International Replication of the Nurse-Family Partnership (NFP)

The NFP is a program of prenatal and infancy and toddler home visiting by nurses for low income women bearing their first children. It has been tested in a series of randomized controlled trials in the United States since 1977 and has been replicated in the United States outside of research contexts since 1996. Since 2006, the NFP has been replicated in 7 countries (The Netherlands, England, Scotland, Northern Ireland, Canada, and Australia).  In addition, the program is being replicated in Alaskan Native and American Indian communities (sovereign nations) within the United States.

Our approach to replication is guided by our awareness of the limitations of data from the US trials in informing community replication in other societies.  Given significant differences in health and human service systems in other contexts, and the often dramatically different cultural and historical factors that have affected vulnerable populations in these other societies, we are reluctant to claim program effectiveness in contexts where the program has not been tested rigorously.  Our approach to international replications requires commitment to delivering the program with essential fidelity to the core elements of the NFP and the following process for integrating the program in new societies:

1. Adaptation. With partners in the other societies, we examine program adaptations needed to deliver the program in new contexts, while ensuring fidelity to the core NFP model.
2. Feasibility and Acceptability through Pilot Testing and Evaluation.  In this phase, we require the conduct of a pilot test of the adapted NFP program to examine its feasibility, acceptability, and degree to which it is being conducted with essential fidelity to the to the model.
3. Randomized Controlled Trial.  Where the number of prospective participants is large enough and trials are culturally accepted, we require that new implementing societies conduct their own independent randomized controlled trial of the program so that policymakers will have localized estimates of program impacts on functional outcomes and costs.
4. Replication and Expansion.  Once the evaluation of the RCT has been completed and outcomes are found of public health significance. We work with new societies to create the infrastructure for high fidelity program replication in new contexts.

This session will summarize the work conducted in other societies to date, including the status of the randomized controlled trials.