Components associated with home visiting program outcomes: a meta-analysis.
Components associated with home visiting program outcomes: a meta-analysis.
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DOI：
10.1542/peds.2013-1021h
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发表时间：
2013-11
期刊：
影响因子：
8
通讯作者：
Cachat P
中科院分区：
文献类型：
--
作者：
Filene JH;Kaminski JW;Valle LA;Cachat P
尽管一些系统评价得出的结论是，家访具有强有力的有效性证据，但个别评估在项目之间和项目内部产生了不一致的结果。我们使用基于组件的、特定领域的方法来确定哪些程序特征最能预测一系列程序和模型的结果。 Medline 和 PsycINFO 搜索确定了对美国实施的普遍和选择性家访计划的评估。编码员经过培训，能够对研究设计、项目内容和服务交付的编码特征进行标准编码。我们利用项目特征进行随机效应、逆方差加权线性回归，以预测六个结果领域（出生结果、养育行为、母亲生命历程、儿童认知结果、儿童身体健康和儿童虐待）的效应大小（ES）。将每项研究 (k=51) 汇总为单个 ES，平均 ES 为 0.20 (95% CI = 0.14, 0.27)，范围为 – 0.68 至 3.95。六个结果领域中的三个（孕产妇生命历程结果、儿童认知结果以及父母行为和技能）的平均 ES 均显着且呈正值，所有六个结果领域的 ES 均具有显着异质性。研究设计特征通常无法预测六个结果领域的 ES。所有结果领域都没有出现一致的有效成分模式。家访计划显示出微小但显着的总体影响，特定领域影响的大小以及显着预测特定领域影响的组成部分存在很大差异。社区可能需要家访计划的补充或替代策略，以确保对这六项重要的公共卫生成果产生广泛影响。
Although several systematic reviews have concluded that home visiting has strong evidence of effectiveness, individual evaluations have produced inconsistent results across and within programs. We used a component-based, domain-specific approach to determine which program characteristics most strongly predict outcomes across a range of programs and models. Medline and PsycINFO searches identified evaluations of universal and selected home visiting programs implemented in the United States. Coders trained to criterion coded characteristics of research design, program content, and service delivery. We conducted random-effects, inverse-variance-weighted linear regressions using program characteristics to predict effect sizes (ESs) on six outcome domains (birth outcomes, parenting behavior, maternal life course, child cognitive outcomes, child physical health, and child maltreatment). Aggregated to a single ES per study (k=51), the mean ES was 0.20 (95% CI = 0.14, 0.27), with a range of – 0.68 to 3.95. Mean ESs were significant and positive for three of the six outcome domains (maternal life course outcomes, child cognitive outcomes, and parent behaviors and skills), with marked heterogeneity of ESs in all six outcome domains. Research design characteristics generally did not predict ESs across the six outcome domains. No consistent pattern of effective components emerged across all outcome domains. Home visiting programs evidenced small but significant overall effects, with wide variability in the size of domain-specific effects and in the components that significantly predicted domain-specific effects. Communities may need complementary or alternative strategies to home visiting programs to ensure widespread impact on these six important public health outcomes.