Chapter 15. English summary

This evaluation study focused on home-based intervention, which is a new nursing intervention for child-rearing families in the Finnish social and health care. This intervention was founded in order to support parent-infant interaction and attachment in case of an infant’s actual or potential developmental risks. Also environmental issues related to parenthood, which may burden the interaction, has been a reason for the intervention. A specially educated nurse visited home with respect to family needs.

Many good results have been obtained by home-based interventions. Benefits to preterm infants cognitive and behavioral development have been found in many studies. Also motherhood competence as well as mother-infant interaction have been improved as a result of the intervention.

Even though many aspects of the home-based interventions have been studied, there still remains a gap to which factors are preconditions for favourable outcomes of the home-based interventions. Likewise there are very few studies concerning costs of such kind of interventions.

The first purpose of this study was to evaluate characteristics of the home-based intervention perceived by mothers with preterm infants. The second purpose was to evaluate the cost of the intervention and impacts of participationat to the first year costs of preterm care. The study sought answers to two main questions: What kind of support the mothers with a preterm infant (≤ 32 wk) received, when they were involved in the home-based intervention? The second question was, what kind of costs the intervention caused to the hospital and which kind of effects the home-based intervention had on the first year cost of preterm care?

Data concerning support perceived by the mothers was gathered by interviewing two groups of mothers with preterm infants. The first group consisted of mothers (N = 17) who had not received the intervention. The focus of their interviews was on motherhood and caring for a preterm infant at home. The second group of mothers (N = 7) where those, who participated in the intervention during the infant’s first year of life. Therefore they were able to describe characteristics of home-based intervention as a means of social support. Data gathered by interviews during 1998–1999 was analyzed by inductive and deductive content analysis. The deductive analysis was based on characteristics of social support such as information, integration, material and active support.

In order to answer the second study question, costs of the intervention as well costs of preterm care during the first year of the infants’ life were computed. This part of the study consisted of two groups of preterm infants (≤ 32 gw) born in 1996–1998 and their families. The control group involved preterm infants (N = 118), who were treated in Oulu University Hospital. The intervention group consisted of preterm infants (N = 18), who were treated in two central hospitals in eastern and northern Finland, and their families who participated in the intervention. Data concerning costs was gathered through a parental questionnaire and from hospital statistics and patient files during 1998–1999. Direct and indirect social and family costs were included. Direct social costs of preterm care consisted of costs from initial hospital care, rehospitalizations, out-patient care and follow-up of preterm infants as well as primary health care and costs of the home-based intervention as well costs of compensation for travelling. Direct family costs included legislative parental co-payment fees and costs of some items for medical or developmental care of the infant and also costs of travelling. Indirect social and family costs were those by which parental participation to care were supported as compensation for staying over-night. Descriptive statistical analysis as well comparing the means were done by a statistical program of SPSS for Windows.

The main results of this evaluation study are as follows:

1. Exceptional motherhood was a concept by which motherhood of mothers with preterm infants was described. It consisted of challenges of daily care for the preterm infants and emotional demands for the mothers. Daily care included demands for caring skills and needs for information concerning prematurity and long-term consequences of it. Mothers’ emotional demands included, in addition to the joy of progress in developmental stages of their infant, many fears, guilt and worries about the infant’s future. Fears also related to mothers themselves about their own resources to care for the infant.

2. The main form of support received from the home-based intervention was situation suitable information for preterm care. It also included emotional, integrative and active forms of support.

3. The costs of home-based consisted of salary, travelling and visiting time of the nurse, as well as compensation of using one’s own car. Mean cost of the intervention for the hospital was 970 euros per an infant during the first year.

4. The main cost of the control group of preterm infants was caused by initial hospital care. The amount of social costs was inversely correlated to the stage of prematurity. This means that the smaller the infant was, the higher the social costs were. However, the smaller the infant, the smaller the proportion of total costs of care the family had.

5. The family costs of preterm care included legislative co-payments and formed less than eight percent of the total costs of preterm care during the first year of preterm infants.

6. The social costs of preterm care among the intervention and control groups were similar during the initial hospitalization. The home-based intervention changed the type of costs of preterm care after discharge from the hospital. Costs of rehospitalization and primary health care were smaller among the intervention groups than those of the control group.

Implications of this study supported the clinical understanding that some mothers with a preterm infant may benefit exceptional support given by the home-based intervention. The perceived features of the home-based intervention indicated that nursing interventions like this should focus on situation suitable information. The study also suggested small cost to be bound to the home-based intervention as a means of support development of preterm infants as well as motherhood competence. These may be the factors which make a difference to future outcomes of preterm infants and their families as it has been revealed in many previous studies.

The study strengthened nursing by revealing the needs for support among mothers with preterm infant. It also increased the understanding for further development of support methods. The study indicated that support as a means of home-based intervention like this, will not necessarily be expensive when comparing it to the cost of the very first episode of preterm care. Instead of this, the home-based intervention may reinforce effectiveness of human and monetary recourses by fortifying developmental potentials of these infants. This will be done by supporting the mother-infant relationship.