Six-Month Outcomes of a Nurse Home Visiting Program in Korea: A Randomized Trial

Abstract

BACKGROUND: The Korea Early Childhood Home-visiting Intervention (KECHI), a nurse-led program, was developed in 2020 to support maternal and child health. This study evaluated the program's impact on the home environment and maternal outcomes at 6 months postpartum. METHODS: A randomized controlled trial was conducted with individual-level 1:1 allocation across 25 district public health centers between 2021 and 2025. Pregnant women under 37 weeks' gestation with a risk factor score greater than or equal to 2 of sociodemographic, psychosocial, and health risk factors and trauma experiences were randomly assigned to the intervention or control group. The intervention group received 11.24 visits on average from intervention providers, beginning during pregnancy and continuing through 6 months postpartum. The control group received usual care. Primary outcomes included scores on the Infant/Toddler Home Observation for Measurement of the Environment (IT-HOME), breastfeeding duration, and maternal self-rated health. Secondary outcomes included maternal knowledge, mental health, and parenting behaviors. RESULTS: Outcome data were obtained for 395 of 408 (96.8%) participants in the intervention group and 385 of 392 (98.2%) in the control group. Compared with the control group, the intervention group demonstrated significantly greater parental involvement on the IT-HOME scale (Cohen's d effect size [ES], 0.14; 95% CI, 0.00 to 0.27), higher safety knowledge (ES, 0.17; 95% CI, 0.02 to 0.32), and fewer depressive symptoms measured by the Patient Health Questionnaire-9 (ES, -0.17; 95% CI, -0.32 to-0.02) and the Edinburgh Postnatal Depression Scale (ES, -0.21; 95% CI, -0.36 to-0.05). Adjusted odds ratios were 0.55 (95% CI, 0.35 to 0.86) for postnatal depression and 0.50 (95% CI, 0.30 to 0.85) for suicidal ideation. No effect on breastfeeding duration was detected. CONCLUSIONS: KECHI improved the home environment and maternal mental health at 6 months postpartum. The upcoming 2-year results will offer further insight into KECHI's impact and support its national scale-up.