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A Randomized Trial

Allison Barlow, MA, MPH; Elena Varipatis-Baker, MPH, MSW; Kristen Speakman, MA, MPH; Golda Ginsburg, PhD; Ingrid Friberg, MHS; Novalene Goklish; Brandii Cowboy; Pauline Fields; Ranelda Hastings; William Pan, DrPH; Raymond Reid, MD, MPH; Mathuram Santosham, MD, MPH; John Walkup, MD

Arch Pediatr Adolesc Med. 2006;160:1101-1107.

Objective  To assess the impact of a paraprofessional-delivered home-visiting intervention to promote child care knowledge, skills, and involvement among pregnant American Indian adolescents.

Design  Randomized controlled trial comparing a family-strengthening intervention with a breastfeeding education program.

Setting  One Apache and 3 Navajo communities.

Participants  Fifty-three pregnant American Indian adolescents were randomly assigned to intervention (n = 28) or control (n = 25) groups. Follow-up data were available for 19 intervention and 22 control participants.

Intervention  Paraprofessionals delivered 41 prenatal and infant care lessons in participants' homes from 28 weeks' gestation to 6 months post partum.

Main Outcome Measures  Child care knowledge, skills, and involvement.

Results  Mothers in the intervention compared with the control group had significantly higher parent knowledge scores at 2 months (adjusted mean difference [AMD], +14.9 [95% confidence interval (CI), +7.5 to +22.4]) and 6 months post partum (AMD, +15.3 [95% CI, +5.9 to +24.7]). Intervention group mothers scored significantly higher on maternal involvement scales at 2 months post partum (AMD, +1.5 [95% CI, –0.02 to +3.02]), and scores approached significance at 6 months post partum (AMD, +1.1 [95% CI, –0.06 to +2.2]). No between-group differences were found for child care skills.

Conclusions  A paraprofessional-delivered, family-strengthening home-visiting program significantly increased mothers' child care knowledge and involvement. A longer and larger trial is needed to understand the intervention's potential to improve adolescent parenting and related child outcomes in American Indian communities.

Author Affiliations: Johns Hopkins Center for American Indian Health and Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.

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