Mum to mum : an evaluation of a community based health promotion programme for first-time mothers in the Netherlands

Background This study evaluated the Dutch Mothers Inform Mothers (MIM) programme. In that programme a visiting mother meets with a first-time mother in her home on a monthly basis to discuss the caring and rearing of her infant. The first-time mothers went also to the well-baby clinics in their locality where they discussed topics in the areas of psychosocial, cognitive and physical development, language, play and safety. The programme lasted for 18 months.Aim/objectives To evaluate the MIM programme with the view to:- provide information and, where appropriate, recommendations concerning the positioning of the programme in the Dutch public infant health services;- integrate appropriate theoretical perspectives into the MIM programme;- determine outcomes in relation to maternal mental health, maternal and infant general health, maternal competence with parenting and satisfaction with the well-baby clinic.Study design/ A literature review on parenting support programme focused on infant health.Instruments A cohort-study using a pre-test - post-test design with one experimental and two control groups. This was used to develop and test a model for the programme and to determine its effects. The mothers' progress was followed for 15 months, which covers the period of infancy. (After 15 months is the toddler period). Validated instruments were used to gather information.- An infant food consumption survey using 24 hour recall and questions on feeding practices (breast feeding or feeding bottle). For maternal fat consumption a popular questionnaire of the National Food Centre was used.Timing The pre-tests for mental health, social support and breastfeeding were administrated when the infants were approximately 6 weeks old (T1). Infant temperament, maternal and infant general health, maternal competence with parenting and satisfaction with the well-baby clinic were measured at 10 months, as was the nutritional survey. The post-tests were administrated when the infants were approximately 15 months old (T3).- A qualitative study was carried out to gain insights in the way MIM co-ordinators perceive visiting mothers and visa versa.Study population Total number of mothers was 346. In control group 1 (no MIM but using thesame well-baby clinics as the experimental mothers) N = 221, control group II (no MIM and not the same well-baby clinics), experimental group (MIM plus attending well-baby clinic) N = 42.Results The visiting mothers visit on average two first-time mothers. This is very not enough for developing expertise as a visiting mother. The workload of co-ordinators was on average 25 visiting mothers / 50% FTE. Some mothers needing the programme were not accommodated due to illness of the programme's co-ordinator, absence of MIM co-ordinator, or because the caseload of visiting mothers are the co-ordinator were felt to be to high.A first attempt was made to develop a theoretical framework for the MIM using maternal and infant characteristics together with social support factors. The boundaries of the model were set by Bronfenbrenner's theory on human ecology. Social support and infant temperament are important factors when caring and rearing a child. These factors are present in the maternal and infant health and maternal competence models. Partners' support with caring and household activities is especially important when a baby arrives. The factor lack of support is also present on numerous occasions.Unexpected was the importance of the factor life events during pregnancy and complicated delivery, which remained so in the development of maternal general health, even after 15 months.MIM had no impact on maternal mental and general health, although maternal general health scores of the experimental mothers increased over time and those of the control mothers decreased. MIM also had no impact on infant general health. The administration of the last inoculation of the Mumps, Measles and Rubella vaccines coincided with the post-test. This may have influenced the infant health score. MIM had a significant impact on maternal competence with parenting. The lower score for maternal competence for MIM mothers measured at baseline had disappeared by T3 relative to the two control groups. The most important influence on maternal competence with parenting seems to be infant temperament. Satisfaction with the well-baby clinic increased over time for all groups. Participation in the MIM programme was not significant in the final longitudinal model, but was significant at baseline and T3. This means that there was no further deterioration in satisfaction with the well-baby clinic of MIM mothers relative to the other two groups in the last six months of the study.Given that lack of support has an important relationship with maternal mental health in T1, T3 and longitudinal regression models, it means that the factors identified by this regression indirectly contribute to the mother's state of mind.Conclusions The evaluation has shown positive programme effects, but these effects need to be improved for the programme to be cost-effective. The programme is instrumental in enhancing the quality of health promotion activities of well-baby clinic members; it plays a role in the quality assurance process and it has an effect on enhancing mothers' competence with parenting. There are no indications that MIM had an influence on the mediating variables. This may be influenced by the fact that variables not included in the study, such as maternal attitudes, locus of control, or self-efficacy, play a role in the theoretical MIM model. Making healthy choices the easy choices through MIM is a strategy for helping people to accept responsibility for healthiness of their own lives, recognising health as a resource to be protected and actively enhanced. In line with the nurses' scope of practice their role as facilitator and coach could be strengthened, giving more responsibilities to the visiting mothers and making MIM a truly community based and community-led programme.