Universal for whom? Evaluating an urban Aboriginal population's access to a mainstream universal health home visiting program

Objective. To investigate access to a Universal Health Home Visit program for families of Aboriginal and non-Aboriginal infants and the effect of a one-off home visit on subsequent health service utilisation. Methods. A case-control study was undertaken drawing 175 Aboriginal infants from an Aboriginal birth cohort study and 352 matched non-Aboriginal infants. A structured file audit extracted data from child and family health nurse records. Receipt of home visit and effect on ongoing use of child and family nurses services was compared for Aboriginal and non-Aboriginal infants. Results. Of the 527 infants, 279 (53.0%) were visited at home within 2 weeks. This is below NSW Health benchmarks. Significantly fewer Aboriginal infants (42.9%) compared to non-Aboriginal infants (58.0%) received a home visit within 2 weeks (P < 0.01). Receipt of a single home visit did not affect future service use or the number of child health checks infants received. Conclusion. This study highlights the challenges of ensuring equitable access to a universal post-natal home visiting program. Assessing ways in which universal services are delivered to ensure equity of access may help to re-evaluate target expectations, reduce demand on nursing staff, improve targeting of vulnerable infants and help in further developing and implementing effective health policy.