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Costs and effectiveness of community postnatal support workers: randomised controlled trial
Open accessAbstract
OBJECTIVES: To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives. DESIGN: Randomised controlled trial with six month follow up. SETTING: Recruitment in a university teaching hospital and care provided in women's homes. PARTICIPANTS: 623 postnatal women allocated at random to intervention (311) or control (312) group. INTERVENTION: Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker. MAIN OUTCOME MEASURE: General health status as measured by the SF-36 and risk of postnatal depression. Breast feeding rates, satisfaction with care, use of services, and personal costs. RESULTS: At six weeks there was no significant improvement in health status among the women in the intervention group. At six weeks the mean total NHS costs were pound 635 for the intervention group and pound 456 for the control group (P=0.001). At six months figures were pound 815 and pound 639 (P=0.001). There were no differences between the groups in use of social services or personal costs. The women in the intervention group were very satisfied with the support worker visits. CONCLUSIONS: There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over six months after the introduction of the community postnatal support worker service.
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“Postal questionnaire follow-up.”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Morrell 2000
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“Intervention group (260/311) vs control group (233/312) at 6 month, control group was relatively high attrition proportion.”
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“By sequentially numbered, sealed opaque envelopes.”
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“Random digit tables prepared in advance.”
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“control group was relatively high attrition proportion”
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“not clearly described”
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The Revised CONSORT Statement for Reporting Randomized Trials: Explanation and Elaboration
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BackgroundWhat works? Interventions for maternal and child undernutrition and survival
Bhutta, Z. A., Ahmed, T., Black, R. E., Cousens, S. N., Dewey, K. G., Giugliani, E. R. J., Haider, B. A., Kirkwood, B. R., Morris, S. S., Sachdev, H. S., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(07)61693-6 · Cited by 2,264
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“…] Gunn 1998 232 5.87 (5.37) 243 6.08 (5.14) 13.4 % -0.21 [ -1.16, 0.74 ] MacArthur 2002 837 6.4 (0.98) 743 8.06 (1.41) 15.9 % -1.66 [ -1.78, -1.54 ] Morrell 2000 260 6.6 (5.1) 233 6.7 (5.6) 13.4 % -0.10 [ -1.05, 0.85 ] Reid 2002 339 5.3 (5.4) 370 5.3 (4.84) 14.2 % 0.0 [ -0.76, 0.76 ] Small 2000…”
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BackgroundInfluentialSupport for healthy breastfeeding mothers with healthy term babies
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BackgroundPackages of care for depression in low- and middle-income countries
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BackgroundLabarère, J., Gelbert-Baudino, N., Ayral, A.-S., Duc, C., Berchotteau, M., Bouchon, N., Schelstraete, C., Vittoz, J.-P., François, P., & Pons, J. C. (2005) · PEDIATRICS · doi:10.1542/peds.2004-1362 · Cited by 198
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BackgroundResultSupport for healthy breastfeeding mothers with healthy term babies.
Gavine, A., Shinwell, S., Buchanan, P., Farre, A., Wade, A., Lynn, F., Marshall, J., Cumming, S., Dare, S., & McFadden, A. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001141.pub6 · Cited by 14
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Support for breastfeeding mothers: a systematic review
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Schedules for home visits in the early postpartum period
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Quinlivan, J. A., Box, H., & Evans, S. F. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12770-5 · Cited by 137
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BackgroundKrol, M., Papenburg, J., Koopmanschap, M. A., & Brouwer, W. B. F. (2011) · PharmacoEconomics · doi:10.2165/11539970-000000000-00000 · Cited by 130
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Investing in mental health and well-being: findings from the DataPrev project
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“(Morrell et al., 2000), England I: Post-natal support from a community midwifery”
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“Table 2: CPSW Study [7] Observed Effect Sizes for Control vs.”
BackgroundMethodHealthy Steps in an Integrated Delivery System
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A two-centred pragmatic randomised controlled trial of two interventions of postnatal support
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Health status and quality of life in postpartum women: a systematic review of associated factors
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“Twenty-four studies measured QOL [6,21,28–49], 40 studies measured HS [23–27,50–84], and two studies measured both”
BackgroundMethodInfluentialSupport for breastfeeding mothers
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BackgroundMethodA concept analysis of women's vulnerability during pregnancy, birth and the postnatal period.
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Wiggins, M., Oakley, A., Roberts, I., Turner, H., Rajan, L., Austerberry, H., Mújica, R., Mugford, M., & Barker, M. (2005) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2004.021808 · Cited by 85
Home versus Hospital Breastfeeding Support for Newborns: A Randomized Controlled Trial
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“Clinical interventions for PPD have focused primarily on supporting mothers [37, 38] and promoting optimal mother-infant relationships [39, 40], by utilizing various modalities for maternal support, such as telephone [37], group [41-43], or home visiting interventions [44, 45].”
BackgroundA systematic review of home-based interventions to prevent and treat postpartum depression
Leis, J. A., Mendelson, T., Tandon, S. D., & Perry, D. F. (2009) · Archives of Women's Mental Health · doi:10.1007/s00737-008-0039-0 · Cited by 76
“Upon closer review of those 24 studies, seven were excluded because they reported on nonpsychological interventions (Armstrong et al. 1999; Armstrong et al. 2000; Fraser et al. 2000; Gelfand et al. 1996; Morrell et al. 2000; Navaie-Waliser et al. 2000; Roman et al. 2007), one was excluded because the sample was not re…”
BackgroundInfluence of depressive symptomatology on maternal health service utilization and general health
Dennis, C. (2004) · Archives of Women s Mental Health · doi:10.1007/s00737-004-0053-9 · Cited by 80
“, 1994) and has been used previously with postpartum women (Morrell et al., 2000; Reid et al., 2002; Small et al., 2000; Waterstone et al., 2003).”
MethodPreventing Postpartum Depression Part II: A Critical Review of Nonbiological Interventions
Dennis, C. (2004) · Canadian journal of psychiatry. Revue canadienne de psychiatrie · doi:10.1177/070674370404900804 · Cited by 81
Home-based support for disadvantaged teenage mothers
Macdonald, G. M., Bennett, C., Dennis, J. A., Coren, E., Patterson, J. V., Astin, M., & Abbott, J. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006723.pub2 · Cited by 75
Buultjens, M., & Liamputtong, P. (2006) · Midwifery · doi:10.1016/j.midw.2006.04.002 · Cited by 89
Intervening to reduce depression after birth: A systematic review of the randomized trials
Lumley, J., Austin, M., & Mitchell, C. (2004) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462304000911 · Cited by 83
New mothers and postpartum depression: a narrative review of peer support intervention studies
Leger, J., & Letourneau, N. L. (2014) · Health & Social Care in the Community · doi:10.1111/hsc.12125 · Cited by 73
Lumley, J., Watson, L. F., Small, R., Brown, S., Mitchell, C., & Gunn, J. (2006) · BMC Public Health · doi:10.1186/1471-2458-6-37 · Cited by 425
The need for a nutrition-related quality-of-life measure
Barr, J. T., & Schumacher, G. E. (2003) · Journal of the American Dietetic Association · doi:10.1053/jada.2003.50058 · Cited by 68
Consultants' forum: should post hoc sample size calculations be done?
Walters, S. J. (2008) · Pharmaceutical Statistics · doi:10.1002/pst.334 · Cited by 68
“Nevertheless, the trial had over 80% power to detect a 5 point different in GH scores which is the smallest change in score that can be considered clinically and socially relevant’’ [6].”
BackgroundFlight, L., Allison, A., Dimairo, M., Lee, E. C., Mandefield, L., & Walters, S. J. (2016) · BMC Medical Research Methodology · doi:10.1186/s12874-016-0249-5 · Cited by 64
“Case studies We compared 10 models using four example case studies from iRCTs with clustering in one arm: specialist clinics for the treatment of venous leg ulcers [15], acupuncture for low back pain [7], cost-effectiveness of community postnatal support workers (CPSW) [16], and Putting Life in Years (PLINY) [17].”
BackgroundMethodInfluentialRowe, H. J., & Fisher, J. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-499 · Cited by 68
“All of the interventions were intended to reduce depression and four [20-23] also assessed general psychological distress and role functioning using the SF-36 [26].”
BackgroundMethodInfluentialHewitt, C., & Gilbody, S. (2009) · BJOG: an International Journal of Obstetrics and Gynaecology · doi:10.1111/j.1471-0528.2009.02148.x · Cited by 74
Pezley, L., Cares, K., Duffecy, J. L., Koenig, M. D., Maki, P. M., Odoms‐Young, A. M., Withington, M. H. C., Oliveira, M. L., Loiacono, B., Prough, J., et al. (2022) · International Breastfeeding Journal · doi:10.1186/s13006-022-00501-9 · Cited by 71
“Successful interventions included relaxation therapy [55], in-home postpartum support [56], prenatal psycho-educational group support [54], community health worker program plus incentive package [53], and journal therapy counseling [57].”
BackgroundResultInfluentialThe Neurobiological Impact of Postpartum Maternal Depression
Drury, S. S., Scaramella, L. V., & Zeanah, C. H. (2016) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2015.11.001 · Cited by 67
Support Intervention Needs and Preferences of Fathers Affected by Postpartum Depression
Letourneau, N. L., Tryphonopoulos, P. D., Duffett‐Leger, L., Stewart, M., Benzies, K., Dennis, C., & Joschko, J. (2012) · The Journal of Perinatal & Neonatal Nursing · doi:10.1097/jpn.0b013e318241da87 · Cited by 61
“Despite this observation, clinical interventions for postpartum depression have focused primarily on supporting mothers(30,31) and promoting optimal motherinfant relationships,32−34 by utilizing various modalities for maternal support, such as telephone,(30) group,35−37 or home visiting interventions.(38,39) In summar…”
MethodAttitudes to emotional expression, social support and postnatal adjustment in new parents
Castle, H., Slade, P., Barranco-Wadlow, M., & Rogers, M. (2008) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646830701691319 · Cited by 60
“Particular postnatal initiatives in this regard in relation to women have not shown positive impact (Honey, Bennett, & Morgan, 2002 ; Morrell, Spiby, Stewart, Walters, & Morgan, 2000 ).”
BackgroundExpanding developmental and behavioral services for newborns in primary care
Johnston, B., Huebner, C. E., Tyll, L. T., Barlow, W. E., & Thompson, R. S. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2003.12.018 · Cited by 61
Nkonki, L. L., Tugendhaft, A., & Hofman, K. J. (2017) · Human Resources for Health · doi:10.1186/s12960-017-0192-5 · Cited by 59
“Economic evaluations of CHW interventions aimed at promoting exclusive breastfeeding Setting Five studies were conducted from a variety of settings: South Africa [17], Uganda [19], United Kingdom [31], and two from the USA [28, 29].”
BackgroundInfluentialWhat interventions may reduce postpartum depression
Lumley, J. M., & Austin, M. (2001) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/00001703-200112000-00009 · Cited by 58
Herron‐Marx, S., Williams, A., & Hicks, C. (2006) · Midwifery · doi:10.1016/j.midw.2006.04.005 · Cited by 58
“, 2003) and increasing support to women in the postnatal period (Morrell et al., 2000).”
BackgroundStevenson, M., Scope, A., Sutcliffe, P., Booth, A., Slade, P., Parry, G., Saxon, D., & Kalthenthaler, E. (2010) · Health Technology Assessment · doi:10.3310/hta14440 · Cited by 57
Mcdonald, S., Henderson, J. J., Faulkner, S., Evans, S., & Hagan, R. (2010) · Midwifery · doi:10.1016/j.midw.2008.03.001 · Cited by 66
“, 2003), and 13% in the UK (Morrell et al., 2000).”
McIntosh, E., Barlow, J., Davis, H., & Stewart-Brown, S. L. (2009) · Journal of Public Health · doi:10.1093/pubmed/fdp047 · Cited by 56
Petrou, S., Morrell, J., & Spiby, H. (2009) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-7-40 · Cited by 56
Postnatal experience and health needs of Chinese migrant women in Brisbane, Australia
Chu, C. M. Y. (2005) · Ethnicity & Health · doi:10.1080/1355785052000323029 · Cited by 76
Roman, L. A., Gardiner, J. C., Lindsay, J. K., Moore, J. S., Luo, Z., Baer, L. J., Goddeeris, J. H., Shoemaker, A. L., Barton, L. R., Fitzgerald, H. E., et al. (2009) · Archives of Women s Mental Health · doi:10.1007/s00737-009-0083-4 · Cited by 61
“Home visiting trials in Australia (Fraser et al. 2000) and England (Morrell et al. 2000; Wiggins et al. 2005) also reported no significant differences in depressive symptoms in the latter postpartum year to 18 months.”
A RCT of peer-mentoring for first-time mothers in socially disadvantaged areas (The MOMENTS Study)
Cupples, M., Stewart, M. C., Percy, A., Hepper, P. G., Murphy, C., & Halliday, H. L. (2010) · Archives of Disease in Childhood · doi:10.1136/adc.2009.167387 · Cited by 55
“This is the first randomised controlled trial of a peer-mentoring programme delivered both antenatally and for a year postnatally in the UK. The intervention design was informed by the local community and underpinned by a theoretical framework, based on the social cognitive theory of health promotion, providing inform…”
MethodA Randomized Trial of Two Public Health Nurse Follow-up Programs after Early Obstetrical Discharge
O’Connor, K. O. S., Mowat, D. L., Scott, H. M., Carr, P. A., Dorland, J. L., & Tai, K. F. W. Y. (2003) · Canadian Journal of Public Health · doi:10.1007/bf03404580 · Cited by 63
Safeguarding Children Across Services: Messages from Research
Davies, C., & Ward, H. (2011) · Cited by 52
Perceptions of primiparas on a postnatal psychoeducation programme: The process evaluation
Shorey, S., Chan, S. W., Chong, Y. S., & He, H. G. (2014) · Midwifery · doi:10.1016/j.midw.2014.08.001 · Cited by 51
Boyd, R. C., Mogul, M., Newman, D., & Coyne, J. C. (2011) · Depression Research and Treatment · doi:10.1155/2011/320605 · Cited by 50
“Other studies have demonstrated the effectiveness of community health workers in the provision of services for PPD [24, 25]; however, limited information is available from the community health worker’s perspective.”
BackgroundMurphy, C. A., Cupples, M. E., Percy, A., Halliday, H. L., & Stewart, M. C. (2008) · BMC Health Services Research · doi:10.1186/1472-6963-8-46 · Cited by 50
“Possible explanations for the apparently contradictory evidence include difficulties in measuring maternal and infant well-being [13], and programme difficulties such as poor uptake of the intervention [10,11,14,15] and high staff turnover among lay-workers [9,15-17].”
BackgroundResultInfluentialFisher, J., Rowe, H. J., Wynter, K. H., Tran, T. D., Lorgelly, P. K., Amir, L. H., Proimos, J., Ranasinha, S., Hiscock, H., Bayer, J. K., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-009396 · Cited by 57
Schedules for home visits in the early postpartum period
Yonemoto, N., Nagai, S., & Mori, R. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009326.pub4 · Cited by 47
The effect of a self-care program based on the teach back method on the postpartum quality of life
Ghiasvand, F., Riazi, H., Hajian, S., Kazemi, E., & Firoozi, A. (2017) · Electronic physician · doi:10.19082/4180 · Cited by 47
“In contrast, some studies found postpartum interventions to be ineffective in physical and mental health (26, 45-48).”
Result
Metadata
- Authors
- Morrell, C. J.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Morrell, C J.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2000-09-09
- Volume
- 321
- Issue
- 7261
- Pages
- 593-598
- ISSN
- 0959-8138 (ISSN-L)
- PMC
- PMC27472
- OpenAlex
- W2158759181
- Cited by
- 229
- References
- 29
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 2 · 2022: 9 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 2 · 2017: 5 · 2016: 9 · 2015: 7 · 2014: 11 · 2013: 8 · 2012: 10
- FWCI
- 11.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Health Technology Assessment Programme
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Keywords
- postpartum care, home visits, community midwifery, cost-effectiveness, postpartum depression, breastfeeding, patient satisfaction, NHS costs, women's health
- MeSH terms
- Adolescent, Adult, Allied Health Personnel, Breast Feeding, Community Health Nursing, Cost-Benefit Analysis, Female, Follow-Up Studies, United Kingdom, House Calls, Humans, Nurse Midwives, Postnatal Care, Pregnancy, Treatment Outcome, Patient Satisfaction, Depression, Postpartum
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