Impact of home visiting programs on parenting stress in low-income women: Findings from a community-based trial at an urban health department

Four decades of home visiting research has yet to reveal clear implications regarding the amount and type of services required to produce intended outcomes like reduced parenting stress. This study compared the effects of two home visiting programs on parenting stress and examined whether depressive symptoms and social support were associated with stress levels and differential program effects. Data were collected during an impact study at an urban health department in the Midwest United States from 237 low-income pregnant women who were referred for services between April 2014 and March 2017. Referrals were randomly assigned to a Healthy Families America program or a briefer prenatal care coordination program. A third quasi-experimental study group included women who were referred to but did not receive services. Data on demographics, depressive symptoms, and social support were collected at baseline near the time of program enrollment; 210 participants completed post-baseline parenting stress assessments at up to three time points during the child's first year. Results from mixed model repeated measures analysis of covariance showed that receiving prenatal care coor-dination was associated with lower parental distress at 14-60 days postpartum. Neither intervention was linked to reduced stress at 6 or 12 months postpartum. Higher depressive symptoms and lower social support predicted greater stress. Depressive symptoms moderated the effects of prenatal care coordination, with benefits concen-trated among participants with higher depression scores. Joining recent calls for greater precision in home visiting, the findings highlight the need to optimize limited resources by effectively tailoring services to address specific outcomes in different populations and contexts.