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Original Investigation
April 23/30, 2019

Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life: A Randomized Clinical Trial

Author Affiliations
  • 1School of Nursing, McMaster University, Hamilton, Ontario, Canada
  • 2Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  • 3Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
  • 4Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  • 5Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
  • 6Faculty of Information and Media Studies, Western University, London, Ontario, Canada
  • 7The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 8Department of Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 9Department of Emergency Medicine, West Virginia University, Morgantown
  • 10School of Public Health, West Virginia University, Morgantown
  • 11Department of Community, Systems, and Mental Health Nursing, Rush University Medical Center, Chicago, Illinois
  • 12College of Nursing, University of Colorado Anschutz Medical Campus, Denver
  • 13Nurse-Family Partnership National Service Office, Denver, Colorado
  • 14Department of Pediatrics, University of Colorado School of Medicine, Denver
  • 15Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
JAMA. 2019;321(16):1576-1585. doi:10.1001/jama.2019.3211
Key Points

Question  Does augmentation of a nurse home visitation program with an intimate partner violence intervention, starting in pregnancy, compared with the home visitation program alone, lead to improved maternal quality of life at 24 months after infant delivery?

Findings  In this cluster randomized clinical trial that included 492 pregnant women, randomization to the augmented program compared with nurse home visitation alone resulted in maternal quality-of-life scores at 24 months postdelivery of 311.3 vs 316.2 (measured using the WHOQOL-BREF scale; range, 0-400)—a difference that was not statistically significant.

Meaning  These findings do not support augmenting a nurse home visitation program with this complex, multifaceted intimate partner violence intervention.

Abstract

Importance  Intimate partner violence (IPV) is a public health problem with significant adverse consequences for women and children. Past evaluations of a nurse home visitation program for pregnant women and first-time mothers experiencing social and economic disadvantage have not consistently shown reductions in IPV.

Objective  To determine the effect on maternal quality of life of a nurse home visitation program augmented by an IPV intervention, compared with the nurse home visitation program alone.

Design, Setting, and Participants  Cluster-based, single-blind, randomized clinical trial at 15 sites in 8 US states (May 2011-May 2015) enrolling 492 socially disadvantaged pregnant women (≥16 years) participating in a 2.5-year nurse home visitation program.

Interventions  In augmented program sites (n = 229 participants across 7 sites), nurses received intensive IPV education and delivered an IPV intervention that included a clinical pathway to guide assessment and tailor care focused on safety planning, violence awareness, self-efficacy, and referral to social supports. The standard program (n = 263 participants across 8 sites) included limited questions about violence exposure and information for abused women but no standardized IPV training for nurses.

Main Outcomes and Measures  The primary outcome was quality of life (WHOQOL-BREF; range, 0-400; higher score indicates better quality of life) obtained through interviews at baseline and every 6 months until 24 months after delivery. From 17 prespecified secondary outcomes, 7 secondary end points are reported, including scores on the Composite Abuse Scale, SPAN (Startle, Physiological Arousal, Anger, and Numbness), Prime-MD Patient Health Questionnaire, TWEAK (Tolerance/Worry About Drinking/Eye-Opener/Amnesia/C[K]ut Down on Drinking), Drug Abuse Severity Test, and the 12-Item Short-Form Health Survey (physical and mental health), version 2.

Results  Among 492 participants enrolled (mean age, 20.4 years), 421 (86%) completed the trial. Quality of life improved from baseline to 24 months in both groups (change in WHOQOL-BREF scores from 299.5 [SD, 54.4] to 308.2 [SD, 52.6] in the augmented program group vs from 293.6 [SD, 56.4] to 316.4 [SD, 57.5] in the standard program group). Based on multilevel growth curve analysis, there was no statistically significant difference between groups (modeled score difference, −4.9 [95% CI, −16.5 to 6.7]). There were no statistically significant differences between study groups in any of the secondary participant end points. There were no adverse events recorded in either group.

Conclusions and Relevance  Among pregnant women experiencing social and economic disadvantage and preparing to parent for the first time, augmentation of a nurse home visitation program with a comprehensive IPV intervention, compared with the home visitation program alone, did not significantly improve quality of life at 24 months after delivery. These findings do not support the use of this intervention.

Trial Registration  ClinicalTrials.gov Identifier: NCT01372098

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