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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.”
From Schedules for home visits in the early postpartum period (2021) · cites this paper as Morrell 2000
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“control group was relatively high attrition proportion”
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BackgroundTwo interventions for postnatal support
Reid, M., Glazener, C. M. A., Connery, L., Mackenzie, J., Ismail, D., Prigg, A., & Taylor, G. (2003) · British Journal of Midwifery · doi:10.12968/bjom.2003.11.5.11226 · Cited by 8
Knapp, M. R. J., Barrett, B. M., Byford, S., Hallam, A., Davis, H., Tsiantis, J., Puura, K., Išpanović-Radojković, V., & Paradisiotou, A. (2005) · International Journal of Mental Health Promotion · doi:10.1080/14623730.2005.9721953 · Cited by 8
“The support workers aimed to help women rest and recover after childbirth, but the study found that they were more costly than usual care without improving outcomes (Morrell et al, 2000).”
BackgroundZadoroznyj, M. (2006) · Health and Social Care in the Community · doi:10.1111/j.1365-2524.2006.00664.x · Cited by 38
Kahraman, S., & Havlıoğlu, S. (2023) · International Journal of Nursing Practice · doi:10.1111/ijn.13150 · Cited by 7
Breastfeeding interventions for preventing postpartum depression
Lenells, M., Uphoff, E., Marshall, D. C., Wilson, E., Gustafsson, A., Wells, M. B., Andersson, E. P., & Dennis, C. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014833.pub2 · Cited by 10
Wimmer-Puchinger, B. (2006) · Springer eBooks · doi:10.1007/3-211-29956-4_3 · Cited by 8
Exploratory study to evaluate the provision of additional midwifery support to teenage mothers
Cohen, D. R., Lisles, C., Williams, W. R., Brunsdon, C., & Batstone, T. (2011) · Public Health · doi:10.1016/j.puhe.2011.06.008 · Cited by 7
Jones, G. L., Morrell, C. J., Cooke, J. M., Speier, D. S., Anumba, D. O. C., & Stewart-Brown, S. (2011) · Quality of Life Research · doi:10.1007/s11136-010-9832-0 · Cited by 7
“In addition, postnatal trials have been limited by the lack of instruments to measure postnatal health, and researchers have already identified the need to establish the outcomes that mothers themselves value [17, 18].”
BackgroundSelf-citationHenderson, J. (2014) · Evidence-Based Nursing · doi:10.1136/eb-2014-101880 · Cited by 5
Lambermon, F. J., van Duijnhoven, N. T. L., Kremer, J. A. M., & Dedding, C. W. M. (2021) · Midwifery · doi:10.1016/j.midw.2021.103068 · Cited by 7
Models of Maternity Care: A Review of the Evidence
Henderson, J., Hornbuckle, J., & Doherty, D. A. (2007) · UWA Profiles and Research Repository (UWA) · Cited by 7
Health economic evaluation evidence of interventions for peripartum depression: A scoping review
TECİRLİ, G., Barsbay, M. Ç., Sheaf, G., Öner, N., Ganho-Ávila, A., Costafreda, R. P., Ribeiro, I., Lassemo, E. I., Camacho, E. M., Ferreira, P. L., et al. (2025) · Health Policy · doi:10.1016/j.healthpol.2025.105264 · Cited by 6
Prévention et traitement de la dépression du post-partum
Chabrol, H., Callahan, S., & Séjourné, N. (2008) · Devenir · doi:10.3917/dev.083.0211 · Cited by 8
Au, F., Shiell, A., Pol, M. M. V. D., Johnston, D. W., & Tough, S. (2006) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2006.04036.x · Cited by 6
Evidence‐Based Treatments and Pathways to Care
O’Hara, M. W., Dennis, C., McCabe, J. E., & Galbally, M. (2015) · Wiley eBooks · doi:10.1002/9781118509722.ch11 · Cited by 7
Murphy, P. J., Hinde, S., Fulbright, H., Padgett, L., & Richardson, G. A. (2022) · British Medical Bulletin · doi:10.1093/bmb/ldac035 · Cited by 5
Costs and effectiveness of community postnatal support workers
Barlow, J. (2001) · BMJ · doi:10.1136/bmj.322.7281.301 · Cited by 5
Petch, J. F. (2006) · Griffith Research Online · doi:10.25904/1912/734 · Cited by 5
Health economics of depression
Sobocki, P. (2006) · Figshare · Cited by 4
The experience of birth and early mothering after assisted conception
Hammarberg, K. (2006) · Minerva Access (University of Melbourne) · Cited by 4
Jaffer, M. Q., Jan, R., Kaufman, K. J., Lakhani, A., & Shahid, S. (2017) · British Journal of Midwifery · doi:10.12968/bjom.2017.25.6.372 · Cited by 3
Alam, S., Christman, B. D., McNeill, E., Tang, M. ‐., Rong, R., Li, Q., Hillegass, W. B., Hall, J., Wright, L. L., Lanier, C., et al. (2025) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2025.11.005 · Cited by 3
Reading, R. (2007) · Child Care Health and Development · doi:10.1111/j.1365-2214.2007.00774_7.x · Cited by 3
Testing Communication Models for Relactation in an Egyptian Setting
Abul-Fadl, A., Kharboush, I. F., Fikry, M. M., & Adel, M. (2012) · Breastfeeding Medicine · doi:10.1089/bfm.2011.0026 · Cited by 3
Acevedo, M. B., Becerra, F. N. P., Ospina, J. N. T., Escobar-Paucar, G., Córdoba, A., & Correa, F. P. (2009) · Investigación y Educación en Enfermería · doi:10.17533/udea.iee.2833 · Cited by 3
“(13), reportan que no hay evidencias para establecer una relación costo-efectividad en los programas de educación para la salud, con lo cual se cuestiona el valor de la educación en los programas de salud, y se pone en peligro la asignación de recursos y el apoyo que necesita.”
BackgroundA New Postnatal Home Care Worker: Challenges for Training, Implementation and Policy
Zadoroznyi, M., & Sutherland, J. (2007) · Australian Journal of Social Issues · doi:10.1002/j.1839-4655.2007.tb00051.x · Cited by 3
Lambermon, F. J., van Duijnhoven, N. T. L., Braat, D. D. M., Kremer, J. A. M., & Dedding, C. W. M. (2020) · Midwifery · doi:10.1016/j.midw.2020.102737 · Cited by 3
Community midwifery support workers
Crowther, S., Spiby, H., & Morrell, C. J. (2001) · British Journal of Midwifery · doi:10.12968/bjom.2001.9.12.9403 · Cited by 3
Self-citationGender and Mental Health Prevention: When Differences Matter
Comacchio, C. (2022) · Springer eBooks · doi:10.1007/978-3-030-97906-5_1 · Cited by 2
Home visiting for postpartum depression
Yu, M., Washburn, M., Bayhi, J. L., Xu, W., Carr, L. C., & Sampson, M. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015984 · Cited by 2
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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