improve maternal and child health care globally, with a focus on promoting postnatal home visitation care. Despite the known significance of postnatal home visits, concerns still exist regarding mothers' satisfaction with home visitation care. This study examined maternal satisfaction with postnatal home visitation care in the Ashanti Region. A cross sectional correlational study design was used to gather data from the study participants using the Jipi's questionnaire to assess maternal satisfaction with healthcare. Ten (10) district hospitals were randomly selected from 27 district hospitals in the region. A sample size of 170 postnatal mothers were then selected randomly from the 10 districts hospitals according to proportion of mothers at each facility. SPSS version 25 was used to analyse the data using descriptive statistics and Chi-square at a p-value = 0.05. The results indicated that the mothers were satisfied with the overall home visitation services, yet, showed dissatisfaction towards some specific postnatal care, including the quality of information on maternal care and support rendered by the CHNs regarding the care of the newborn during their visit. The satisfaction levels of mothers with these services are high, yet there are still opportunities for improving them by addressing specific challenges and tailoring these services to the diverse needs of postnatal mothers. In conclusion, CHNs' work during postnatal period is essential in promoting the health of both the baby and the mother.

Des efforts ont été déployés pour améliorer les soins de santé maternelle et infantile à l'échelle mondiale, en mettant l'accent sur la promotion des soins postnatals à domicile. Malgré l'importance connue des visites postnatales à domicile, des inquiétudes subsistent quant à la satisfaction des mères à l'égard des soins de visite à domicile. Cette étude a examiné la satisfaction des mères à l'égard des soins postnatals à domicile dans la région d'Ashanti. Un plan d'étude corrélationnelle transversale a été utilisé pour recueillir des données auprès des participantes à l'étude à l'aide du questionnaire Jipi afin d'évaluer la satisfaction des mères à l'égard des soins de santé. Dix (10) hôpitaux de district ont été sélectionnés au hasard parmi 27 hôpitaux de district de la région. Un échantillon de 170 mères postnatales a ensuite été sélectionné au hasard dans les 10 hôpitaux de district en fonction de la proportion de mères dans chaque établissement. SPSS version 25 a été utilisé pour analyser les données à l'aide de statistiques descriptives et du chi carré à une valeur p = 0,05. Les résultats ont indiqué que les mères étaient satisfaites de l'ensemble des services de visites à domicile, mais qu'elles montraient une insatisfaction à l'égard de certains soins postnatals spécifiques, notamment de la qualité des informations sur les soins maternels et du soutien apporté par les CHN concernant les soins du nouveau-né lors de leur visite. Les niveaux de satisfaction des mères à l'égard de ces services sont élevés, mais il existe encore des possibilités de les améliorer en relevant des défis spécifiques et en adaptant ces services aux divers besoins des mères postnatales. En conclusion, le travail des RCS pendant la période postnatale est essentiel pour promouvoir la santé du bébé et de la mère.

Neighborhood Racialized Economic Polarization, Home Visiting Coverage, and Adverse Birth Outcomes in a Medicaid-eligible Population.

BACKGROUND: Residential polarization shaped by racial segregation and concentrations of wealth (hereafter neighborhood racialized economic polarization) results in both highly deprived and highly privileged neighborhoods. Numerous studies have found a negative relationship between neighborhood racialized economic polarization and birth outcomes. We investigated whether community-informed home visiting programs achieve high rates of service coverage in highly deprived neighborhoods and can attenuate the deleterious effect of neighborhood polarization on birth outcomes. METHODS: We used 2016-2019 data from Michigan's statewide database that links birth records, Medicaid claims, and program participation (N = 211,412). We evaluated whether 1) home visiting programs achieved high rates of service coverage in highly deprived neighborhoods, 2) participation in home visiting may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and 3) the reductions in preterm birth and low birthweight were larger among Black birthing individuals. Data were examined using multilevel generalized linear models and mediation analysis. RESULTS: The statewide home visiting program achieved higher rates of coverage in the most deprived neighborhoods (21.0% statewide, 28.3% in the most deprived vs. 10.4% in the most privileged neighborhoods). For all, home visiting participation was associated with a decrease in the relationship between neighborhood polarization and preterm birth by 6.8% (mean indirect effect, -0.008; 95% confidence interval, -0.011 to -0.005), and by 5.2% (mean indirect effect, -0.013; 95% confidence interval, -0.017 to -0.009) for low birthweight, adjusting for individual-level risk factors. The decrease was larger among Black individuals. CONCLUSIONS: A statewide Medicaid-sponsored home visiting program achieved high rates of service coverage in highly deprived neighborhoods. Program participation may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and more so among Black individuals. Continued support for home visiting services is required to better engage birthing individuals in neighborhoods with concentrated deprivation and to decrease disparities.

Advancing the Primary Health Care Mandate for Nursing.

A call to increase home visits and human function documenting by nurses.