|Learning Objective #1: discuss issues concerning provision and research of home care for postpartum families|
|Learning Objective #2: understand the importance of evidence based evaluations of public health nurse interventions|
A cluster randomised trial was undertaken, in which health visitors were the unit of randomisation (n=40, control; n=40 intervention). For the purposes of this study ‘risk’ was defined according to modified Browne and Herbert (1997) criteria, excluding families with physical and psychosocial concerns. First-time mothers (n=159) with a control group health visitor received one planned home visit and 136 ‘intervention’ parents received six, weekly visits. Mothers self-completed depression, self-efficacy and role restriction psychometric scales at 2 and 8-weeks postpartum and data regarding duration of breastfeeding, use of emergency services, service satisfaction and infant difficulties were collected 8-weeks. Multilevel modelling data analysis was performed.
Mothers in the intervention group used less emergency services (CI 0.162/1.584 p=0.016) and were more satisfied by their care (CI 8.363/21.12 p<0.000). No group differences were found regarding self-efficacy, role restriction, infant problems or duration of breastfeeding. Parents who received a higher frequency of home visits reported high levels of depression (CI 0.31/2.341 p=0.012) however, evidence was found that several nurses accounted for this greater distress. It was concluded there is a need for greater use of evidence based practice protocols and monitoring of post-birth care outcomes. Further research should consider the effect of antenatal services on postpartum wellbeing.