REPORT: January 2005

Research News You Can Use: Base Your Practice on Evidence

Nurse visitation for adolescent mothers

by Mary Ann Jezewski, PhD, RN, Associate Professor, Associate Dean for Research, University at Buffalo, State University of New York

Teen pregnancy has far reaching societal, economic, and health consequences both during pregnancy and after the birth of the child. The teenage mother as well as her baby can suffer the negative results of early motherhood. Children of adolescent mothers have higher mortality and morbidity rates than their counterparts born to older women. Children born to teenage mothers have higher rates of ER visits and hospitalizations than those born to women beyond their teen years.

Koniak-Griffin and colleagues conducted a randomized control trial with a sample of adolescent mothers who were predominantly Latina and African American. The study was designed to determine the effects of an early intervention program (EIP) provided through home visits by public health nurses to culturally diverse adolescents and their children and to compare the EIP program with traditional pre- and post-natal public health care.

The study

Pregnant adolescents were recruited from county health department referrals in California . Once recruited, the adolescents were randomly assigned to either the EIP intervention or traditional public health nursing care. Traditional care included two prenatal home visits and one postpartum visit within six weeks of the baby’s birth. The EIP intervention consisted of multiple pre- and postnatal visits through the baby’s first year of life. The EIP intervention focused on improving maternal and infant health, increasing maternal care-taking skills and social competence as well as increasing maternal educational achievements.

Multiple data collection methods were used in this study including medical records, self reporting by the mothers, and scales to measure acculturation, and quality of interactions between mothers and their infants. The researchers also collected extensive data on the mother’s and infant’s health including hospitalizations and emergency room (ER) visits. Statistical analysis appropriate for the level of measurement of the instruments (scales) used in data collection was performed. The results of the statistical analysis were used to compare the two groups of mothers, those who participated in the EIP intervention and those who received traditional public health nursing care.

Discussion of the findings

Comparison of socio-demographic characteristics revealed no significant differences between groups as well as no significant differences in the study drop out rate in the groups (a strength of the study). Infants in the EIP intervention group had significantly less non-birth related hospitalizations than the traditional care group. A significantly higher number of mothers in the EIP intervention never used the ER compared to the traditional public healthcare group.

There were no significant differences in immunization rates, mothers’ educational outcomes, social competence, or repeated pregnancy rates between groups.

Translation into practice

A strength of this study was the recruitment of a culturally diverse sample of adolescent mothers. So often study samples consist primarily of white non-Hispanic subjects. Random assignment of subjects into the intervention and traditional treatments groups was also a strength, as were the multiple methods of data collection especially those that were used to verify the accuracy of self-reported data. Despite the strengths of the design of this study, we need to be careful not to be too quick to incorporate the findings of one study into the practice setting. The investigators in this study do substantiate several findings from other studies. The primary “take home” message is that repeated and intensive intervention with teen mothers does improve their overall health behaviors and the health of their babies. Increased communications with these teen mothers seemed to improve their competence to care for their babies and themselves. Communication between the nurses and mothers about their children’s illnesses probably contributed to the decrease in hospitalizations and ER visits in the EIP group. The interventions significantly decreased their use of the ER as well as reduced the number of hospitalizations. These are two significant indicators that they were not using hospital emergency rooms for primary or non-urgent care. Based on this study and previous studies on the same topic, nurses, especially those in community health, should advocate for home visit programs that focus on promoting healthy behaviors in vulnerable populations.

One weakness of this article was that the investigators did not address the cost of the EIP intervention vs. traditional care and the cost-saving benefit of the EIP intervention, if any, in reducing the number of ER visits and hospitalizations. In today’s cost-saving, cost-cutting health care environment, intervention studies need to address the cost of the intervention vs. standard care practices. While visits that are more frequent may be costly, it may be possible that the decreased use of the ER and hospital for non-urgent care balanced that cost. We don’t know. Well-designed interventions that improve care also have to be cost-effective and hopefully reduce the overall expense of providing competent care in order for them to be incorporated into accepted practice.

Reference:

Koniak-Griffin, D. Verzemnieks, I. Anderson , N., Brecht, M. Lesser, J., Kim, S., Turnter-Pluta, C. (2003). Nurse visitation for adolescent mothers: Two-year infant health and maternal outcomes. Nursing Research, 52(2), 127-136.