Table 1

Description of Health Start Program goals, CHW activities (non-exhaustive), predicted client actions, study aims and measurable outcomes. Five maternal and child health goals guide the Arizona Health Start Program CHW activities to support at-risk pregnant and postpartum women and families with children up to 2 years of age. CHWs provide support and services to meet the individual needs of their clients during home visiting sessions that promote self-sufficiency, empowerment, positive health change and improved health outcomes. Our three study aims align with the HSP goals, which we will analyse via the listed outcomes.

Programme goalsCHW inputProcess indicatorEvaluation aimsMeasurable outcomes
1. Reduce the incidence of very low birthweight babies.
  • Prenatal home visits. Education on pregnancy, labour, delivery, nutrition, inter-conception.

  • Screening, education, and assistance for mood and anxiety disorders, substance cessation, and domestic violence.

  • Increased knowledge of and engagement in pregnancy process and activities to promote a healthy pregnancy. Increase knowledge of available services, completed assistant referrals, increased access to services.

Aim 1: assess the impact of the HSP on newborn health.
  • Preterm birth (gestational age).

  • Birth weight (birth weight, low birth weight <2500 g, very low birth weight <1500 g, and small size for gestational age).

  • Newborn hospital length of stay and 30-day hospital charges.

2. Increase prenatal services to pregnant women.
  • Perinatal home visits. Assistance with access and enrollment to continuous perinatal care.

  • Education on pregnancy, labour, delivery, inter-conception.

  • Initiate prenatal care earlier in pregnancy and attend more prenatal care visits.

  • Increased knowledge of and engagement in pregnancy process, delivery options and activities to promote a healthy pregnancy.

Aim 2: assess the impact of the HSP on maternal health and care utilisation.
  • Month prenatal care initiated.

  • Total number of prenatal visits.

  • Method of delivery (eg, first-time caesarean delivery).

  • Maternal morbidity (eg, uterine rupture).

  • Inter-pregnancy intervals.

3. Reduce the incidence of children affected by childhood diseases.
4. Increase the number of children receiving age appropriate immunisations by 2 years of age.
  • Perinatal home visits. Screening, education and assistance with child well-being services.

  • Timely completion of all immunisations for children.

Aim 3: assess the impact of the HSP on child health and development.
  • Probability of a child being on schedule for immunisations.

  • Utilisation of emergency room (ER) visits and inpatient (IP) stays at age of 1, 3 and 5 years.

  • Any charges associated with ER and IP utilisation.

5. Increase awareness by educating families on the importance of good nutritional habits, developmental assessments and preventative healthcare.Not evaluated by this study.Not evaluated by this study.Not evaluated by this study.N/A
  • CHW, community health worker; HSP, Health Start Program.