Effects of nurse-home visiting on intimate partner violence and maternal income, mental health and self-efficacy by 24 months postpartum: a randomised controlled trial (British Columbia Healthy Connections Project)

Objective: To evaluate the impact of Nurse-Family Partnership (NFP), a home-visiting programme, on exploratory maternal outcomes in British Columbia (BC), Canada.

Design: Pragmatic, parallel arm, randomised controlled trial conducted October 2013-November 2019. Random allocation of participants (1:1) to comparison (existing services) or NFP (plus existing services). Researchers were naïve to allocation.

Setting: 26 local health areas across four of five BC regional health authorities.

Participants: 739 young (<25 years), first-time mothers (enrolled <28 weeks gestation), experiencing socioeconomic disadvantage.

Intervention: Public health nurses with NFP education offered home visits (up to 64) during pregnancy and until children's second birthday plus existing services on offer in BC.

Outcome measures: Prespecified exploratory outcomes included exposure to intimate partner violence (IPV), income (annual from employment) and not in education, employment or training (NEET) by 24 months postpartum, and psychological distress and self-efficacy across five time points (34-36 weeks gestation, 2, 10, 18 and 24 months postpartum).

Results: A total of 739 participants were randomised (368 NFP, 371 comparison) and analysed via an intention-to-treat analysis. At 24 months postpartum, for participants receiving NFP, a lower percentage reported IPV (group difference -7.14; 95% CI: -14.17, -0.10); incomes were larger ($1629.74, 95% CI: $5.20, $3254.28) after adjusting for baseline differences and no difference in percentage of NEET (-2.41, 95% CI: -10.11, 5.30). For participants receiving NFP, psychological distress was lower across time points (-1.59, 95% CI: -2.35 to -0.84); self-efficacy was greater at 34-36 weeks gestation (0.78, 95% CI: 0.34, 1.22), then decreasing and becoming insignificant by 24 months postpartum (0.29, 95% CI: -0.18, 0.75). No unanticipated serious adverse events were reported.

Conclusion: Relying on the maternal report, at 24 months postpartum, the NFP group had reduced IPV exposure and increased incomes. Benefits observed in late pregnancy were sustained to study end for psychological distress, but not self-efficacy. Longer-term follow-up is recommended.

Trial registration: NCT01672060.