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Long-term outcomes and significance of extended home visits for children in disadvantaged areas

Research project

Short description

In Gothenburg, the Extended Home Visits (EHV) parenting program has been implemented in socioeconomically disadvantaged areas. The program, conducted by child health care (CHC) nurses and parent supporters from preventive social services, is offered to all first-time parents and includes six home visits during the child's first 15 months. Short-term evaluation of EHV shows positive results. The current research project examines the long-term outcomes of EHV. Families who have received EHV will be followed up until the children are five years old. The project employs mixed methods such as interviews, medical record reviews, and cost-consequence analysis. Through close collaboration with CHC and social services, and the target group, the project aims to generate knowledge about the importance of EHV in reducing inequities in health.

Background to the project

With the aim of reducing health inequities and promoting a good start in life, the City of Gothenburg and Region Västra Götaland have implemented the Extended Home Visits (EHV) parenting program based on the Rinkeby model. The program is offered in socioeconomically disadvantaged areas to first-time parents and parents who have older children but are having their first child in Sweden. Conducted within a family-centred approach, the EHV is performed by teams consisting of child health care (CHC) nurses and parent supporters, who are preventive social workers employed by social services or Angered Hospital. Complementing the ordinary CHC program, EHV entails six home visits during the child's first 15 months.

From 2019 to 2022, the initiative was evaluated by the Research unit at the Gothenburg Region (FoU i Väst). The evaluation aimed to describe the implementation of EHV, the experiences of the program from the perspectives of both staff and parents and investigate the short-term outcomes and potential effects of the program. A third objective was to highlight the significance of social services in EHV. Results indicated high fidelity to the original Rinkeby model, and positive experiences from both professionals and parents. Compared to children from families not receiving EHV, more children in the intervention group were breastfed at four months, received rotavirus vaccination, and more mothers were screened for postpartum depression. A pilot study on longer-term outcomes revealed better language development and parental self-efficacy in the group that received UH compared to a control group.

What does the current research project aim to investigate?

Previous studies have shown positive short-term effects and experiences of the EHV program, but there is a knowledge gap regarding its long-term outcomes and significance. Additionally, there is a lack of health economic analyses of the program. In the current project, children and parents who received EHV from 2019 to 2022 will be followed up until the children reach five years of age. The overarching questions of the project are:

  • What are the long-term outcomes and significance of EHV on children's health and development?
  • What are the cost consequences of EHV with regard to the program's key outcomes?

How will the study be conducted?

The study will be carried out over a four-year period and consist of four sub-studies utilizing both quantitative and qualitative research methods. One sub-study will conduct structured interviews with parents of children aged 2.5 and 5 years from both the intervention and control groups, focusing on parental health, trust in health care and authorities, and perceptions of child development. Another sub-study will review medical records from both intervention and control groups, focusing on children's health and development from birth to five years of age. A third sub-study will conduct a cost-consequence analysis comparing EHV with the regular CHC program. A fourth sub-study will conduct semi-structured interviews with parents and focus groups with professionals to gain a deeper understanding of the program's long-term significance and outcomes.

The studies will be conducted in close collaboration with CHC and social services. The project adopts a co-productive approach, actively involving representatives from both professionals and the target group of parents in each phase of the research, with the aim of creating an inclusive and well-informed research process.

What do we hope to achieve?

This research project is the first in Sweden to examine long-term outcomes of a home visiting program. Our research aims to produce crucial knowledge about whether early-detected effects of health-promoting and preventive interventions persist over time. Our research design also enables studies of language and socioemotional development, aspects that may only be examined in the long term. Furthermore, our health economic analyses will provide important information for decisions regarding the continued implementation of home visiting programs at both local and national levels. By collecting and analyzing data from various methods and perspectives - children, parents, and staff - the project strives to generate reliable and useful insights into EHV and similar initiatives. These insights can then be used to inform policy and practice, ultimately leading to improvements in the health and living conditions of families affected by the program.

Project management

Elin Alfredsson 
Jeanette Olsson (GR)
Lisbeth Lindahl (GR)
Ann Jansson (VGR)