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Healthy Start Home Visit Program
• The Hong Kong Polytechnic University • Professor Cynthia Leung • The University of Hong Kong • Dr. Sandra Tsang • Tung Wah Group of Hospitals • Ms Kitty Heung
「健康由家庭開始」計劃
合辦
贊助
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Characteristics
Early
Intervention
Home Visit
Model
Multi-
discipline
collaboration
Evidence-
based Parent
Education
Parent
Involvement
Home-
school
collaboration
VIDEO
Program Introduction
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Academic: 2 Professors •Curriculum development •Research support •Lectures
Community: Tung Wah Group of Hospitals (3 social workers) •Coordinate, implementation and monitoring of project • Link up parents to community
28 Nurseries/kindergartens •Select suitable parents • Assist project implementation
5 Health Professionals: Doctor, dentist, dental therapist, physiotherapist, nutritionist •Review curriculum •Lecture on related health knowledge
Funder: QEF
Funder and Partner: Role and Responsibility
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Need for empirically supported treatment
• Evidence-based practice
• Empirically supported treatment
• Ineffective or untested practice is expensive
• Well-meaning interventions may do harm (ethical obligation)
Frances Gardner
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Hierarchy of evidence • Systematic reviews of all randomized controlled
trials (RCT) • Large scale multi-centre RCTs • Individual RCTs • Controlled trials without randomization • Pre and post studies • Single case experimental designs • Narrative case studies • Opinions based on clinical practice/ expert
committees/ clinical opinion/ credible theory/ professional colleagues
Adapted from Brocklehurst & McGuire (2005) and Thyer (2011)
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Evaluation methodology - Design
• Pilot study – pre and post design
– Outcome evaluation (quantitative) – parent and child measures
– Process evaluation (qualitative) – focus group with participants
• Efficacy study – cluster randomized controlled trial design
– 24 preschools (191 families) randomized into
• Intervention group (12 schools) – Healthy Start Home Visit Program (84 families)
• Control group (12 schools) – a series of parent talks (107 families)
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Evaluation methodology - Measures
• Validated measures for use with Chinese population – Parent outcomes (parent self-report)
• Parenting Stress Index (Lam, 1999) • Social support (Broadhead, Gehlbach, de Gruy & Kaplan, 1988) • Self-efficacy (Zhang & Schwarzer, 1995)
– Child outcomes (parent report) • Eyberg Child Behaviour Inventory (Eyberg & Ross, 1978) • School readiness (Ho, Leung & Lo, 2013) • Behaviour academic competence (Leung, Lo & Leung, 2012) • Motivation (Leung & Lo, 2013) • Health status – weight-for-height, home injuries, hospital
admission, sedentary activities • Oral health (Department of Health, Hong Kong SAR) • Hong Kong Parent Feeding Questionnaire (Department of
Health, 2012)
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Evaluation methodology - Measures
• Child outcomes (teacher report)
–School readiness (Ho, Leung & Lo, 2013)
–Behaviour academic competence (Leung, Lo & Leung, 2012)
–Motivation (Leung & Lo, 2013)
• Child outcomes (direct assessment of children)
–Preschool Developmental Assessment Scale (Leung, Mak, Lau, Cheung & Lam, 2010; 2013)
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Study results
• Baseline characteristics of intervention and control group
‒ No significant difference
• Psychometric properties of the scales
– Reliability of most scales >.70
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Study results
• Significant decrease in parenting stress Significant increase in parent self-efficacy and social support
• Significant decrease in child behavior problems
• Significant increase in child learning
• Significant increase in frequency of tooth brushing and healthy feeding practice
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A. Knowledge on Child Health Development – Written test
– Results
• Average: 41/45 full mark
• Range: 33 to 45
B. Home Visit Skills – Demonstration on site
• Parenting skills (PRIDE )
• Quiet time and time-out zone – Results: 100% passed
Parent ambassadors
C. Child and parenting measures
– Decrease in child
behavior
– Decrease in parenting stress
– Increase in self-efficacy
– Increase in social support
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Confirm program efficacy
Promote evidence-based practice
Facilitate smooth delivery of the model to schools and NGOs
Enhance respect by schools and NGOs
Raise the concern of policy maker
Enlist more funding support
Advance image building
Use of findings
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Manpower: research assistant
Questionnaire : Incentive and individual support
Coordination between partners: venue, manpower, schedule
Control group arrangement
Program fidelity: quality control, professional input, supervision and random checking
Balance between practice and research
Lesson learned from having evidence-based service evaluation