Description of the studies
In total, 13 studies met the inclusion criteria as presented in Table 2. Of the 13, nine were quantitative studies and four were qualitative studies. There were no mixed-methods studies that met the inclusion criteria. The studies took place in five countries; Australia (n=6), the United States of America (USA; n=2), Germany (n=2), Canada (n=2), and Ireland (n=1).
Table 2
Characteristics of studies included in the review
Author, Year | Country | Study design | Participants | Frequency of home visits, intervention duration, and providers |
Quantitative studies | |
Kemp et al., 2019 | Australia | Randomised controlled trial | N=352 Women <37 weeks gestation, having sufficient English proficiency, having two or more of ten sociodemographic risk factors by screening | Intended frequency: Antenatal - fortnightly, birth to 6 weeks - weekly, 1.5 to 3 months - fortnightly, 6 months to 2 years - bi-monthly Duration: antenatal to 2 years Providers: nurses |
Goldfeld et al., 2018 | Australia | Randomised controlled trial | N=722 (Intervention=363, Control=359) Women <37 weeks gestation, having sufficient English proficiency, having two or more of ten sociodemographic risk factors | Intended frequency: Antenatal - fortnightly, birth to 6 weeks - weekly, 1.5 to 3 months - fortnightly, 6 months to 2 years - bi-monthly Duration: antenatal to 2 years Providers: nurses |
Fraser et al., 2000 | Australia | Randomised controlled trial | N=181(Intervention=90, Comparison=91) Mothers at risks (one of the risk of sole parent, ambivalence, domestic violence, childhood abuse, OR three or more of eight sociodemographic risks) | Intended frequency: Weekly visits until the infant was 6 weeks old, fortnightly visit until the infant was 3 months old, then monthly visit until the age of 12 months. Duration: after birth to 1 year Providers: nurses |
Armstrong et al., 1999 | Australia | Randomised controlled trial | N=181(Intervention=90, Comparison=91) Mothers at risks (one of the risk of sole parent, ambivalence, domestic violence, childhood abuse, OR three or more of eight sociodemographic risks) | Intended frequency: Weekly visits from the primary visiting nurse until the child age 6 weeks, fortnightly visit until the child age 3 months, monthly visit until the child age 12 months. Duration: after birth to 1 year Providers: nurses |
Armstrong et al., 2000 | Australia | Randomised controlled trial | N=160(Intervention=80, Comparison=80) Mothers at risks (one of the risk of sole parent, ambivalence, domestic violence, childhood abuse, OR three or more of eight sociodemographic risks) | Intended frequency: Weekly visits from the primary visiting nurse until the child age 6 weeks, fortnightly visit until the child age 3 months, monthly visit until the child age 12 months. Duration: after birth to 1 year Providers: nurses |
Christie & Bunting, 2011 | Ireland | Randomised controlled trial | N=295 (Intervention=136, Control=159) First-time low risk mothers | Intended frequency: Six home visits from 10 – 14 days to 8 weeks postpartum (weekly home visit). Families were followed-up at 7 months postpartum. Duration: after birth to 8 weeks Providers: nurses |
Bashour et al., 2008 | Syria | Randomised controlled trial | N=876 3 groups: 4 postnatal visits (n=285), one visit (n=294), or no visit (n=297) | Intended frequency: One or four postnatal visits on day 3 (for one visit) and day 1, 3, 7, and 30 after childbirth (for four visits). Providers: midwives |
Brand & Jungmann, 2014 | Germany | Cross-sectional study | N=434 Low-income, first-time mothers | Intended frequency: Weekly in the first four weeks of program participation, bi-weekly after that until child ages 2 years. Duration: Antenatal period (12-28 weeks pregnant) to child ages 2 years Providers: midwives |
Brand & Jungmann, 2012 | Germany | Quasi-experimental study | N=430 Low-income, first-time mothers | Intended frequency: Weekly in the first four weeks of program participation, bi-weekly after that until child ages 2 years. Duration: Antenatal period (12-28 weeks pregnant) to child ages 2 years Providers: midwives |
Qualitative studies | |
Zapart et al., 2016 | Australia | Qualitative descriptive study | N=36 | Reported frequency: On average, participants received 20 home visits of the program’s 25 scheduled visits Duration: Antenatal to 104 weeks after birth Providers: nurses |
DeMay, 2003 | USA | Qualitative study (content analysis) | N=62, Intervention group=22, current practice group=40 | Reported frequency: Intervention group received almost twice the average number of visits per year (8 and 4.8 respectively) and twice the average amount of time per visit (120 and 60 minutes, respectively) as current practice group clients. Duration: no specific description Providers: nurses |
Landy et al., 2012 | Canada | Qualitative case study | N=18 Low income, young (<=21 years), and first-time mothers | Reported frequency: biweekly except during the first month of the intervention and the first postpartum month, when nurses visit weekly. Duration: Before 29 weeks gestation until the child age 1 year Providers: nurses |
Byrd, 1998 | USA | Qualitative descriptive study | N=11 (One nurse and 10 clients) | Reported frequency: every one to two weeks Duration: no specific description, but data collection took 8 months Providers: nurse |
Of the nine quantitative studies, seven were randomised controlled trials with sample sizes ranging from 160 to 876 participants. Other quantitative studies included one quasi-experimental design and one cross-sectional design. The majority of participants in the included studies were parents with sociodemographic risks such as low income, unemployment, first-time mothers, and limited time in formal education. The primary purpose of these quantitative studies was to assess the effectiveness of home visiting programs and inventions.
All four qualitative studies employed a narrative study design. The primary purpose of these studies was to describe parents’ perceptions and experiences of sustained home visiting care. Two of the qualitative studies used in-depth and semi-structured interviews, one used both interviews and observations, and one drew data from essays written by parents for data collection.
Intervention characteristics and measures of parent satisfaction
All interventions were home visiting programs for women or mothers and children. In six studies (20, 39–43), interventions commenced in the antenatal period and continued up to the postpartum period. The interventions were provided by nurses (n=10) and midwives (n=3).
All quantitative studies employed questionnaires or simple survey instruments to capture information on parent satisfaction. Four studies (39, 44–46) used the tools modified from the Parent Satisfaction Questionnaire (PSQ), and others used the Service-surgery Satisfaction Questionnaire (n=1), and the Session Rating Scale (SRS) (n=1). The remaining studies (n=3) used author-constructed questionnaires for data collection. Queries ranged from binary ‘yes/no’ questions to multiple point Likert scales for scoring the levels of parent satisfaction. Satisfaction with specific elements of care, such as communication, convenience, interpersonal manner, and time spent, as well as overall satisfaction, were asked in the questionnaires in most of the studies.
In three qualitative studies (42, 43, 47), women were interviewed about their perceptions and experiences of home visiting care and interventions. One study (47) undertook a content analysis of essays (n=62) written by mothers about their experiences in nurse home visiting program.
Level of parent satisfaction with sustained home visiting care
In all but one of the quantitative studies (48), parents reported higher levels of satisfaction with home visiting interventions compared to routine or standard community care or facility-based services, as shown in Table 3.
Table 3
Summary of satisfaction with care provided and measures used
Author, Year | Findings on satisfaction | Measures used |
Kemp et al., 2019 | • Families in the intervention rated the Session Rating Scale (SRS) highly with the mean score 39.4 (SD 1.31) out of possible 40. | Session Rating Scale (SRS) |
Goldfeld et al., 2018 | • The scores of families’ Parent Satisfaction Questionnaire (PSQ) were rated more highly by the families in the intervention program than usual care: higher PSQ scores of the intervention group (mean=44.4, SD=4.1) out of possible 50 with compared to the usual care group (mean=37.9, SD=7.2) (p<0.001). | Parent Satisfaction Questionnaire (PSQ) (modified) |
Fraser et al., 2000 | • Greater satisfaction for the home visiting program group compared with comparison group participants accessing standard clinic-based services. • Statistically significant group differences (home visiting group compared with standard clinic-based services group) were found for each sub-scale of satisfaction: communication (p<0.05); convenience (p<0.05); interpersonal manner (p<0.05); general satisfaction (p<0.05); time spent (p<0.05); and overall satisfaction (p<0.05) with greater satisfaction reported for the home visiting program. | A short form of the PSQ III. Measures of technical quality and financial aspects were excluded, using only the statements of communication, convenience, interpersonal manner, general satisfaction, and time spent. Overall satisfaction was calculated by addition of these five subscales. |
Armstrong et al., 1999 | • Statistically significant group differences were found for every scale used to measure satisfaction with the home-based program at 6 weeks. | Modified PSQ-18. Ten items from the PSQ-18 were used. The measures of technical quality and financial aspects were excluded. Ten statements for general satisfaction, interpersonal manner, communication, time spent, and accessibility/convenience. |
Armstrong et al., 2000 | • Statistically significant group differences were found for every scale used to measure satisfaction with the service at 4 months, greater satisfaction being shown by those in the home-based program: communication (p<0.05), manner (p<0.05), satisfaction (p<0.05), time spent (p<0.05), overall satisfaction (p<0.05) | Modified PSQ-18. Ten items from the PSQ-18 were used. The measures of technical quality and financial aspects were excluded. Ten statements for general satisfaction, interpersonal manner, communication, time spent, and accessibility/convenience. |
Christie & Bunting, 2011 | • The itervention group had higher service satisfaction (mean=154.6, SD=23.8) (out of possible 170) with compared to the control group (mean=139.9, SD=29.7) (p<0.000) at 8 weeks; and (mean=150.4, SD=27.6) and (mean=134.2, SD=37.5) (p=0.003) respectively at 7 months. | Service-surgery satisfaction questionnaire |
Bashour et al., 2008 | • The answer to the question "you are happy about your experience during the postnatal period". The percentage responded ‘Yes’ was 80.1% among mothers received 4 postnatal visits, 81.0% among mothers received 1 postnatal visit, and 84.2% among mothers received no visit. | A questionnaire constructed by researchers |
Brand & Jungmann, 2014 | • With regards to process variables, unsuccessful visits attempt, maternal engagement during home visits, quality of the helping relationship, satisfaction with service and time spent on parenting issues during pregnancy were associated with both early and late attrition. Satisfaction with service Odds Ratio (OR)=0.56 (95% Confidential Interval (CI) 0.45-0.70) (p<0.001). | An author-constructed questionnaire with 4-item scale:1) dissatisfied, 2) rather dissatisfied, 3) rather satisfied, 4) satisfied. |
Brand & Jungmann, 2012 | • Ratings of satisfaction with service and quality of the relationship were higher in the comparison model (both p<0.05, but unequal variances). | Satisfaction with service was measured on an author-constructed, 4-item scale: 1) dissatisfied, 2) rather dissatisfied, 3) rather satisfied, 4) satisfied. |
Zapart et al., 2016 | • 27 participants were happy with the structure of the program, that is, what happened during the visits, and did not think any changes were needed. Program length was talked about by 17 women. Five were happy with the program concluding the child-age 2- years, ten thought it should run for longer. Only two women thought the program should run for less than 2 years. • 28 participants talked about their relationship with the nurse. 24 mothers described it as being good to excellent or saying they got on very well. Women stated that the nurse was ‘very friendly’, ‘very nice’, ‘non-judgemental’, and ‘straightforward’. | N.A. |
DeMay, 2003 | • Participants were satisfied with learning from the nurse on how to understand their infant better. “I think the nurses do an excellent job encouraging good eating habits, trying to avoid stress and making you aware of this wonderful little person living inside you, and how its future depends on you” “It’s just amazing to me to see what goes on in an infant’s life” • Participants wrote about how information helped relieve feelings of being unprepared, afraid, and anxious during their pregnancy. • Descriptions demonstrated how much they valued the intimate relationship with their public health nurse. | N.A. |
Landy et al., 2012 | • Mothers’ experiences in the program were very positive and highlight the critical importance of the nurse-client relationship. • The positive relationships described by the mothers had multiple dimensions which are captured under the following six subthemes: (1) the nurse’s personality; (2) The nurse is “like a friend” who supports you; (3) the nurse is respectful and trusting; (4) the nurse is empowering and an advocate; (5) the nurse is an honest expert; and (6) the nurse is easy to access when you need her help. | N.A. |
Byrd, 1998 | • A participant stated, "I like the support and help the nurse gives me. It is wonderful. Someone to validate you". Likewise, another mother stated, "She says 'You're doing right' because sometimes I question it. Am I doing the right thing? Yeah. She's been good". • A participant described that the nurse was familiar with the characteristics and needs that participant mothers shared. | N.A. |
Goldfeld and colleagues (39) reported that family satisfaction with services was rated more highly by the home visiting intervention group than the usual care group. Similarly, Kemp and colleagues (20) showed that families who received the home visiting intervention rated the Session Rating Scale (SRS) more highly than the usual care group. There was no evidence of differences in SRS scores at any time between those who completed the program (SRS mean=39.5, SD=1.2) and those intervention families who did not complete the program (SRS mean=38.9, SD=1.9).
Fraser and colleagues (44) reported that the sustained home visiting intervention group reported significantly greater satisfaction with the care received compared with the comparison group who received standard clinic-based services. Furthermore, there were significant differences for sub-scales of communication, convenience, interpersonal manner, general satisfaction, time spent, and overall satisfaction with greater satisfaction for the intervention group. Similarly, the study conducted by Armstrong and colleagues (46) showed statistically significant differences for every scale used to measure satisfaction with the service at four months, with greater satisfaction for the home visiting intervention group than standard community health services.
In contrast, only one study (n=876) reported a lower percentage (80.1%) of home visiting intervention group mothers who were satisfied with their experience compared with the comparison group (84.2%) who received services in health facilities (48). The authors of this study hypothesised that the lower level of satisfaction among the intervention group was because the midwives who delivered the service were recruited from a hospital setting, rather than a community setting. Thus, they may not have had the competencies necessary for effective home visiting service delivery, such as advanced listening and empathy skills, or experience in engaging with individualised problem-solving techniques.
Zapart and colleagues (42) reported that of 36 participating women, 27 were satisfied with the structure of the program, that is, what happened during the visits, and did not think any changes were needed. Program length was discussed by 17 participants. Five were satisfied with the program concluding when the child was two years old, and ten thought it should run for a longer period of time. Only two women stated the program should run for less than the standard two years. Similarly, Landy and colleagues (43) found that mothers’ experiences with home visiting were positive. Most of the mothers shared the view that they were becoming better parents by participating in the program (43). In a study conducted by DeMay (47), the mothers were satisfied with learning from a nurse how to understand their infant better.
Factors and elements of care that parents find important for satisfaction in sustained home visiting care
None of the studies included in this review were specifically designed to identify the factors and elements of care that were important for parent satisfaction with sustained home visiting care. However, data analysis and synthesis provide insight into factors associated with parent satisfaction and critical elements of care that could contribute to parent satisfaction: service dose; nurse-client relationship; care with respect and empowerment; and emotional support.
In several studies (20, 48, 49), service dose was tested for its association with parent satisfaction with the care provided at home. Christie and Bunting (49) conducted a study to determine the effect of the service dose (frequency of home visits). The study results showed that mothers who received six postpartum visits reported higher levels of satisfaction with the care provided compared to mothers who received only one visit at eight weeks and another at seven months. Similarly, Bashour and colleagues (48) found that a larger number of home visits was associated with positive service experience (48). In addition, one qualitative study (43) suggested a positive relationship between satisfaction and program retention. However, one study showed no relationship between program completion and satisfaction (20).
All four qualitative studies included in this review (42, 43, 47, 50) reported how much women valued the intimate relationship with home visiting nurses. Landy and colleagues (43) found that mothers’ accounts highlight the critical importance of the nurse-client relationship. The positive relationships described by the participant mothers had multiple dimensions, including: the nurse’s personality; the nurse is ‘like a friend’ who supports them; the nurse is respectful and trusting; the nurse is empowering and an advocate; the nurse is an honest expert; and the nurse is easy to access when they need help. Similarly, a study conducted by DeMay (47) also demonstrated how much the participant mothers valued the intimate relationship with their home visiting nurse. This study highlighted the importance of consistency in the relationship and found an association between best outcomes for clients with nurse consistency throughout the program. In the study conducted by Zapart and colleagues (42), 28 of the 36 participants talked about their relationship with the nurse, and 24 described the relationship as being good to excellent. The participating women described the nurses as ‘very friendly’, ‘very nice’, ‘non-judgmental’, and ‘straightforward’. Byrd (50) described client-nurse relationships as two-way, easy, conformable, relaxed, informal and friendly across home visits.
The mothers valued being treated with respect and empowered to make their own choices in home visiting care. Mothers found information and care helpful when it was provided in a respectful and non-judgmental manner (47). One woman stated that ‘I think the nurses do an excellent job encouraging good eating habits, trying to avoid stress and making you aware of this wonderful little person living inside you, and how its future depends on you”. Participants also talked about how information given by a nurse helped relieve feelings of being unprepared, afraid, and anxious during their pregnancy (47).
The participants in a study by Byrd (50) described feeling strengthened by the nurse who provided emotional support and expressed admiration for mothers in their caregiving efforts. A foster mother who participated in the study stated that “I like the support and help the nurse gives me. It is wonderful. Someone to validate you”. Likewise, another mother said “she (nurse) says ‘You are doing right’ because sometimes I question it – am I doing the right thing? Yeah, she has been good”.