Nurse-Family Partnership (NFP) - Nursed visiting low-income homes, from pregnancy to the second birthday
At a glance
Country of origin
- USA
Level(s) of intervention
- Targeted intervention
Nurse-Family Partnership begins during pregnancy, as early as is possible, and continues until the child’s second birthday. Nurses work with low-income pregnant mothers bearing their first child to improve the outcomes of pregnancy, infant health and development, and the mother’s own personal life-course development through instruction and observation during home visits. These visits generally occur every other week and last 60-90 minutes.
A Dutch study adapted the programme for Dutch women and their healthcare system by placing more emphasis on home delivery, instructing women to stop smoking during pregnancy and offering more information about the advantages of breastfeeding.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
Professor David Olds, PhD
University of Colorado Health Sciences Centre
Prevention Research Centre for Family and Child Health
1825 Marion St, Denver 80220
United States of America
Email: olds.david[a]tchden.org
Website: www.nursefamilypartnership.org/
Overview of results from the European studies
Studies overview
The programme has been evaluated in three randomised controlled trials (RCTs) in Europe: in Germany with financially or socially disadvantaged first-time mothers; in England with nulliparous women aged 19 years or younger; and in the Netherlands with nulliparous women aged 25 years or younger with a low level of education.
The German study found no impact on birth outcomes – weight, height or head circumference – and no effect on children’s fine and gross motor abilities or language at any time-point. However, there was a statistically significant effect favouring the intervention on infants’ cognitive abilities at 12 months (but not at six or 24 months) and on mothers reading or telling stories at 24 months (but not at 6 or 12 months). An analysis of a subgroup – participants who had taken part in the first three assessments (end of pregnancy, six months and 12 months) by the end of 2008 found no statistically significant difference between intervention and control conditions in mothers’ smoking habits.
The English study found no effects on any of four birth outcomes, smoking outcomes for mothers (proportion of mothers who smoked and number of cigarettes smoked per day at late pregnancy) or the majority of secondary outcomes. There were small positive impacts on the following secondary outcomes: intention-to-breastfeed; maternal-reported child cognitive development (at 24 months only); language development using a modified maternal-reported assessment (at 12 and 18 months) and a standardised assessment (at 24 months); levels of social support; partner-relationship quality; and general self-efficacy.
In the Dutch study, there were statistically significant effects favouring the intervention on smoking: fewer women in the intervention condition smoked during and after the birth, and they smoked fewer cigarettes per day after the birth and fewer cigarettes in the presence of the baby. There was also a statistically significant positive impact on domestic violence (two of 10 measures of victimisation, and one of 10 measures of perpetration) and breastfeeding at six months. There were no effects on pregnancy outcomes, such as birthweight, weeks of gestation, low birthweight, prematurity and the baby being small for their gestational age. Two other statistically significant effects favouring the intervention condition were child protection reports at 36 months and the prevalence of children with internalising (but not externalising) behaviour at 24 months.
The programme has been rated as Model by Blueprints for Healthy Youth Development based on a review of studies conducted world-wide.
Countries where evaluated
- Germany,
- Netherlands,
- United Kingdom
Characteristics
Protective factor(s) addressed
- Family: attachment to and support from parents
- Family: attachment to and support from romantic partner
- Family: opportunities/rewards for prosocial involvement with parents
- Family: parent social support
Risk factor(s) addressed
- Family: aggressive or violent parenting
- Family: family conflict
- Family: Family history or involvement with substance abuse/problem behaviour
- Family: family management problems
- Family: family/individual poverty
- Family: mother substance use during pregnancy
- Family: neglectful parenting
- Family: parental attitudes favourable to alcohol/drug use
- Family: parental attitudes favourable to anti-social behaviour
- Family: parental depression or mental health difficulties
- Family: unintended child birth (parent)
- Individual and peers: anti-social behaviour
- Individual and peers: early initiation of drug/alcohol use
Outcomes targeted
- Academic performance
- Other educational outcomes
- Talking and reading
- Depression or anxiety
- Emotion regulation, coping, resilience
- Other mental health outcomes
- Chronic health problems
- Other health outcomes
- Relations with parents
- Alcohol use
- Use of illicit drugs
- Smoking (tobacco)
- Crime
- Other behaviour outcomes
- Risky sex, STIs, teen pregnancy
Description of programme
Nurse-Family Partnership sends nurses to the homes of pregnant women who are predisposed to infant health and developmental problems (i.e. at risk of pre-term delivery and low-birth-weight children). The goal is to improve parent and child outcomes. Treatment begins during pregnancy, with 60- to 90-minute visits about once every other week, and continues to 24 months post-partum. Programme content covered in the home visits includes (i) parent education about influences on fetal and infant development; (ii) the involvement of family members and friends in the pregnancy, birth and early care of the child, and support for the mother; and (iii) linking family members with other formal health and social services.
Specific objectives include improving women’s diets; helping women monitor their weight gain and eliminate the use of cigarettes, alcohol and drugs; teaching parents to identify the signs of complications in pregnancy; encouraging regular rest, appropriate exercise and good personal hygiene related to obstetrical health; and preparing parents for labour, delivery and early care of the newborn.
In addition to working with mothers directly, nurses promote the goals of the programme by engaging other family members and close friends in the programme and by helping families to use other formal health and social services.
A Dutch study (Mejdoubi et al., 2013) adapted the programme for Dutch women and their healthcare system. The most important adaptations included placing more emphasis on home delivery, instructing women to stop smoking during pregnancy and offering more information about the advantages of breastfeeding.
