Does Supplementary Prenatal Nursing and Home Visitation Support Improve Resource Use in a Universal Health Care System? A Randomized Controlled Trial in Canada

Authors

  • Suzanne C. Tough MSc, PhD,

    Corresponding author
    1. 1Suzanne Tough is an Associate Professor, Departments of Paediatrics and Community Health Sciences, University of Calgary; 2David Johnston is a Research Associate, Decision Support Research Team, Calgary Health Region; 3Jodi Siever is a Biostatistician, Decision Support Research Team, Calgary Health Region; 4Gayleen Jorgenson is a Family Physician, Maternity Care Clinic, Calgary Health Region; 5Linda Slocombe is a Family Physician, Grace Maternal Child Clinic, Calgary Health Region; 6Carolyn Lane is a Family Physician, Low Risk Maternity Clinic, Calgary Health Region; and 7Margaret Clarke is a Professor, Department of Paediatrics, University of Calgary and Division Chief of Developmental Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada.
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  • 1 David W. Johnston MA,

    1. 1Suzanne Tough is an Associate Professor, Departments of Paediatrics and Community Health Sciences, University of Calgary; 2David Johnston is a Research Associate, Decision Support Research Team, Calgary Health Region; 3Jodi Siever is a Biostatistician, Decision Support Research Team, Calgary Health Region; 4Gayleen Jorgenson is a Family Physician, Maternity Care Clinic, Calgary Health Region; 5Linda Slocombe is a Family Physician, Grace Maternal Child Clinic, Calgary Health Region; 6Carolyn Lane is a Family Physician, Low Risk Maternity Clinic, Calgary Health Region; and 7Margaret Clarke is a Professor, Department of Paediatrics, University of Calgary and Division Chief of Developmental Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada.
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  • 2 Jodi E. Siever MSc,

    1. 1Suzanne Tough is an Associate Professor, Departments of Paediatrics and Community Health Sciences, University of Calgary; 2David Johnston is a Research Associate, Decision Support Research Team, Calgary Health Region; 3Jodi Siever is a Biostatistician, Decision Support Research Team, Calgary Health Region; 4Gayleen Jorgenson is a Family Physician, Maternity Care Clinic, Calgary Health Region; 5Linda Slocombe is a Family Physician, Grace Maternal Child Clinic, Calgary Health Region; 6Carolyn Lane is a Family Physician, Low Risk Maternity Clinic, Calgary Health Region; and 7Margaret Clarke is a Professor, Department of Paediatrics, University of Calgary and Division Chief of Developmental Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada.
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  • 3 Gayleen Jorgenson MD,

    1. 1Suzanne Tough is an Associate Professor, Departments of Paediatrics and Community Health Sciences, University of Calgary; 2David Johnston is a Research Associate, Decision Support Research Team, Calgary Health Region; 3Jodi Siever is a Biostatistician, Decision Support Research Team, Calgary Health Region; 4Gayleen Jorgenson is a Family Physician, Maternity Care Clinic, Calgary Health Region; 5Linda Slocombe is a Family Physician, Grace Maternal Child Clinic, Calgary Health Region; 6Carolyn Lane is a Family Physician, Low Risk Maternity Clinic, Calgary Health Region; and 7Margaret Clarke is a Professor, Department of Paediatrics, University of Calgary and Division Chief of Developmental Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada.
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  • 4 Linda Slocombe MD,

    1. 1Suzanne Tough is an Associate Professor, Departments of Paediatrics and Community Health Sciences, University of Calgary; 2David Johnston is a Research Associate, Decision Support Research Team, Calgary Health Region; 3Jodi Siever is a Biostatistician, Decision Support Research Team, Calgary Health Region; 4Gayleen Jorgenson is a Family Physician, Maternity Care Clinic, Calgary Health Region; 5Linda Slocombe is a Family Physician, Grace Maternal Child Clinic, Calgary Health Region; 6Carolyn Lane is a Family Physician, Low Risk Maternity Clinic, Calgary Health Region; and 7Margaret Clarke is a Professor, Department of Paediatrics, University of Calgary and Division Chief of Developmental Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada.
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  • 5 Carolyn Lane MD,

    1. 1Suzanne Tough is an Associate Professor, Departments of Paediatrics and Community Health Sciences, University of Calgary; 2David Johnston is a Research Associate, Decision Support Research Team, Calgary Health Region; 3Jodi Siever is a Biostatistician, Decision Support Research Team, Calgary Health Region; 4Gayleen Jorgenson is a Family Physician, Maternity Care Clinic, Calgary Health Region; 5Linda Slocombe is a Family Physician, Grace Maternal Child Clinic, Calgary Health Region; 6Carolyn Lane is a Family Physician, Low Risk Maternity Clinic, Calgary Health Region; and 7Margaret Clarke is a Professor, Department of Paediatrics, University of Calgary and Division Chief of Developmental Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada.
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  • and 6 Margaret Clarke MD 7

    1. 1Suzanne Tough is an Associate Professor, Departments of Paediatrics and Community Health Sciences, University of Calgary; 2David Johnston is a Research Associate, Decision Support Research Team, Calgary Health Region; 3Jodi Siever is a Biostatistician, Decision Support Research Team, Calgary Health Region; 4Gayleen Jorgenson is a Family Physician, Maternity Care Clinic, Calgary Health Region; 5Linda Slocombe is a Family Physician, Grace Maternal Child Clinic, Calgary Health Region; 6Carolyn Lane is a Family Physician, Low Risk Maternity Clinic, Calgary Health Region; and 7Margaret Clarke is a Professor, Department of Paediatrics, University of Calgary and Division Chief of Developmental Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada.
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  • This study was funded by the Calgary Children’s Initiative of the United Way of Calgary and Area, Calgary, and the Physician Partnership Steering Committee and the Child and Women’s Health Portfolio of the Calgary Health Region, Calgary, Alberta, Canada. Salary support for Suzanne Tough was provided through the Alberta Heritage Foundation for Medical Research, Edmonton, Alberta, Canada.

Suzanne Tough, Alberta Children’s Hospital, Rm. 3013, 1820 Richmond Road SW, Calgary, Alberta, Canada, T2T 5C7.

Abstract

ABSTRACT: Background: The addition of supplementary prenatal support may improve the health and well-being of high-risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community-based population of pregnant women. Methods: Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling). Results: Overall, those in the nurse intervention group were more likely to attend an “Early Bird” prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy-related topics but had little impact on resource use for mental health and poverty-related needs. Among those with added support, resource use among low-risk women was generally greater than among high-risk women. Conclusions: Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community-based resources. This finding was true even for high-risk women, although this intervention did not reduce the difference in resource use between high- and low-risk women. (BIRTH 33:3 September 2006)

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