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Community Mothers

Evidence level:
Best PracticePromising PracticeEmergent Practice
 
Evidence of Effectiveness:
?-0+++
Transferability:
?-0+
Enduring Impact:
?-0+
Review criteria and process

Policy category

Helping Vulnerable Children, Supporting Parenting and Assisting with Childcare

Recommendation Pillars

Enhance family support and the quality of alternative care settings

Countries that have implemented practice

Ireland

Age Groups

Young Children (age 0 to 5), Adults (age 20+)

Target Groups

Parents, Low-income Families

Years in Operation

1989  - still operating

Type of Organization Implementing Practice

State/district or Other Sub-national Government

Practice Overview

The Community Mothers’ Programme was first started in 1988 in Dublin by the Health Service Executive, a public organization responsible for the provision of healthcare and personal social services for everyone living in Ireland.

The programme targets first-time parents living in disadvantaged areas and is aimed at providing support and encouragement to first-time parents through home visits from “community mothers”.

It focuses on promoting parent capacity and parent empowerment, specifically by developing of parenting skills and enhancing parents’ self-esteem. Some of the methods used include the promotion of parents’ potential through a behavioural approach in which parents are encouraged to stimulate, breast-feed, and praise their children, as well as ensure their safety. The Community Mothers Programme also uses illustrated sequences to trigger discussions on healthy and developmentally appropriate means of coping with various child-rearing challenges.

Community mothers are volunteers who were first identified by local public health nurses. They are then interviewed by a regional family development nurse to assess their suitability. After being identified as suitable candidates, community mothers undergo four weeks of training before starting to work under the guidance of a family development nurse. This training focuses on health care, nutritional improvement and overall child development. The work of community mothers consists in monitoring between five and fifteen families during monthly home visits during the first year of the child’s life (Johnson, Z., Howell, F., and Molloy, B., 1993).

Evidence of Effectiveness

Evaluation 1

  • Johnson, Z., Howell, F., and Molloy, B., Community mothers’ programme: randomised controlled trial on non-professional intervention in parenting, British Medical Journal, vol 306, pp 1449-52, 1993.

Programme outcomes were evaluated at the child’s first birthday. Nutrition was assessed by 24 hour recall, and responses were categorized as inappropriate if mothers reported not enough or too much of a particular food. See `Evaluation Details’ below for more information.

Summary of Results for Evaluation 1

Outcome

Treatment Group

Control Group

Outcomes improved (statistically significant)

Mothers’ self-esteem - Percentage of mothers feeling:

  • Tired

78%

90%

  • Miserable

57%

76%

  • Staying in

31%

54%

Twenty four hour dietary recall history for children - Percentage of children eating:

  • Inappropriate animal protein

17%

58%

  • Inappropriate non-animal protein

16%

49%

  • Inappropriate wholefoods

14%

54%

  • Inappropriate vegetables

12%

38%

  • Inappropriate fruit

23%

61%

  • Inappropriate milk

6%

28%

  • Inappropriate energy intake

7%

44%

Twenty four hour dietary recall history for mothers – Percentage of mothers eating:

  • Inappropriate animal protein

24%

52%

  • Inappropriate non-animal protein

43%

72%

  • Inappropriate wholefoods

34%

77%

  • Inappropriate vegetables

36%

59%

  • Inappropriate fruit

57%

73%

  • Inappropriate milk

44%

69%

  • Inappropriate energy intake

26%

49%

Developmental and positive/negative scores

  • Cognitive games

3.75

1.62

  • Nursery rhymes

7.74

3.50

  • Positive feelings

2.61

1.17

  • Negative feelings

0.93

1.42

Percentage of children receiving all 3 shots of primary immunizations by 1st birthday

85%

65%

Mean number of days spent in the hospital among children admitted to hospital

14.0

7.0

Length of time children were kept on formula feeds in weeks

38.1

28.0

Percentage of children drinking cows’ milk before 26 weeks

19%

47%

Percentage of mothers reading to their child

98%

54%

Percentage of mothers reading daily to their child, as percentage of all mothers reading

56%

26%

Outcomes with no effect

 

 

Percentage of infant hospitalizations

19%

20%

Percentage of mothers feeling:

 

 

  • Headaches

49%

50%

Developmental and positive/negative scores:

 

 

  • Motor games

0.83

0.76

Mean number of days spent in the hospital

2.6

1.3

Number of children suffering an accident

3

8

 

Evaluation 2

  • Johnson, Z. Molloy, B., Scallan, E., Fitzpatrick, P., Rooney, B., Keegan, T., and Byrne, P., Community mothers programme – seven year follow-up of a randomized controlled trial of non-professional intervention in parenting, Journal of public health medicine, vol. 22, no. 3, pp. 337-342, 2000.

Children were eight years old when the follow-up outcomes were evaluated.

Summary of Results for Evaluation 2

Outcome

Treatment Group

Control Group

Outcomes improved (statistically significant)

Percentage of mothers disagreeing with the statement “Children should be smacked for persistently bad behavior”

54.4%

24.3%

Percentage of mothers agreeing that “Parents enjoy participating in their child’s games”

100%

84.2%

Rosenberg self-esteem scale - Percentage of mothers agreeing with the statement: I do not have much to be proud of

97.4%

76.3%

Percentage of mothers having learnt something during their oldest child’s first year that helped with subsequent children

82.1%

56.7%

Percentage of mothers visiting library on a weekly basis

79%

50%

Percentage of mothers checking homework every night

100%

81.6%

Percentage of children admitted to the hospital because of illness

44.7%

21.1%

Outcomes with no effect

Percentage of subsequent children being breast-fed

24.4%

13.0%

Percentage of children receiving Measles-Mumps-Rubella immunizations

94.7

100

Percentage of children receiving school booster

100

94.6

Percentage of children receiving dental check-ups

89.5%

76.3%

Percentage of children having an accident requiring a visit to the hospital

26.3%

44.7%

Percentage of mothers reading to their child

36%

31.6%

Percentage of children stopping television by 9 p.m.

97,4%

86.8%

Percentage of children being bullied in school

23.7%

36.8%

Percentage of mothers disagreeing with the statement “Horror videos do not have any effect on children”

84.2%

84.2%

Percentage of mothers agreeing with the statement “It is important for parents to know who their children’s friends are”

100%

100%

Percentage of mothers agreeing on the importance for parents to become involved in their child’s schooling

94.7%

94.7%

Rosenberg’s self-esteem scale – Percentage of mothers agreeing with the statement:

  • I am a person of worth

97.4%

84.2%

  • I have good qualities

100%

94.7%

  • I do things as well as others

94.7%

92.1%

  • I am satisfied with myself

84.2%

73.7%

  • I have a positive attitude toward myself

86.8%

68.4%

  • I want more respect

52.6%

34.2%

  • I feel useless at times

63.2%

55.3%

  • I feel no good at all

97.4%

86.8%

Transferability

No replications of the Community Mothers Programme have been reported in studies matching our evidence of effectiveness inclusion criteria. Documentation can be found online about general aspects of the program as well as examples of the cartoon illustrations, however no training or curriculum documentation could be found regarding the content of Community Mothers’ training or the monthly visits.

Enduring Impact

A seven-year follow-up study reports statistically significant positive outcomes for several outcomes. The full study results can be found above.

Issues to Consider

The evaluations mentioned above are not led by independent entities, as Brenda Molloy and several co-authors were working for the Community Mothers Programme, with Brenda Molloy being the program director of the Community Mothers programme.

The differences between the intervention and control groups is of concern in the 1993 study, though controlled for when estimating the outcomes remains an issue of concern.

The Community Mothers Programme has also been expanded to the travelling community. Experienced community mothers were given additional training to heighten their awareness of sensitivity to the needs of traveller parents (Fitzpatrick, P, Molloy, B., Johnson, Z., 1997). The evaluation of this replication of the programme was not included because the study design that did not include a sufficient comparison group for this intervention.

Contact Information

Name

Brenda Molloy

Title

Director of Community Mothers Programme

Organization

Health Service Executive

Address

3rd Floor Park House, North Circular Road, Dublin 7

Phone

00 353 1 8387341

Email

brenda.molloy@hse.ie

Available Resources

Brenda Molloy, Director of the Community Mothers Programme, has published a review of the evaluations and the development of the program, including some material used in the program (Molloy, 2002). The Community Mothers Programme’s 2010 annual report also provides various quantitative as well as many qualitative remarks on the program (Molloy, 2010).

Evaluation Details

The sample for the initial study in 1993 was composed of 141 mother-infant pairs for the intervention group, and 121 mother-infant pairs for the control group. All first-time mothers with a child born during six months in 1989 and who resided in a given deprived area of Dublin were eligible to participate. The eligibility assignment to the intervention or control groups was randomized, and there were no significant differences across the treatment and control groups at baseline except for mothers’ and fathers’ employment status, which was accounted for throughout the analysis.  Baseline data were collected during the first interview, while the follow-up interview and measurements of outcomes occurred at the child’s first birthday.

The seven-year follow-up study included 38 mother-infant pairs in each the control and the intervention group who could be located and agreed to interview, representing one third of the original sample. Outcomes in this study were evaluated when the child was eight.  The evaluation uses each mother-infant pair’s original assignment to treatment and control groups in the 1993 study to compare outcomes (Johnson, Z. et al., 2000).

Bibliography

Last updated

August 2012