Catherine, N.L.A., MacMillan, H., Jack, S., Zheng, Y., Xie, H., Boyle, M., Sheehan, D., Gonzalez, A., Gafni, A., Tonmyr, L., Barr, R., Marcellus, L., Varcoe, C., & Waddell, C. (2025). Effects of nurse-home visiting on intimate partner violence and maternal income, mental health and self-efficacy by 24 months postpartum: a randomised controlled trial (British Columbia Healthy Connections Project). BMJ Open. https://doi.org/10.1136/bmjopen-2023-083147

Abstract

Objective To evaluate the impact of Nurse-Family Partnership (NFP), a home-visiting programme, on exploratory maternal outcomes in British Columbia (BC), Canada.

Design Pragmatic, parallel arm, randomised controlled trial conducted October 2013–November 2019. Random allocation of participants (1:1) to comparison (existing services) or NFP (plus existing services). Researchers were naïve to allocation.

Setting 26 local health areas across four of five BC regional health authorities.

Participants 739 young (<25 years), first-time mothers (enrolled <28 weeks gestation), experiencing socioeconomic disadvantage.

Intervention Public health nurses with NFP education offered home visits (up to 64) during pregnancy and until children’s second birthday plus existing services on offer in BC.

Outcome measures Prespecified exploratory outcomes included: exposure to intimate partner violence (IPV), income (annual from employment) and NEET (not in education, employment or training) by 24 months postpartum; and psychological distress and self-efficacy across five timepoints (34–36 weeks gestation, two, 10, 18 and 24 months postpartum).

Results 739 participants were randomised (368 NFP, 371 comparison) and analysed via intention-to-treat. At 24 months postpartum, for participants receiving NFP; a lower percentage reported IPV (group difference -7.14; 95% CI: -14.17, -0.10); incomes were larger ($1629.74, 95% CI: $5.20, $3254.28) after adjusting for baseline differences; no difference in percentage of NEET (-2.41, 95% CI: -10.11, 5.30). For participants receiving NFP, psychological distress was lower across timepoints (-1.59, 95% CI: -2.35, -0.84); self-efficacy was greater at 34–36 weeks gestation (0.78, 95% CI: 0.34, 1.22) then decreasing and becoming insignificant by 24 months postpartum (0.29, 95% CI: -0.18, 0.75). No unanticipated serious adverse events were reported.

Conclusion Relying on maternal report, at 24 months postpartum, NFP group had reduced IPV exposure and increased incomes. Benefits observed in late pregnancy were sustained to study end for psychological distress, but not self-efficacy. Longer-term follow up is recommended.

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