Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and infancy: a randomized trial

Am J Public Health. 1999 Dec;89(12):1847-51. doi: 10.2105/ajph.89.12.1847.


Objectives: This study examined differences between nurses and paraprofessionals in implementation of a home visiting program for low-income, first-time parents during pregnancy and the first 2 years of the child's life.

Methods: Mothers were randomly assigned to either a nurse-visited (n = 236) or a paraprofessional-visited (n = 244) condition. Nurse- and paraprofessional-visited families were compared on number and length of visits, topics covered, number of program dropouts, and relationship with home visitor.

Results: On average, nurses completed more visits than paraprofessionals (28 vs 23; P < .001) and spent a greater proportion of time on physical health issues during pregnancy (38% vs 27%; P < .001) and on parenting issues during infancy (46% vs 32%; P < .001). Paraprofessionals conducted visits that lasted longer and spent a greater proportion of time on environmental health and safety issues (15% vs 7% pregnancy; 15% vs 8% infancy; P < .001). While home visitors were viewed equally positively by mothers, nurses had fewer dropouts than did paraprofessionals (38% vs 48%; P = .04). More paraprofessional-visited families than nurse-visited families experienced staff turnover.

Conclusions: Nurses and paraprofessionals, even when using the same model, provide home visiting services in different ways.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Child Health Services / organization & administration*
  • Colorado
  • Community Health Workers
  • Female
  • Health Plan Implementation*
  • Home Care Services / organization & administration*
  • Humans
  • Infant
  • Least-Squares Analysis
  • Logistic Models
  • Maternal Health Services / organization & administration*
  • Models, Organizational
  • Nurses
  • Patient Dropouts
  • Patient Satisfaction
  • Poverty
  • Pregnancy
  • Professional-Patient Relations
  • Program Evaluation