Home-visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial

Arch Pediatr Adolesc Med. 2006 Nov;160(11):1101-7. doi: 10.1001/archpedi.160.11.1101.


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.

Publication types

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

MeSH terms

  • Adolescent
  • Community Health Workers
  • Female
  • Home Care Services*
  • Humans
  • Indians, North American
  • Infant
  • Infant Care / methods*
  • Infant, Newborn
  • Mothers / education*
  • Outcome Assessment, Health Care
  • Pregnancy