main CVDs risk factors in hypertensive patients”. (p834) addition to usual care, the intervention group also received weekly email alerts and phone calls from the Nurse Care Manager (NCM). 3, Recommendations were taken from current guidelines on healthy lifestyle. 7. (NCM) coordinated follow-up visits, recorded baseline and follow-up data using structured forms, and carried out the educational programme. significantly increased, salt consumption did not significantly change. The percentage of subjects with low physical activity, uncontrolled hypertension or glycemia, high LDL and total cholesterol and triglycerides decreased in both groups (all p < 0.01). The mean number of alcohol units and cigarettes decreased, however the prevalence of drinkers and smokers did not vary. 9. At 6 months the intervention group showed a statistically significant greater improvement in BMI, alcohol consumption, cigarette smoking, fruit consumption, physical activity, systolic and diastolic blood pressure, LDL and total cholesterol (all p < 0.05). The prevalence of obesity, low fruit consumption, low physical activity, uncontrolled hypertension, high LDL and total cholesterol decreased much more in the intervention group (all p < 0.01). Fasting blood glucose and triglycerides reductions, compliance with therapy hours, did not show a statistically significant difference between groups. The intervention did not affect salt consumption. established, the NRP-e was simple and inexpensive, requiring an average of <20 min per day in addition to normal practice. Coordinating follow-up visits, recording data and carrying out brief educational programmes can be part of ordinary duties, and the only additional actions specifically requested by the intervention were sending email alerts (once a week) and phone calls to non-responding subjects. 11. Use of read receipts useful to determine who required a follow up phone call. 12. Older subjects may be less competent in email management, reading, and comprehension. There may be socio-economic barriers to the use of such interventions (computer access, language, health literacy). medication adherence and healthy lifestyle behaviors. 14. The provision of information alone may not be sufficient for behavior change, and more tailored and targeted interventions are needed. Further studies with longer follow-up and older and more general samples are required to confirm the present findings.
To evaluate the TEAMcare compared with usual primary care (UC) in outpatients with depression and poorly controlled or CHD. nurse care to identify clinical goals and to develop individualized care plans. 3. Nurses educated patients and used motivational interviewing, behavioral activation and strategies to help patients undertake specific self-care activities. Most participants had at least 4 visits and 3-4 telephone contacts per month from the nurse. UC participants consulted their primary care provided for concerns relating to depression CHD or diabetes 6. 14 primary care settings. 7. Practice nurses. Total intervention cost per patient was $1224. Over 24 months, intervention patients had a mean of 114 (95% CI, 79 to149) additional depression-free days and an estimated 0.335 (95% CI, −0.18 to 0.85) additional QALYs compared with UC controls. Intervention patients also had lower mean outpatient health costs of $594 per patient (95% CI, −$3241 to $2053) relative to UC patients. For adults with depression and poorly controlled diabetes, CHD, or both, the intervention seemed to be a high-value program that markedly improved QALYs - mean cost saving of $1773 per QALY. 9. NR. 14. NR. Richardson et al. (2013). UK. Cost effectiveness + RCT To present a cost effectiveness analysis, comparing costs and Health Related Quality of Life (HRQoL), as measured by 1. NR. 2. SL A non-directive counseling approach. PR involves nurses explaining symptoms in the context of a model of illness, providing a rationale for a collaboratively developed 4. Adults 18+ years (n=296). 5. CFS/ME for longer than 6 months. 6. Primary Care. 7. Adult Speciality General Nurses working in Primary 8. Costs (Private expenditures, costs of informal care and costs of lost production at 08/09 prices to NHS) and outcomes as measured by QALYs. HRQL increased in all groups at Wk. 20. Returned toward baseline at Wk.70. 10. NR. 11. Patients need to believe in the intervention model presented in order to engage fully. 12. NR. 13. Evidence suggests that patients with CFS/ME are not satisfied with the care received from primary care, and GPs find management difficult. Suggesting solutions should be implemented is of limited use if patients feel that this option is not acceptable. solving
prescription with ongoing support in general practice” (p.1223) GP, followed by monthly telephone support for 3 months delivered by regional sports trusts. 3. Ten mins of brief advice; written exercise prescription given by a primary healthcare nurse; telephone support for 9 months from an exercise facilitator; half-hour session with the nurse at 6 months. Goal was at least 30 min of moderate-intensity physical activity five times per week. 6. General Practice 7. Primary care nurses 9. Significant improvements in physical activity were found at 12 and 24 months (p<0.01); no significant difference in indirect costs between both groups (12 months: rate ratios: 0.99(95% CI 0.81 to 1.2) and ( 24months: rate ratio: 1.01 (95% CI 0.83 to 1.23, p=0.9); Cost–effectiveness ratios using programme costs were NZ$687 (€331) per person made ‘active’ and sustained - 12 months; NZ$1407 (€678) per person made ‘active’ and sustained - 24 months. 6-month face-to-face nurse follow-up contribute to higher percentage of participants who were active at 12 months. 12. NR. 14. This intervention could be set up in areas other than general practice. Implementation of this intervention would also increase if it was applied systematically to daily practice, with routine screening; delivery; and follow-up. Gibson et al (2013). Australia. Syst rev. 10 studies included Association between chronic disease type 2 diabetes related hospitalisations and primary health care resourcing. 1. NR. 2. NR 3. NR 4. Patients with chronic illness of type 2 diabetes. 5. Type 2 diabetes. 6. Primary Health Care. 7. Practice Nurse part of the primary health care team including GP. 8. NR 9. NR 10. NR. 11. NR. 12. NR. 13. This study is inconclusive with regards to its outcomes. The impression from this body of work is that access to primary care (as distinct from use – which will be highly confounded by health status) is probably associated with a reduced rate of hospitalisation for diabetes-related ACSC. 14. “Collectively, study findings must still be considered inconclusive, and the relationship between PHC resourcing and hospitalisation for diabetes-related ACSC remains uncertain. Thus
therapeutic prospects for obesity management. The value of PNs weight loss counselling may be improved by providing support in addressing barriers; securing support; and setting collaborative goals. Home Based Community Nursing or Midwifery Source Country Type of Evidence Aim 1. Definitions 2. Overview of Models 3. Main components 4. Population Group and Size 5. Health Condition / Problem 6. Healthcare context / setting addressed 7. Nursing disciplines involved 8. Outcomes assessed and effects on outcomes 9. Components associated with improved outcomes 10. Resource Implications 11. Enablers 12. Barriers 13. Key conclusions 14. Recommendations for Practice, Policy, Education, Research Preventative Behm et al. (2014). Sweden. RCT. To analyse the long-term effects of preventive home visits and senior meetings with respect to morbidity symptoms, self-rated health and satisfaction with health. 1. NR. 2. Preventive home visits and group sessions with multiple health professionals (senior visits). 3. Three arm trial comparing preventive home visits x1 with ‘senior visits’ 4 weekly and one 4. Adults >80 living at home, not requiring help with ADL and no cognitive impairment (n=459). 5. Variable levels of frailty and deemed at risk of health decline/ increasing frailty. 6. Community. 8. Progression in morbidity significantly lower at 1 and 2 year follow-ups in both groups. OR 0.44 (p = 0.001, 95% CI = 0.27–0.73) for PHV and 0.61(p = 0.048, 95% CI = 0.38–0.99) for senior meetings after 1 year and 0.60 (p = 0.035, 95% CI = 0.37–0.96) for the PHV and 0.52 (p = .008,95% CI = 0.32–0.84) after 2 years. 10. NR 11. NR 12. NR 13. A decline in health outcomes in very old persons at risk of frailty can be postponed. ‘Senior meetings’ have a greater effect than preventive home visits with respect to self-rated health. 14. NR.
care or unplanned health care utilisation. 9. NR. Sharps et al. (2013). USA. RCT To “test the effectiveness of a structured Intimate Partner Violence (IPV) intervention integrated into health department perinatal home visiting (HV) programs” (p134). 1. NR 2. Domestic Violence Enhanced Home Visitation Program (DOVE) vs usual care 3. DOVE: Based on an empowerment model, combining 2 interventions: a brochure-based IPV intervention and nurse home visitation- 3 DOVE prenatal and 3 postnatal visits. Usual care: standard home visiting and IPV protocols. 4. Abused pregnant women (n=239), randomised to DOVE (n=124), or usual care (n=115). 5. Pregnancy, intimate partner violence. 6. Home visiting. 7. Home visitors.- discipline unspecified. 8. Retention rates of abused pregnant women in perinatal HV programs. Retention of women in program: retention rates from baseline for DOVE women were 91% at delivery, 77% at 3 months, 75% at 6 months, and 70% of women at 12 months compared to UC 84% of women at delivery, 75% at 3 months, 72% at 6 months, and 70% retained at 12 months. 9. Screening for IPV appeared to promote a beneficial relationship with the home visitor. 10. Training to deliver intervention (4-hour training included information about IPV, particularly in pregnancy, importance of screening and intervening + DOVE intervention 4-hour training including use of the screening and assessment instruments, delivering the brochure-based DOVE intervention, developing individualized safety plan, strategies for revisiting and reinforcing safety plan at each home visit, and appropriate documentation). 11. Home visitors were persistent in maintaining contact with participants, and strategies to increase retention rates included sending birthday and holiday cards to every participant, 13. Findings suggest that many abused pregnant women who are screened for IPV will disclose their abuse histories and will remain in perinatal HV programs and research programs that specifically address IPV. Results indicate that home visitors’ confidence in screening for IPV increased with additional training and opportunities to observe health care professionals screen women for IPV and educate women on IPV. 14. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs’ federal government mandates for the appropriate identification and intervention of women and children exposed to IPV.
which also assisted with notification of address changes. 12. Telephone services with nurses was inconsistent due to financial restraint Barriers to screening for IPV: home visitors’ fear of either being a victim of violence from the abusive partner or having the client withdraw from HV because discussing IPV would be too sensitive and intrusive for participants. Tappenden et al. (2012) UK. Systematic Review. (n=14 – 11 RCTs and 3 economic evaluations). To evaluate the clinical and economic effectiveness of home-based, nurse-led health promotion programmes in the UK. 1. Nurse led health promotion activities described as a complex intervention. 2. Nurse led health promotion. 3. (a) health education, involving communication directed at individuals, families and communities to influence; (b) service improvement, involving quality and quantity of service; and (c) advocacy involving agenda-setting for healthy public policy. 4. Adults >65 (n=5850). 5. Long-term medical/social needs at risk of admission to hospital, residential or nursing care e.g. heart disease, Parkinson’s disease, stroke, venous leg ulcers. 6. Home. 7. Trained nurses / health visitors with access to MDT. 8. Admission to hospital, residential or nursing care, mortality, morbidity including depression, falls, accidents, deteriorating health status, patient satisfaction. Outcomes measured and reported differently between studies preventing meta-analysis. 9. Mortality: reduced the risk of death [odds ratio (OR) = 0.80, 95% confidence interval (CI) 0.68 to 0.95]. Also statistically significant effects favouring the intervention on Leg ulcer 10. There is a dearth of good-quality economic studies available to inform decisions about the cost effectiveness of home-based, health promotion. At best a weak suggestion that the cost-effectiveness may be dependent on the population at whom the programme is targeted. 11.NR. 12.NR. 13. Given the limitations of the current evidence base, it remains unclear whether home-based health promotion interventions offer good value for money. 14. Recommended appropriate training of nurses, and potentially other elements of a multidisciplinary team, but may have considerable implications in terms of costs and capacity. There may be a role for qualitative research in led
cardiac complications” (p.1) . providing home care services, offering continuing educational input and providing follow up care at home. Further studies required to reveal other effects of home-based cardiac rehabilitation such as return to work, further complications and other outcomes are recommended. Case Management Aragones et al. (2012). Spain. RCT (n=338). “To assess the effectiveness of a multi-component programme to improve the management of depression in primary care” (P. 297) 1. NR. 2. The intervention consists of a multi-component programme based on he chronic care model adapted to primary care. 3. Components are of a training based organizational clinical and health related educational nature. Nurses act as case managers. Care guided by NICE 2008. Carefully scheduled contact with doctors and nurses. Primary Care psychiatry 4. Adults 18 + Years. 5. Major depression . 6. Primary Health Care Service. 7. General Trained Primary Care Nurses. 8.The severity of depression (mean Patient Health Questionnaire -9 score) was 1.76 points lower in the intervention group [7.15 vs. 8.78, 95% CI=-3.53 to 0.02, p=0.053]. The treatment response rate was 15.4% higher in the intervention group than in the controls [66.9% vs 51.5%, odds ratio 1.8, 95% CI=1.2 to 3.1, p=0.011], and the remission rate was 13.4 per cent higher [48.8% vs 35.4%, odds ratio 1.8, 95% CI=1.1 to 2.9, p=0.026]. 10. Resource neutral. 11. NR. 12. NR. 13. The programme for managing depression in primary care was designed so that – if effective – it could be applied in habitual care and is straightforward to implement. 14. NR.
Policy makers and service planners can now calculate the extent to which current home palliative care services may need expansion locally on the basis of current and target home death rates, applying NNTB from this meta-analysis to current and projected local need. Further meta-analyses on symptom burden and caregiver grief would produce more robust data Future studies need to harmonise measurement and reporting practices. Hudson et al. (2013). Australia. Phase III parallel group (three-armed)RCT To “prepare caregivers for the role of supporting a patient with advanced cancer receiving home-based palliative care by offering a one-to-one psycho-educational intervention”. 1. NR. 2. Intervention based on transactional model of stress and coping. Two variations based on whether the person received 1 or 2 visits. Control group – usual palliative care support. 3. Intervention delivered over 4 weeks and involved phone calls with family, a family caregiver guidebook, written information about the intervention, assessment of caregiver needs, development of a 4. Primary family caregivers >18 years (n=298). 5. Caregivers of patients with advanced cancer receiving home-based palliative care. 6. Home. 7. Family Caregiver Support Nurse (FCSN) who assisted the local palliative care service to assess caregiver needs, establish a care plan and provide additional caregiver support. 8. Relative to participants in the control group; the psychological well-being of participants in the intervention condition improved by a small, amount. No significant reduction in unmet needs or improvements in positive aspects of caregiving amongst the intervention group were identified. 9. The intervention demonstrated significant improvements in participants’ levels of preparedness and competence when the intervention consisted of 2 visits (as opposed to 1). Effect 10. Training of FCSN. 11.NR 12. NR 13. Relatively short interventions can enable family caregivers to feel more prepared and competent in the role of supporting a dying relative. 14. Further investigation is required to determine the longer term outcomes of such interventions. Constructs such as preparedness and competence may be linked to overall psychological wellbeing. Further
Patients who lack a home caregiver and who are socioeconomically disadvantaged are less likely to have access to community A better understanding of the barriers and facilitators for remaining at home is needed, including detailed exploration of known drivers of hospital admission near the time of death, such as problems with symptom management. data to inform the optimal combination of specialist and generalist provision, the role of nurses vs. other health professionals, and the necessary scope of practice and expertise in different service contexts. A better understanding also is needed of who will benefit most from community-based SPCSs and the configuration of nursing services required to meet patient and caregiver needs. Health professionals assessing the suitability of individual patients for home care would be assisted by validated tools for evaluating the viability of home death. Tools for assessing prognosis (with the aim of avoiding acute care admissions for people who are dying and prefer to die at home) also are required. Improved targeting of services will become increasingly important as Western populations age and informal caregivers
diminish in availability and capacity. Even where evidence-based support for home care is available, patients and family caregivers should remain at liberty to choose the place of care and death. Need to support families better in making an informed decision between home vs. institutional care, acknowledging that preferences may change over time and may differ for patients vs. caregivers and place of care vs. place of death. Parker et al. (2012). UK Systematic Rev.iew (n= 37 papers on 26 studies of which 11= RCTs & 15 = health economic studies) 1. Care closer to Home: “any model of care that acted to prevent immediate inpatient admission and/or enable a reduced length of stay for children (up to the age of 18 years) with acute, chronic, complex or palliative care needs” (p. 3). 2. Most common model is generic community children’s nursing teams & condition specific services, nurse led only or multidisciplinary teams. 4. Children care. Samples in studies ranged from 15 to 210. 5. Long-term conditions/ short term health needs/in need of palliative care. 6. Home care. 7. NR for some studies reviewed. Nurses/primary care provider/case manager where reported. 8. Paediatric home care has equivalent clinical outcome results to in-patient hospital treatments e.g. Weight gain in premature infants; HBA1C for diabetes care; Adaptation to school 7 work re mental health problems; Readmissions to hospital; Adverse events from chemotherapy. Costs: Savings associated with paediatric home care. 9. NR. 10. Care closer to home offers potential for reduced health service costs, but this is sensitive to case mix, skill mix and change in the local health economy. 11. NR. 12. NR. 13. See Q14 14. Research: Areas for further investigation on care closer to home (CCTH) in minority communities or socio-economically deprived groups and in rural areas. Consider factors influencing whether families feel able to use CCTH services, the views of children about service and and the impact of CCTH on primary and community care services.
care at home and prefer to die at home. 14. Further research on the frequency and the duration of visits is necessary in a cost utility study. Because the costs are largely determined by travel time and travel expenses, a study also should investigate if the follow-up can be performed by nurses with less travel time and costs (e.g., community nurses) or by innovative interventions such as tele-health. Nurse-Family Partnerships/ VoorZorg nurses Mejdoubi et al. (2013). Netherlands. RCT To assess the effect of VoorZorg, the Dutch Partnership (NFP)on addressing Intimate Partner Violence (IVP) victimization and perpetration among young, low-educated pregnant women and mothers 1. NR. 2. Intervention group received usual care and home visits from nurse throughout pregnancy, and until child turned 2. Control group received usual care. 3. Usual care includes physical examination, monitoring development of foetus, health education, postnatal advice, and monitoring of infant’s health. 4. Disadvantaged pregnant women <26 years, with no previous live births. (n= 460). Randomised to intervention (n=237) or control (n=223). 5. Intimate partner violence, pregnancy. 6 Home care. 7. Home visits: VoorZorg nurses. Usual care: midwives/ obstetricians. 8. Primary outcome: psychological, physical or sexual violence, and injury towards the participant (victim) as well as towards her partner (perpetrator). Secondary outcomes were a summation of forms of violence, and both experiencing and perpetrating IPV. 9. Home visit program was effective in reducing victimization by IPV. Improvement greater in intervention group than control group at 32 weeks of pregnancy 10. NR. 11. Open and dialogue between nurse and patient; trusting and professional relationships with HCP 12 NR. 13. Home visiting interventions shown to be successful in reaching high risk young pregnant women and identifying at risk individuals. Suggests the need for healthcare professionals to focus on this group due to their vulnerability. 14. Need to screen at risk individuals/ groups and address IPV risk factors e.g. alcohol, financial dependency. Need for open Family Nurse-
women smoking in late pregnancy (56%). No difference in number of cigarettes per day for women classified at baseline as smokers. Hospital visits for child: 81% in FNP, 77% in controls. Second pregnancy within 24 months: No difference between groups (66%). Secondary outcomes suggested small positive effects of FNP: intention to breastfeed, maternally reported cognitive and language development, levels of social support, quality of relationship with partner, and self-efficacy. Greater documentation of child concerns in FNP group. FNP was ￡4670 (95% CI 3322–6017). Not cost-effective for main outcomes – smoking cessation, and second pregnancies. 11. NR. 12. NR Miscellaneous Alicea-Planas et al (2013) Randomised experimental (pretest/posttest intervention) trial. USA To investigate whether and self-rated health would improve following a 1 NR 2 Goal setting intervention Chronic care model (CCM) used as theoretical framework- focuses on empowerment and support to self-manage health 3 ‘Healthy changes’ action plan - identified small health 4 Spanish speaking adult patients (n=184) divided between intervention (n=91) and control (n=93). 5 Chronic diseases 6 Community health centre 7 Staff nurses 8. Self rated health scores: no significant difference between pretest to posttest by study group F(2, 156)=0.13, p=.72 Mean scores decreased from pretest to post test in control group (M=3.79, SD=0.82 vs M=3.55, SD= 0.94), and intervention group (M=3.68, SD 0.86 vs M=3.38, SD= 0.86) 10 Intervention required no extra money or staff. Intervention was implemented into practices of the community health centre easily. 11 NR 13 Self-efficacy appears to be related to ability to manage chronic disease. Although not statistically significant, the intervention group did demonstrate a larger increase in than the usual care group did. efficacy efficacy
Examine if transitional care interventions associated with reduction of readmission rates in short (30 days or <), intermediate (31-180) and long term (181-365 days). 3. 26 studies reviews. :54% included comp t assessment at admission, 81% self manage education during admission, 54% involved caregiver as secondary recipients of intervention. 69% had care coordination by nurse. 6. “Hospital to home” continuum setting. 7. NR. (OR: 0.77; 95% CI: 0.62, 0.96) and 13% in long-term readmissions (OR: 0.58, 95% CI:0.46, 0.75) (Exhibit 1–3; not effective in reducing short-term readmissions (OR:0.76; 95% CI: 0.52, 1.10). High-intensity interventions associated with reduced short-term readmissions (OR: 0.59; 95% CI: 0.38, 0.92), intermediate term (OR: 0.69; 95% CI: 0.51 0.92), and long-term readmissions (OR: 0.57; 95% CI: 0.35,0.92) Low-intensity interventions sig. associated with reduced long-term readmission (OR: 0.62; 95% CI: 0.46, 0.82). Transitional care associated with a 5% lower rate of intermediate-term readmission(OR: 0.74; 95% CI: 0.59, 0.93) and 8%lower rate of long-term readmission (OR:0.71; 95% CI: 0.56, 0.91) in patients > 60 yrs. No evidence transitional care associated w/ To reduce hospital readmission, high intensity interventions might be needed such as home visit within 3 days. Interventions for effect on intermediate and long term readmit lasted >30 days. 11. NR. 12. NR. effective in reducing readmissions. To reduce short-term readmissions, transitional care should consist of interventions that include care coordination by a nurse, communication between the primary care provider and the hospital, and a home visit within three days after discharge. Transitional care effective for pts >60 yrs. Ideal content of transitional care programs and target groups are still unclear. 14. Transitional interventions important where countries have a target to reduce 30 day readmissions.
follow up. detail lacking on the actual components of the calls and home visits. Telehealth Source and type of evidence Country Aim 1. Definitions 2. Overview of Models 3. Main components 4. Population Group and Size 5. Health Condition / Problem 6. Healthcare context / setting addressed 7. Nursing disciplines involved 8. Outcomes assessed and effects on outcomes 9. Components associated with improved outcomes 10. Resource Implications 11. Enablers 12. Barriers 13. Key conclusions 14. Recommendations for Practice, Policy, Education, Research Telephone support Fischer et al (2015). US. RCT. To evaluate the ability of an additional nurse directed telephone intervention to reduce primary medication non-adherence. 1. NR. 2. Nurse reminder to patient to pick up medicines not collected at the pharmacy. 3. Up to three attempts over 2 days to call the patient on the phone at different times of day. Message left on patient’s phone if not contacted. 4. Patients identified as PMN (primary medication non-adherent) i.e. who had not collected their newly prescribed medicines after 14 days and three automated and one live call from the pharmacy (n=290). 5. Patients who were on medicines for hypertension, hyperlipidaemia, asthma and type 2 diabetes. 6. Geisinger Health System – network of over 40 community based clinics in Pennsylvania. 8. Primary outcome was pick up of prescription within 30 days. 25% of intervention patients and 24% of control patients picked up their prescriptions within 30 days. Difference non significant Multivariate analysis OR 1.08 (95% CI 0.62-1.89, p=0.79). 9. Anti-hypertensives showed the highest rate of pick up (47%), hyperlipidaeamia meds lowest (5.3%). 10. NR 11. NR. 12. Delay before contact by nurses initiated was identified as a possible factor in apparent ineffectiveness of intervention. Low level of primary medication (6% - much lower than found in previous studies) was also a factor in the lack of effectiveness of the intervention 13. Nurse reminder calls for patients who were primary medication for newly prescribed medicines for certain chronic diseases did not prove to be effective. 14. More research needed on current rate of primary medication non-adherence (which may have changed from when first researched). Intervention may need to be changed to include re-engagement with the primary care provider who prescribed the medicine.
9. NR. cost-effectiveness and feasibility with other chronic disease states. Mohammadi et al. (2013). Iran. RCT The aim of the study was to assess the effect of nursing pulmonary rehabilitation on fatigue, ADL and QOL in patients referred to a subspecialty training hospital 1 NR. 2. The model is termed home based nursing pulmonary rehabilitation …however the only nursing discipline input is training and follow up by a research nurses while the patient is home in the community. 3. The home-based rehabilitation programme consisted of 3 x 1hr sessions of face-to-face, individual training in the intervention group on education of COPD symptoms, correct methods of walking and pursed lip breathing and a pictorial booklet followed by practical sessions and follow-ups by nurses at the patients’ home by telephone. Control group usual care consisting of drug tx. Patients were telephone contacted daily by research nurse. 4. Patients (n=106) at stage 2 or 3 COPD based on GOLD criteria (2009) 5. COPD. 6. Initial training and follow up at home after 7 weeks. 7. In-hospital nurse training of patients in intervention and research nurses follow up with telephone calls. 8. Home-based nursing pulmonary rehabilitation had a significant effect on fatigue (p<0.001); ADL (p<0.001). and QOL (p<0.001). 9. Nursing input was remote but deemed significant in motivating and providing feedback to patients. 10. NR. 11. Willing and suitable patients. 12. Need for training of patients on the HM systems that are person-centred and followed up by nurses. 13. Home-based nursing pulmonary rehabilitation could reduce fatigue and improve ADL and QOL in patients with stage 2 or 3 COPD offering an alternative to institution based rehabilitation. 14. Research suggests that although home-based nursing rehabilitation has been shown to be effective, there is still a need to design an applied model in order to present it. It seems that home-based rehabilitation programmes should be moderated based on patients’ needs and contextual conditions. Walters et al. (2013). RCT. 1. NR. 4. Adults aged 68 +/-8yrs (n=182). 62% moderate COPD, 53% men). 8. There was no difference in quality of life between groups, but 10. NR. 13. Health mentoring delivered by community health nurses increased the
signs information and a text message component addressing symptoms, functional status, and medical regimen compliance. Steventon et al (2013) UK Cluster Randomised trial (n=2426) Telecare was compared with ‘usual care’ NR 2. Telecare using functional monitoring 3’Functional monitoring, including the ‘Lifeline’ base units and pendants, bed and chair occupancy sensors, enuresis sensors, epilepsy sensors, fall detectors and medication dispensers. • Security monitoring, including bogus caller buttons, infrared movement sensors and property exit sensors. • Environmental monitoring, including gas, monoxide and smoke detectors, heat sensors, temperature extremes sensors and flood detectors • Standalone devices not linked to a monitoring centre, such as big button phones, key safes for careers and memo minders. Data from the peripheral devices were sent to a 4. People with social care needs, aged over 18 5 people with social care needs e.g. minimum level of social care service, mobility difficulties; At risk of falling; cognitive impairment 6. All general practices in Cornwall, Kent and Newham with 238 practices allocated to control or intervention groups, of which 217 ultimately supplied participants for the trial 7 practice nurse 8. Followed up for 12 months proportion admitted to care Secondary endpoints included: mortality Health care utilization: number of weeks receiving domiciliary care, inpatient hospital bed days, emergency admissions, elective admissions, admissions for falls, outpatient attendances and accident and emergency visits. 9 Of intervention group 46.8% were admitted to hospital compared with 49.2% of controls. This difference was not statistically significant There were also no significant differences in the number of weeks receiving domiciliary social care between groups General practitioner contacts were significantly higher among intervention than controls (incidence rate ratio: 1.18, 95% CI: 1.01–1.38, P = 0.033), There were no 10. NR 11 Decision-making should wait until results relation to the quality of life, carer outcomes and experience are available 12NR 13. Telecare as implemented in the Whole Systems Demonstrator trial did not indicate any significant reductions in service use assessed over 12 months 14. No major recommendations
multidisciplinary care approach including patient guidance and support for self-care . intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients’ clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study telemonitoring-assisted care approach led to increased use of health care resources while showing no quantified improvement in the patients’ condition Wakefield et al (2013) RCT USA ‘To evaluate the efficacy of a nurse managed home intervention to improve outcomes in veterans with co-morbid diabetes and HTN’ (p254). 1 NR 2 Home tele-health intervention involving nurse led remote monitoring. High and low intensity interventions compared 3 High intensity: daily BP, blood glucose as directed. Branching disease management algorithm focusing on diet, exercise, smoking cessation, foot care, medications, weight management, preventative care and behaviour modification and lifestyle modifications. Prompts, 4 Adults (n=302) divided between high intensity (n=93), low intensity (n=102) and usual care (n=107). 5 Comorbid diabetes and hypertension 6 Home 7 Tele Nurses (n=unspecified) 8 HbA1C: reduced in intervention group during the 6 months of the intervention (P= 0.0003 - 0.0001) but comparable with control group by 6 months after intervention. Systolic Blood Pressure (SBP): significant reduction for high intensity group at 6 and 12 months (p=0.01) Adherence: Improved in all groups, with no differences between groups. 9 NR 10 NR 11 Nurse monitoring and collaboration with a primary care physician 12 NR 13 Home telehealth increases contact with patients and enables earlier detection of problems. Home telehealth can improve outcomes in patients with comorbid chronic illness in the community. 14 Further research neeeded to establish optimal frequency and intensity for these types of interventions Home telehealth is a viable intervention for patients with chronic conditions in the community setting.
were also referred to a school nurse for a consultation. Adolescents in the control group received no messages following the initial assessment. vs mean 73.73, SD 18.17 ) Both intervention groups reported a significantly better mental health status compared to adolescents in the control group (SDQ: mean 8.42, SD 5.05 vs 9.07, SD 5.38). No improved effects found on health behaviors from the intervention. Adolescents in the and consultation group, who were at risk of mental health problems and referred for consultation with the nurse, had significantly better mental health status (SDQ: mean 12.79, SD 5.63 vs 14.57, SD 5.03) and a better health-related quality of life (mean 69.56, SD 18.37 vs 62.53, SD 20.08) at follow-up than those in the E-health4Uth group and the control Finkelstein et al 2011 RCT USA ‘To evaluate the perception, satisfaction and utilisation of a home telehealth service for frail elderly people living independently in their home communities’ (p288) 1 NR 2 Virtual Assisted Living Umbrella for the Elderly (VALUE) Home telehealth service 3 Web portal which allowed videoconferencing and electronic messaging between nurses and clients. This provided access to 4 Older adults (n=99) 5 Frail 6 Home 7 Nurses (n=unspecified) 8 Perception of telehealth service: intervention group significantly more positive towards technology at 60 days compared with their baseline scores , and compared with the control group at 60 days (P<0.001) Satisfaction: Intervention group reported that the system met their overall 10 Telehealth intervention was reported by some patients as saving them money. 11 Simple system and basic instructions from nurses necessary for participants to learn to use system. 12 Lack of Broadband availability in some areas 13 Frail older people were able to utilise a home telehealth system easily and this was associated with a decrease in healthcare utilisation. The system also appeared to have high levels of patient satisfaction. 14 Web portal home telehealth system was effective and had high rates
Nursing or Midwifery in Community with Non-Professional workers Miscellaneous Filene et al. (2013). Meta-analysis. (n=51 studies. Type of studies NR other than noting that effect sizes could be calculated from studies). “to determine which individual home visiting program components have the most power to predict key parent and child outcomes” (p. S101). NR 2. NR other than home visiting 3. Typical child development information, child care & routines, focus on home, environment – safety & cleanliness, attending to child’s emotional needs, promoting cognitive & socio-emotional development, instrumental assistance, Selecting alternative caregivers, parental relationships & health, parenting practices, family planning, self-, stress & anger management, support & social networks, adult literacy & academic achievements, problem solving, goal setting, case management, rehearsal or role-playing, matching home visitor to client e.g. race, ethnicity, standardized curriculum. 4. Pregnant women and families with children from birth to 3 years in U (n=unspecified) 5. Early childhood development (typically developing). 6. Children’s family homes and clinics 7. Professional (e.g. nurse, psychologist, social worker) & non-professional home visitors. 8. Clinical/Health outcomes: (6 in total) Maternal life course, child cognitive outcomes & parenting behavior & skills: significant positive average effect sizes. Birth outcomes, child physical health, & child. Maltreatment: no significant differences in effect sizes. 9. Non-professionals, matching of home visitors to clients & problem solving associated improved birth outcomes (e.g. birthweight, absence of complications). Parent education on developmental norms, behavioural management & discipline techniques, responsive associated with improved parent behaviours & skills outcomes. Parenting practices associated with better parenting behaviours & skills and with cognitive outcomes in children. Professional home visitor predicted better child physical health, 10. NR. 11. NR. 12 NR. 13. NR. 14. NR.
Parent support groups associated with small effect sizes for child physical health, Selecting alternative caregivers & problem solving associated with better outcomes for child maltreatment. Note: Based on sensitivity analysis effects of problem solving on birth outcomes no longer significant. Tafts et al (2015). Australia. RCT “To test whether a maternal and child health (MCH) nurse- designed model increased and sustained DV screening, disclosure, safety planning and referrals compared with usual care” (p1). 1. NR. 2 MOVE model (Intervention informed by Normalisation Process Theory, a nurse-designed good practice model). 3. Intervention: nurse mentors, strengthened relationships with DV services, nurse safety, a self-completion maternal health screening checklist at three or four month consultations and DV clinical guidelines. Usual care: government mandated face-to-face DV screening at four weeks postpartum and follow-up as required. 4. Community based maternal and child health teams (n=8). 5. Maternal and child health. 6. Community. 7. Nurses (n=163), and domestic violence liaison workers. 8. Primary: women screened for DV; Women’s disclosure and nurse safety planning; Referrals. Secondary: Prevalence of any DV in the previous 12 months; DV during pregnancy and maternal reporting of abuse as a child; difference in proportions of women reporting harm. MCH team screening: No significant differences between groups at 4 months but increased proportion of screening (36.5% in intervention vs 23.5% in controls). Maternal heath checklists at 3 months show average screening rate of 63.1%. Safety planning rates: Increased for intervention group, 3 to 4 times higher than control 10. NR. 11. Longer screening time focused on the mother and her needs. 12 MOVE process evaluation identified implementation barriers, such as lack of nurse reflective practice and the coinciding introduction of a new practice framework. Using survey data online may reduce response rate. 13. Safety planning rates may be improved by nurse designed model of screening and care. The involvement of staff is critical both for effectiveness and sustainability of DV interventions in health care settings 14. Greater attention should be given to how screening is implemented in primary care and further research should be undertaken on intermediate outcomes such as safety planning and its benefits.
programme using home visitation in improving infant health in low-income families, when compared with usual community care (CC) including nurse home visitation’ (p.28). 2. Home visitation programme, state sponsored through Medicaid enhanced prenatal & postnatal services (ESSP) with the addition of nurse-CHW home visits. 3. Standard Medicaid ESSP during pregnancy & 1st 12 months of life: Risk screening, transportation, psychosocial counselling, nutritional guidance and pregnancy and parenting education, primarily through home visitation by a nurse during pregnancy. Additional components for IG were CHW phone contacts & home visits with specific activity modules: self-esteem; positive health behaviors; self-awareness of stressors, causes of stressors and active problem solving; through development of personal life goals; and community resources. 7. Community Care nurses (IG & CG groups) & community health workers (CHW – IG only). low psychosocial resources and high stress (17% vs. 29%, P = 0.08). No other statistically significant infant health effects of the nurse–CHW team home visitation programme compared with CG. in the subgroups defined by low psychosocial resources and high stress. No improvements in recurrent ear infections or feeding problems. No differences in immunizations, hospitalisations or ear infections. 9. No applicable since IG Nurse–CHW team intervention did not improve general infant health compared with standard CC including nurse home visiting. chronic conditions may prove more successful. 12. NR. nurse-only home visitation. 14. Cost effectiveness research on home visiting programmes needed. Volunteer Kemp et al. (2011). Australia. 1. NR. 2. MECSH: Structured nurse home visiting and 4. At-risk mothers living in a 8. Primary Outcomes: Quality of the home environment for child development (12–24 months): parent child interaction during 10. NR. 11. NR. 13. The MECSH programme showed that in many outcome areas there nurse–
RCT “To investigate the impact of a long-term nurse home visiting programme, embedded within a universal child health system, on the health, development and well-being of the child, mother and family” (p1). parenting education and support programme vs usual universal care. 3. Structured home visits, post natal child development education, access to secondary and tertiary early childhood health services, volunteer home visiting services and family support services within the local area, group activities and community links. socioeconomically disadvantaged area (n=208). 5. Child and maternal health. 6. Home care, socioeconomically disadvantaged area. 7. Child and family health nurses. play; Child mental, psychomotor and behavioural development at 18 months. Perinatal outcomes: low birth weight and preterm birth, extracted from hospital clinical records. Child respiratory and gastrointestinal illness and immunization status, measured by maternal self-report, being fully immunized or not at 24 months. Maternal and household smoking during pregnancy and over the first 2 years of life. Breastfeeding over the first 2 years of life, Maternal health (SF-12), depression (EDS) and social support, the number of stressful life events in the previous year and family functioning, and experience of being a mother. Parent–child interaction: No significant difference in interaction between the intervention and comparison groups Mothers receiving the intervention were more emotionally and verbally 12. The number of participating nurses, and hence mothers, was limited by the funding, infrastructure and management capacity within the service. were no differences in outcomes for first-time and multiparous mothers. This challenges the assumptions of many nurse home visiting programmes that their benefits are confined to first-time mothers. 14. The MECSH trial showed some significant results and some trends that require replication in larger samples of mothers drawn from a similarly widely defined at-risk group, including older, multiparous mothers, and mothers with higher levels of education.
responsive than comparison group mothers (mean difference 0.5; 95% CI 0.1 to 0.9). Duration of breastfeeding was longer for intervention mothers than comparison mothers (mean difference 7.9 weeks; 95% CI 2.9 to 12.9). Child mental, psychomotor and behavioural development at 18 months: no significant overall group differences in child mental, psychomotor or behavioural development. Birth weight: No significant difference between groups. Mothers assessed antenatally as having psychosocial distress benefitted from the intervention across a number of areas. 9. NR Lay personnel Dennis and Dowswell. (2013). Cochrane Systematic Review To assess the effect of psychosocial and psychological interventions to reduce the risk of developing postpartum depression. 1. NR. 2. Postpartum home visits provided by public health nurses or midwives/ lay (peer)-based telephone support/ interpersonal psychotherapy 3. Psychosocial and psychological interventions vs usual AN/,PN care to 4. 28 trials, N= 16912/ almost 17,000 pregnant women and new mothers including adolescents and younger mothers. 5. Primary care. 6. Postnatal depression- EPDS used most frequently to assess but other tools also used. 8. Less prevalence of PND: outcome assessments varied considerably between studies, ranging from three to 28 weeks. 9. Psychosocial interventions: antenatal/postnatal classes/groups, home visits/ telephone support/, early postpartum support/ continuity of care models. 10. NR. 11. Midwifery-based flexible postpartum care and lay telephone support interventions incorporated screening with the Edinburgh Postnatal Depression Scale (EPDS) for the early identification of 13. Psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression. No evidence that a specific health professional providing an intervention increased the likelihood of a preventative effect.
reduce risk PND. Also to examine (1) effectiveness types interventions, (2) effectiveness of professional versus lay interventions, (3) effectiveness individual vs group interventions, (4) effects of intervention onset and duration, (5) whether interventions more effective in women selected with specific risk factors. 7. Nurses, midwives and others (physicians, mental health specialists, therapists, lay (peer) individuals. Psychological interventions: debriefing, CBT, interpersonal psychotherapy. There was beneficial effect on the prevention of depressive symptomatology in the of all types of psychosocial and psychological interventions. Intervention group significantly less likely to develop PND (ave RR 0.78, 95% CI 0.66 to 0.93; 20 trials, 14,727 women). Promising interventions: (1) intensive, home visits by PHNs or midwives (RR 0.56, 95% CI 0.43 to 0.73; two trials, 1262 women); (2) lay (peer)-based telephone support (RR 0.54, 95% CI 0.38 to 0.77; one trial, 612 women); (3) interpersonal psychotherapy (st m diff -0.27, 95%CI -0.52 to -0.01; five trials, 366 women). Professional- and lay-based interventions were both effective in reducing the risk to develop depressive symptomatology. Individually-based interventions reduced depressive symptomatology at final assessment (RR 0.75, 95% CI 0.61 to 0.92; 14 trials, 12,914 depressive symptomatology 12. NR. 14. Interventions that are individually based and initiated postnatally may be beneficial. Interventions targeting mothers may be more beneficial and feasible than those including a general maternal population.
problems (RR 0.46, 95% CI 0.21 to 1.01), infants not in care of biological mother (two studies, 254 infants; RR 0.83, 95% CI 0.50 to 1.39), non-accidental injury and non-voluntary foster care (two studies, 254 infants; RR 0.16, 95% CI 0.02 to 1.23) or infant death (three studies, 288 infants; RR 0.70, 95% CI 0.12 to 4.16). Individual studies reported a significant reduction in involvement with child protective services (RR 0.38, 95% CI 0.20 to 0.74) and failure to use postpartum contraception (RR 0.41, 95% CI 0.20 to 0.82). Preventative Miscellaneous Fahs et al (2012). USA. Multisite RCT “To compare 2 strategies, stage-matched nursing and community intervention (SMN+CI) and community intervention (CI) alone in changing cardiovascular 1. NR. 2. Transtheoretical model included assessment of stage of change (SOC) at 5 levels. The Moos model addressed environmental system limitations associated with rural lifestyle. 4. 274 Rural Women age 35-65 years (n=117). 5. Framingham score ≤20 points with no history of coronary heart disease (CHD) or diabetes. 6. 2 rural counties in US to enable ethnic mix. 8. SMN+CI group had higher fruit intake by meal (P = .005) and showed greater pre-post change in total fruit and vegetable intake (P = .03). There was no significant difference on Framingham by group after the intervention (t (115) = 1.07, P = .28), yet, Framingham scores decreased significantly for the entire sample (t (116) = 6.01, P = 10. 2 day workshop to train nurses. 11. NR. 12. 21% attrition usual for such studies. 13. More work needs to be done to reduce CVD risks to promote heart health among rural women. 14. Nursing interventions focused on lowering cholesterol through behaviour modification should receive consideration. A design focusing on intervention
Secondary outcomes: Receipt of at least one vaccine within different age groups (6 months to 5 years, 6–12 years, and 13–18 years): largest increases seen among and adolescent children. Differences for 6-month-old to 5-year-old children did not reach significance. Comparison of missed opportunities (yes/no) for each eligible child during the second intervention year between intervention and control practices: 51.3% (n= 5490) of children in the control practices missed an opportunity for influenza vaccines, compared to 40.8% in intervention group (n= 7078) (p b .0001). collaboration included uncertainty regarding the delivery of vaccine supplies, concerns about using up all purchased vaccine by practices, and concerns about documentation of vaccination if collaboration occurred. pharmacies, is needed to enable universal yearly vaccination to be achieved. Kokkvoll et al. (2013). Norway. RCT To compare a new comprehensive lifestyle programme performed in groups of families with overweight (included obese) children with a more conventional single family programme. 1. NR. 2. Family based intervention. 3. Multiple family intervention (MUFI) compromised of a 3 day inpatient programme at the hospital with other family and interdisciplinary team. Single family intervention (SIFI) comprised of individual counselling by pediatric nurse consultant and nutritionist at the 4. Children aged 6-12 years (n=97). 5. Cut off point was children with a BMI of ≥27.5. 6. Community Health. 7. Pediatric Nurse. 8. BMI increased by 0.37units in the MUFI compared to 0.77units in the SIFI (P=0.18). BMI SDS decreased by 0.16 units in the MUFI group compared to 0.07 units in the SIFI group (P=0.07). 9. Interim analysis after 12 months showed no between group difference in terms of BMI or BMI SDS. The MUFI group had a significant decrease in waist circumference compared to the SIFI group. 10. NR. 11. NR. 12. NR. 13. The modest difference between the two treatment groups after 2 years raises the question whether the cost of the MUFI approach can be justified. 14. Obesity interventions in children and adolescents should examine health and evaluate mental health and wellbeing in addition to other health outcomes.
teacher vs school nurse)” (p.190) HIV/STI and condom use knowledge immediately and at 4 months (p<0.5). A change in student intentions when taught by school nurses was reported in relation to the use of a condom. A significant increase was noted in technical skills and condom negotiation skills. Intervention students taught by school nurses reported significant increases in their condom use beliefs at 4 months. teaching as students may be more comfortable and familiar with healthcare professionals. For this intervention to be effective in influencing risk behaviors, schools should utilise school nurses in teaching the technical and interpersonal skills needed for self-protection. Brackney et al. (2015). USA. Systematic Review (n=35). To “determine effective interventions for prevention of T2 DM in youth” (p.6) 1. NR. 2. Non-pharmocological interventions. 3. Included: Daily activity; decreasing caloric intake; increasing muscle mass; psychological and social support 4. Adolescents (15- 19 years). 5. Type two diabetes. 6. School; Family; Community; and Clinic. 7. School Nurse. 8. School based interventions (n=9); Family based interventions (n=4); Community based interventions (n=7); Clinic Interventions (n=15). 9. Components for effective intervention strategies include; different types of physical activity; nutrition education; behavior therapy; cultural sensitivity; and ongoing support i.e. telephone sessions, newsletters, periodic meetings. Less common, components comprised of peer leadership opportunities; CST; and motivational interviewing. School Based Interventions: Positive results were mainly noted in relation to BMI, weight, fitness levels, cardiac blood 10. NR. 11. Follow-up or “continued opportunity” for participants was identified as most effective. Implementing the intervention in a school setting- easily accessible; support from peers an teachers. 12. Transportation to after-school community centers; poor school attendance; funding and training; environmental. 13. The school nurse has the potential to influence future health prevention of T2 DM. 14. More research evaluating the effectiveness of interventions between boys and girls; high school students; and among youth at risk of developing T2 DM is needed.
To “evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma” (p. 262). 3. Direct observation therapy with preventive asthma medication reduces asthma symptoms in school settings. 6. School. 7. School nurses. asthma symptoms, days with activity limitation, days needing rescue medications, and days of missed school. 9. Participants receiving preventive medications in the school setting had significantly more; symptom-free days (adjusted difference=0.92 days per 2 weeks; 95% CI, fewer nighttime symptoms; less rescue medication use; fewer days with limited activity (all P.01); exacerbation requiring treatment with prednisone (12% vs 18%, respectively; relative risk=0.64; 95% CI, 0.41-1.00) than that of the children in the control group. Positive intervention effects seen in participants with smoke exposure (n=285; mean symptom-free days per 2 weeks: 11.6 for children in the treatment group vs 10.9 for those in the control group; difference=0.96 days per 2 weeks; 95% CI, 0.39-1.52). 12. Family stress; poverty; poor access to care; difficulties in communication exacerbations amongst urban children than that of the children in the control group. 14. Further efforts are now needed to estimate the costs of this intervention and to progress forward with dissemination. Kinter et al. (2014). USA. RCT. 1. NR. 2. Staying Healthy–Asthma Responsible & Prepared (SHARP). 4. Caregivers of diagnosed asthma students; Students (dyads, n=216). 5.Asthma. 6. Schools. 8. Episode management; risk reduction/prevention; health promotion. 9. SHARP- the SHARP main effect was significant compared to the control group (t[151] = 10. NR 11. NR 12. NR 13. Collaborative work with school teachers and nurses may increase the use of asthma self-care behaviors. 14. The use of SHARP in school and community
individual needs benefits families and is cost effective. Lopez et al. (2015) USA Cochrane Systematic Review To assess the effectiveness of postpartum educational interventions on contraceptive use. 1. NR. 2. Nurses, midwives (and physicians) postpartum educational interventions on contraceptive use. 3. Included individual or group counselling, written materials, video or audio recordings 4. 12 trials, 4145 women – USA, Australia, Nepal, Pakistan, and Syria. 5. Unplanned pregnancy and contraceptive use. 6. Postpartum hospital or 2-3 wks later (home/clinic/ phone). 7. Nurses, midwives. 8. 2nd birth (by 24 mts). Contraception use at 6mts, effective contraception at 6mths. Adolescents, with homebased mentoring had fewer 2nd births within 2 years compared to the control group (OR 0.41, 95% CI 0.17 to 1.00). The other five interventions had no effect. Of trials with lower quality evidence, two showed some effectiveness. In Nepal, women with an educational session immediately postpartum were more likely to use contraception at six months than those with a later or no session (OR 1.62, 95% CI 1.06 to 2.50). In an Australian study, teenagers in a structured program were more likely to have effective contraception use at six months than those with standard home visits (OR 3.24; 95% CI 1.35 to 7.79). Meta-analysis not done due to varying study designs 9. NR 10. Given the associated costs and logistics, some programs would not be feasible in many settings. 11. NR. 12. NR. 13. Insufficient evidence to recommend any particular educational interventions on contraceptive use. 14. Although half of the interventions were effective in reducing repeat pregnancies or births and increasing contraceptive use, the overall evidence of effectiveness was of low to moderate quality. Two trials of counselling providing one or two sessions were effective but were limited by reported outcomes and short term outcome assessment. Three trials of multifaceted programmes involving multiple contacts were effective but their applicability in other locations is uncertain and health care providers would need to consider which intervention might be appropriate for their setting and level of resources. Valid and reliable outcome measures are needed to obtain meaningful results.
Mirmolaei et al (2014) Iran RCT To compare effect of two midwife home visits to usual care on healthy behaviours of low‑risk mothers 1. NR 2. Attendance at primary care facilities compared with home visits by midwives. 3. First visit at health centre (3-5 days) followed by two postnatal home visits at 10-15 days and 2nd within 42-60 days 4. Postpartum women (n= 200) 5. Maternal health behaviours assessed at 60 days (2 months) 6. Home visits in designated geographical region of Iran 7. Midwives 8. Impact of two postnatal home visits on the healthy behaviours of low risk mothers: included maternal behaviours in relation to nutrition, physical activity, smoking, alcohol, breastfeeding, FP, personal and mental health, and ability to taking care of newborn. Intervention group more likely to receive postpartum care (P < 0.001). Mean score of maternal healthy behaviors increased from 120.5 (SE = 0.76) to 148.9 (SE = 1.02) (P < 0.001) with control group 119.9 (SE = 1.06) to 140.9 (SE = 1.08) (P < 0.001). Mean score of maternal healthy behaviors in the intervention group had significant differences with that in the control group (P < 0.001). 9. Poor uptake for standard care 10. Additional cost of home visits a factor for developing countries. 11. NR 12. Cost of setting up home visiting service for low risk mothers in developing countries when health centre available. 13. Postpartum care at home is effective in improving maternal healthy behaviors such as breastfeeding and family planning. 14. Costs of home‑visits and low rates of receiving routine care in developing countries such as Iran, the cost effectiveness assessments of other methods for postpartum care can enable health policymakers.