Nurse Home Visiting Augmented with Relationship Education to Prevent Intimate Partner Violence among LatinX Mothers

QING LI, MD, DrPH
Colorado School of Public Health

Perinatal intimate partner violence (IPV) is a common but unresolved barrier to achieving preventive effects of early home visiting. Two randomized controlled trials (RCTs) of the Nurse Family Partnership (NFP) program augmented with IPV components did not achieve a reduction in IPV or improvement in maternal quality of life. One reason may be that women do not often disclose IPV experience and care providers face challenges, especially among minority women. Latinx mothers are particularly vulnerable due to reproductive coercion and machismo. Furthermore, immigrant Latinx face barriers (e.g., fear of deportation). However, the IPV prevention effects and nativity differentiation among Latinx mothers have not been analyzed.

In secondary data analyses of one RCT, first-time, low-income mothers were recruited and randomly assigned to the standard or augmented programs of NFP in Multnomah County, Oregon from 2007 to 2011. Among the 238 women completed the baseline survey, retention was 88% and 81% at 1-year and 2-year follow-ups. Among 119 Latinx mothers at baseline, the augmented (n=75) and standard (n=44) program participants were stratified into the U.S.-born (n=33) or foreign-born (n=86) status.

Nurses were trained and delivered the adapted Within My Reach Curriculum to prevent IPV. The sum of any type of physical and sexual victimization and/or perpetration in the past 12 months in the Revised Conflict Tactics Scale was coded as an ordinal outcome from 0 (none) to 4 (types) and measured across 3 time points. We performed the proportional odds model of generalized estimating equations to investigate the association between nativity and IPV, adjusting for the intervention status and covariates such as age.

Foreign-born Latinx mothers were more likely to have lower education and low family yearly income ( <$21,000), but more likely to be employed, older, and older at first sexual intercourse, report being married or engaged, and IPV free or low violence types (p<0.05). Adjusting for maternal age, the visit-intervention and visit-nativity interactions were dropped from the model due to no significance. In the final model, the intervention program and foreign-born status were significantly associated with less IPV types 2 year later [Adjusted Odds Ratio (AOR): 0.57, 95%Confidence Interval (CI): 0.34 to 0.97, p=0.038; AOR: 0.47, 95% CI: 0.27 to 0.83, p=0.009). One-year increase in age at the baseline was marginally associated with less IPV types (AOR: 0.95, 95% CI: 0.90 to 1.01, p=0.081).

Preliminary findings show that the augmented NFP program prevented IPV among Latinx mothers, especial foreign-born and older ones. Culturally tailored curricula can better detect and prevent IPV and optimize the resources for health equity. Evidence re-analyzed from this RCT and further needs assessment can inform the design of cultural-tailored programs to prevent IPV among Latinx families.