Faculty of Education - Research Publications
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ItemNurse home visiting to improve child and maternal outcomes: 5-year follow-up of an Australian randomised controlled trial(PUBLIC LIBRARY SCIENCE, 2022-11-28)OBJECTIVES: Nurse home visiting (NHV) is widely implemented to address inequities in child and maternal health. However, few studies have examined longer-term effectiveness or delivery within universal healthcare systems. We evaluated the benefits of an Australian NHV program ("right@home") in promoting children's language and learning, general and mental health, maternal mental health and wellbeing, parenting and family relationships, at child ages 4 and 5 years. SETTING AND PARTICIPANTS: Randomised controlled trial of NHV delivered via universal, child and family health services (the comparator). Pregnant women experiencing adversity (≥2 of 10 risk factors) were recruited from 10 antenatal clinics across 2 states (Victoria, Tasmania) in Australia. INTERVENTION: Mothers in the intervention arm were offered 25 nurse home visits (mean 23·2 home visits [SD 7·4, range 1-43] received) of 60-90 minutes, commencing antenatally and continuing until children's second birthdays. PRIMARY AND SECONDARY OUTCOMES MEASURED: At 4 and 5 years, outcomes were assessed via parent interview and direct assessment of children's language and learning (receptive and expressive language, phonological awareness, attention, and executive function). Outcomes were compared between intervention and usual care arms (intention to treat) using adjusted regression with robust estimation to account for nurse/site. Missing data were addressed using multiple imputation and inverse probability weighting. RESULTS: Of 722 women enrolled in the trial, 225 of 363 (62%) intervention and 201 of 359 (56%) usual care women provided data at 5 years. Estimated group differences showed an overall pattern favouring the intervention. Statistical evidence of benefits was found across child and maternal mental health and wellbeing, parenting and family relationships with effect sizes ranging 0·01-0·27. CONCLUSION: An Australian NHV program promoted longer-term family functioning and wellbeing for women experiencing adversity. NHV can offer an important component of a proportionate universal system that delivers support and intervention relative to need. TRIAL REGISTRATION: 2013-2016, registration ISRCTN89962120.
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ItemEconomic evaluation of an Australian nurse home visiting programme: a randomised trial at 3 years(BMJ PUBLISHING GROUP, 2021-12)OBJECTIVES: To investigate the additional programme cost and cost-effectiveness of 'right@home' Nurse Home Visiting (NHV) programme in relation to improving maternal and child outcomes at child age 3 years compared with usual care. DESIGN: A cost-utility analysis from a government-as-payer perspective alongside a randomised trial of NHV over 3-year period. Costs and quality-adjusted life-years (QALYs) were discounted at 5%. Analysis used an intention-to-treat approach with multiple imputation. SETTING: The right@home was implemented from 2013 in Victoria and Tasmania states of Australia, as a primary care service for pregnant women, delivered until child age 2 years. PARTICIPANTS: 722 pregnant Australian women experiencing adversity received NHV (n=363) or usual care (clinic visits) (n=359). PRIMARY AND SECONDARY OUTCOME MEASURES: First, a cost-consequences analysis to compare the additional costs of NHV over usual care, accounting for any reduced costs of service use, and impacts on all maternal and child outcomes assessed at 3 years. Second, cost-utility analysis from a government-as-payer perspective compared additional costs to maternal QALYs to express cost-effectiveness in terms of additional cost per additional QALY gained. RESULTS: When compared with usual care at child age 3 years, the right@home intervention cost $A7685 extra per woman (95% CI $A7006 to $A8364) and generated 0.01 more QALYs (95% CI -0.01 to 0.02). The probability of right@home being cost-effective by child age 3 years is less than 20%, at a willingness-to-pay threshold of $A50 000 per QALY. CONCLUSIONS: Benefits of NHV to parenting at 2 years and maternal health and well-being at 3 years translate into marginal maternal QALY gains. Like previous cost-effectiveness results for NHV programmes, right@home is not cost-effective at 3 years. Given the relatively high up-front costs of NHV, long-term follow-up is needed to assess the accrual of health and economic benefits over time. TRIAL REGISTRATION NUMBER: ISRCTN89962120.
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ItemPrevalence of language and pre-literacy difficulties in an Australian cohort of 5-year-old children experiencing adversity(WILEY, 2021-03)BACKGROUND: Early reading success is predicated on language and pre-literacy skills. Children who are behind their peers in language and pre-literacy development before formal schooling are less likely to be proficient beginner readers, and difficulties may persist throughout primary school and beyond. We know children experiencing adversity are at greater risk of early language and pre-literacy difficulties; we do not know the prevalence of these difficulties in an Australian adversity context. AIMS: To investigate the prevalence and co-occurrence of language and pre-literacy difficulties in a cohort of Australian 5-year-old children experiencing social adversity. METHODS & PROCEDURES: Data were drawn from a large Australian community-based trial of nurse home visiting (right@home), which aimed to support women experiencing social adversity from pregnancy until their child turned 2 years of age. Social adversity was determined by two of more risk factors: young pregnancy, not living with another adult, no support, poorer health, current smoker, long-term illness, anxious mood, not finishing high school, no household income and no previous employment. Children whose mothers were enrolled in the control group (receiving usual maternal and child healthcare) were included in the current study (n = 359). Language and pre-literacy skills were measured at age 5 using the Clinical Evaluation of Language Fundamental Preschool-Second Edition (CELF-P2) and the School Entry Alphabetic and Phonological Awareness Readiness Test (SEAPART). Language difficulties were defined as ≥ 1.25 standard deviations (SD) below the Australian normative mean on CELF-P2 Core Language scores. Pre-literacy difficulties were defined as children scoring in the Beginner (versus Developing or Competent) criterion-referenced level on the SEAPART First Sound Identification and/or Alphabet Letter Identification subtests. Co-occurrence of language and pre-literacy difficulties was also determined. OUTCOMES & RESULTS: At the 5-year follow-up, 201/359 (56%) children were assessed (mean age = 5.1 years, SD = 0.1). Mean Core Language score for this cohort (91.8, SD = 15.9) was 0.54 SD below the normative mean (100, SD = 15). The proportion of children presenting with language difficulties was 24.9%. Regarding pre-literacy skills, 43.8% of children were 'Beginner' for identifying first sounds and 58.6% for identifying alphabet letters/sounds. There was also considerable overlap whereby 76.7% of children with language difficulties also exhibited pre-literacy difficulties. CONCLUSIONS & IMPLICATIONS: This is the first empirical Australian-based study highlighting the high prevalence and co-occurrence of language and pre-literacy difficulties in preschool children experiencing social adversity. Clinicians should be aware of co-morbid language and pre-literacy difficulties in disadvantaged populations and consider both areas during assessment and intervention planning. What this paper adds What is already known on the subject The prevalence of language and literacy difficulties is substantially higher in cohorts experiencing social adversity when compared with more advantaged families. There is some evidence that adversity also contributes to pre-literacy difficulties, but less is known here. What this paper adds to existing knowledge This study presents new prevalence data showing high rates of language and pre-literacy difficulties for 5-year-old children experiencing adversity within an Australian context. It is the first to explore these skills in a large cohort of pre-schoolers recruited from community settings in Australia. What are the potential or actual clinical implications of this work? In this cohort experiencing adversity, most children who presented with language difficulties likewise exhibited pre-literacy difficulties. This concordance reflects how early oral language and pre-literacy skills develop together. Clinicians should assess both skills in preschool populations-especially those working with children experiencing adversity-to ensure all children have strong foundations to become proficient beginner readers.
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ItemThe Impact of Policy Modifiable Factors on Inequalities in Rates of Child Dental Caries in Australia(MDPI, 2019-06-01)Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally representative birth cohort Longitudinal Study of Australian Children (N = 5107), using questions assessing: The experience of dental caries during each biennial follow-up period (2-3 years to 10-11 years), socioeconomic position (SEP), and policy modifiable oral health factors. Results: The odds of dental caries were higher for children with lowest vs. highest SEP (adjusted OR (adjOR) 1.92, 95% CI 1.49-2.46), and lower where water was fluoridated to recommended levels (adjOR 0.53, 95% CI 0.43-0.64). There was no evidence of an association between caries experience and either reported sugary diet or tooth brushing. When SEP and fluoridation were considered in conjunction, compared to the highest SEP group with water fluoridation children in the lowest SEP with fluoridation had adjOR 1.54 for caries, (95% CI 1.14-2.07), and children in the lowest SEP without fluoridation had adjOR 4.06 (95% CI 2.88-5.42). For patterns of service use: The highest SEP group reported a greater percentage of service use in the absence of caries. Conclusions: Dental caries appears prevalent and is socially distributed in Australia. Policy efforts should consider how to ensure that children with dental caries receive adequate prevention and early care with equitable uptake.
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ItemDriving Precision Policy Responses to Child Health and Developmental Inequities(Mary Ann Liebert, 2019-01-01)The growing evidence base on the extent of and opportunities to reduce inequities in children's health and development still lacks the specificity to inform clear policy decisions. A new phase of research is needed that builds on contemporary directions in precision medicine to develop precision policy making; with the aim to redress child inequities. This would include identifying effective interventions and their ideal time point(s), duration, and intensity to maximize impact. Drawing on existing data sources and innovations in epidemiology and biostatistics would be key. The economic and social gains that could be achieved from reducing child inequities are immense.