Reaching the most vulnerable: A study of factors affecting enrolment in nurse-led home visiting in very remote communities of Australia’s Northern Territory

This study reports preliminary findings of an evaluation of the implementation of maternal and early childhood sustained nurse home visiting (the MECSH program) by three Aboriginal Community Controlled Health Services (ACCHS) in very remote communities of Australia’s Northern Territory (NT). MECSH was available to all women who were pregnant regardless of age and parity. There is a need to understand differences in access to the program among those eligible. A prospective evaluation cohort study gathered data for all women in three regions who were pregnant and eligible to be offered enrolment in MECSH over the period from 2019–2024. Using de-identified primary healthcare service records, demographic characteristics, perinatal risk factors and services used by women eligible to join the program are described. Differences in potential vulnerability to adverse birth and health outcomes are identified. Multivariable modified Poisson regression is used to identify characteristics of women that are associated with offer of enrolment. In total, 1412 women were eligible to join MECSH from 2019–2024: of these, 45% were offered enrolment in the program, while 55% were not offered a place. There were differences in perinatal outcomes, psychosocial and behavioural risk factors and antenatal healthcare utilisation patterns within the cohort both by age and by enrolment in the program. Women offered MECSH were higher users of antenatal care than those not offered MECSH. Young women, women with other children, those with mental health concerns, who used drugs, had a chronic condition or who experienced domestic violence had somewhat increased likelihood of program offer. This study provides support for sustained nurse home visiting to be implemented at scale and made available regardless of age and parity. There is no evidence to justify focusing exclusively on teenage or first-time mothers at the expense of older and multiparous women, although there are likely to be significant differences in needs for support within the cohort. Assertive engagement of clients should identify those at risk of being missed through low use of antenatal services and should proactively consider both psychosocial needs and quality of family support in assessment of potential for benefit from the program.