Journal List > J Korean Acad Nurs > v.47(5) > 1003264

Kim and Lee: An Integrative Review of Home Care Service for Pregnant Women, Mothers, Infants, and Toddlers in Vulnerable Group

Abstract

Purpose

This study was intended to integrate the evidence of home care service intervention for mothers and children in vulnerable groups through an integrative literature review.

Methods

We searched the MEDLINE (PubMED), EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, DBpia databases. The quality of the articles was assessed by one doctoral researcher and verified by one professor of community health nursing who had participated in the systematic review of literature. A framework was developed to identify the intervention patterns in the selected papers and categorize various elements. The extracted intervention elements were grouped into potential themes, which were verified by assessors on whether they clearly reflected the interventions in the papers.

Results

Among 878 searched papers, we selected 16 papers after excluding literature that does not satisfy the selection criteria and quality evaluation. The intervention elements of 16 selected papers were categorized into six themes. The extracted intervention elements were divided into the themes of Patient-specific/Situation-specific care planning and intervention, Emphasis on self care competency, Intense home visit by developmental milestone, Reinforcing and modeling mother-child attachment, Communication and interaction across the intervention, Linkage with community resource and multidisciplinary approach.

Conclusion

As a result of the analysis of proper interventions of home care services for mothers and children in vulnerable groups, it was found that it is necessary to consider indispensable intervention elements that can standardize the quality of home care services, and conduct studies on developing intervention programs based on the elements.

References

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Figure 1.
Quality assessment of selected studies. (A) Risk of bias for randomized controlled trials (RoB). (B) Risk of bias for non-randomized studies (RoBANS)
jkan-47-577f1.tif
Figure 2.
Flow diagram of study selection process.
jkan-47-577f2.tif
Table 1.
Analysis of Home Care Services of Relevant Research
Theme Population Intervention Study No. Intervention effect
Positive effect Non-significant effect
Patient-specific/ Pregnant Identifying of patients social, [14-16] N/A N/A
Situation-specific    women,    health problem (Needs
   care planning and    mother, infant    assessment) and reflects it to
   intervention    and toddlers    planning
Language/culture specific [14] N/A N/A
   intervention (e.g. refugees,
   immigrants)
Situation specific intervention [17-19] N/A N/A
(e.g. single parents,
   adolescent mother)
Emphasis on self Pregnant Decision making (school, [18,19] N/A N/A
   care competency    women,    employment)
   mother Improve parent’s self- [18-21] Parenting knowledge [21] N/A
   sufficiency Parenting attitude [21]
Responsibility [21]
Parent’s sense of
   competence [21]
Social competence [18,19]
Providing pre-pregnancy [14,18-20, Casaerean section rate [22] Apgar scores [22]
   information 22] Rate of spontaneous onset of Birth weight [22]
   labour [22] Gestational age [22]
Prematurity [22]
Information about maternal [18,19] N/A N/A
   self-care (e.g. Nutrition,
   physical activity)
Modifying behaviors [18,19] Smoking behavior [18,19] N/A
Infant and Supporting management of [16,23,24] Caregiver quality of life [23] Symptom severity of
   toddlers    acute/chronic communicable Caregiver self-sufficiency [23]    asthma [23]
   disease Episodes of malaria treated Emergency department
   at community level [24]    visit [23]
Safety management [16,18,19] N/A HOME score [16]
Intense home visit Infant and Providing information of child [25,26] Infant weight gain [25] Frequency of eating [25]
   by developmental    toddlers    nutrition and physical activity Introduction of solids [25]    processed meat [25]
   milestone    by developmental milestone BMI [25] No continuous effect on
Eating habits (TV viewing BMI, physical activity,
   time) [25]    eating habit (3 years after
Intake of fruit and    intervention) [26]
   vegetables [25]
Physical activity [25]
Knowledge of fetal/infants/ [17,20,21, Parenting knowledge [21] Parenting stress [21]
   toddlers’physical and 23,27] Parenting attitude [21] Gross motor [23]
   cognitive development Cognitive development [23] Fine motor [23]
Expressive language [23] Receptive language [23]
Providing information [15,28] Immunization rate [15,28] ER, ICU admission rate [28]
   and notification of age- Influenza vaccine rate [28]
   appropriate immunizations
Scheduling regular health [15] ER visit [15] N/A
   check-ups Health care charge [15]
Reinforcing Pregnant women, Maternal stress, anxiety [15,22] Maternal perceived stress [15] N/A
   and modeling    mother    management
   mother-child Maternal depression [18,19] Maternal substance use [18,19] Parenting stress [18,19]
   attachment    management Parental depression
[18,19]
Social isolation [18,19]
Pregnant women, Developing parent-infant [20-22, Acceptability of child [21] Breast feeding [21]
   mother, infant    attachment 29] Restriction of parental role [21] Utilization of medical
   and toddlers Home environment    care [21]
(HOME) [29] Parenting stress [29]
Maternal depression [29]
Infant and toddlers Prevent child abuse and [17,20] Minor physical aggression [20] Reported abuse and
   neglect Serious physical abuse [20]    neglect [20]
Self-reported physical
   aggression [20]
Psychological aggression [20]
Harsh parenting in
   the past week [20]
Physical abuse and neglect [17]
Communication Pregnant women, Providing counseling [15,21,29] Perceived maternal stress [15] N/A
   and interaction    mother, infant    pertaining to health Perceived maternal health and
   across the    and toddlers    concerns    social support [15]
   intervention Infant weight gain [15]
ER visit [15]
Infant hospitalization [15]
Health care charge [15]
Premature birth [15]
Revitalizing family [17-19] Social competence [18,19] N/A
   communication
Developing communication [17-19] Social competence [18,19] N/A
   skills
Pregnant women, Counselling on family [18,19,27] Repeat pregnancies in N/A
   mother    planning    adolescent mothers [27]
Linkage with Pregnant women, Refer for specific health [17-21] Satisfaction of community N/A
   community    mother, infant    problem identified to    child health service [21]
   resource and    and toddlers    expert (e.g. dietician,
   multidisciplinary    relaxation group,
   approach    general practitioner,
   physiotherapist)
Refer to social service (e.g. [17-21,28] N/A N/A
   food stamps)
Linkage with community [17-21] N/A N/A
   networks (e.g. play-group,
   self-help group)

*N/A=Not applicable; cannot be specified in particular outcome variables.

Table 2.
Characteristics of Relevant Studies and Interventions (N=16)
Variables Categories N (%)
Study
   Publication year ~2000 1 (6.3)
2000~2010 10 (62.5)
2010~2017 5 (31.3)
   Sample size 1~30 0 (0.0)
31~100 2 (12.5)
101~200 6 (37.5)
Over 201 8 (50.0)
   Study design Randomized controlled study 13 (81.3)
Non-randomized controlled study 2 (12.5)
Prospective cohort study 1 (6.3)
   Theoretical frame Discribed 5 (31.3)
Not discribed 11 (68.8)
Intervention
   Intervenor Community health worker 2 (12.5)
Public health nurse 5 (31.3)
Child health nurse 3 (18.8)
Advanced nurse practitioner 1 (6.3)
Trained para-professionals 4 (25.0)
Occupational Therapist 1 (6.3)
   Intervention scope Infants/toddlers 2 (12.5)
Pregnant women 3 (18.8)
Infants/toddlers and mothers 5 (31.3)
Family 6 (37.5)
Frequency 1~10 session 7 (43.8)
11~20 session 1 (6.3)
21~30 session 2 (12.5)
Over 31 session 3 (18.8)
Not discribed 3 (18.8)
   Duration 0~6 months 3 (18.8)
7~12 months 5 (31.3)
13~24 months 4 (25.0)
Over 25 months 2 (12.5)
Not discribed 2 (12.5)
   Time per session 0~60 min 3 (18.8)
61~120 min 5 (31.3)
Over 2 hours 1 (6.3)
Not discribed 7 (43.8)
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