Peer mentors help improve maternal and infant health outcomes in Hispanic families

MIHOW participant

A study of the Maternal Infant Health Outreach Worker (MIHOW) program, which employs peer mentors, found that this home visiting program was effective in improving maternal and child health outcomes in Hispanic mothers.

The MIHOW Program is a Vanderbilt parent-to-parent home visiting program, housed in the School of Nursing, which aims to improve the health and development of young children in families who live in underserved communities.

MIHOW began in 1982 to serve isolated communities in Appalachia. Its goals were to improve maternal health and child development in the first three years of life, to combat isolation, and to increase access to health care.

The belief that every family, regardless of living conditions or circumstances, has strengths is the foundation of MIHOW, which relies on trained peer mentors—members of the communities they serve—to be home visitors.

Melanie Lutenbacher, R.N., Ph.D.

Melanie Lutenbacher, R.N., Ph.D.

Tonya Elkins

Tonya Elkins

“Trained peer mentors are the heart of MIHOW,” said Tonya Elkins, MIHOW director and study co-author. “They build trusting relationships. They are a helpful resource, confidant, and role model.”

MIHOW peer mentors receive extensive and ongoing training about pregnancy, childbirth, infant feeding, child development, and positive parenting.

“Although peer mentors and home visiting may be an effective strategy for immigrant women and their infants, there hasn’t been rigorous research yet to demonstrate this,” said Melanie Lutenbacher, R.N., Ph.D., associate professor of Nursing and Pediatrics, and Vanderbilt Kennedy Center researcher. “That led us to designing and carrying out a randomized clinical trial of MIHOW for Hispanic families.”

The research team focused on Hispanic families for a number of reasons. Data indicate that the majority of Hispanic pregnant women in the U.S. start prenatal care in the first trimester, suggesting that pregnancy may be an excellent time to involve Hispanic families in a program like MIHOW that promotes good health outcomes for children and moms.

Data also indicate that Hispanic women experience higher rates of depression than in the general population. Depression has serious consequences for the health of their children as well their own health, and it is not known whether a home visiting program could reduce depression.

Breastfeeding has well-established benefits for child health, and although Hispanic women initiate breastfeeding at high rates, they also supplement with formula at high rates. The research team was interested in seeing whether a program like MIHOW that promotes breastfeeding exclusively for a defined period would affect this.

Study Description

To take part in the study, women had to meet the following qualifications: eligibility for MIHOW services, self-identify as Hispanic, written confirmation of pregnancy (less than 26 weeks gestation), live in a defined geographic radius from study offices, and willingness to be randomly assigned to one of two study groups.

Ultimately, the study enrolled 188 pregnant Hispanic women who lived in a large urban area in Tennessee; of these, 178 completed the study. The average age of mothers at enrollment was 29.6 years. Most reported a Mexican heritage (66.9%), less than a high school education (80.6%), never marrying (56.7%), and annual incomes less than $15,000.

All data were collected by trained study staff who were women hired for this project from the local communities served by the project, so that they were native speakers of Spanish and fluent in English, and also understood the community culture. The study staff interviewed the participating mothers at 5 points in time beginning with enrollment when women were less than 26 weeks pregnant, continuing through infants turning 6 months.

Mothers were randomly assigned to one of two groups: (a) mothers who received home visits from the trained MIHOW Hispanic peer mentors, and (b) mothers who received printed educational materials about mother and infant health and development at each of the 5 points in time at which the MIHOW group were interviewed to collect data. Both groups had similar sociodemographic characteristics and similar scores on standardized measures used to assess outcomes. Both groups of mothers received the printed educational materials so that data collectors did not know to which group mothers had been assigned.

Mothers in the MIHOW group received all the core elements of the MIHOW model, which emphasizes recognizing family strengths and using those to address family needs; and emphasizes peer relationships, which begin in pregnancy and continue through monthly home visits and periodic group sessions.

MIHOW peer mentors listen to mothers’ concerns, educate them on issues relevant to their current stage of pregnancy or age of infant (e.g., healthy eating, developmental milestones, attachment, breastfeeding), and link families to needed medical and social services.

Home visits typically are 1 hour long. Because of limited funding for this study, services were delivered from pregnancy through infants turning 6 months of age, contrasted to the usual MIHOW practice of continuing home visits until a child is 3 years old.


“Overall, women who took part in the MIHOW home visiting program had fewer depressive symptoms and less parenting stress and more social and emotional help, and better infant feeding and safe sleep practices,” Lutenbacher said.

At all time points after the infant’s birth, data collectors (who did not know to which of the two groups each mother was assigned) reported moms in the MIHOW group showing a higher level of quality and quantity of stimulation and support of their infants compared to the print-education-only group.

“Moms in the MIHOW group reported singing songs, telling stories, and reading books to their children more often than moms in the comparison group,” Lutenbacher said. “These kinds of activities provide a good foundation for child development and school readiness.”

Mothers in the MIHOW group breastfed their infants for longer periods of time without supplementing with formula, in contrast to the comparison group.

With regard to sleep safety, women in the MIHOW group were much more likely to report positioning their infants on the back than did the women in the comparison group.

Receiving and following through on service referrals also was higher in the MIHOW group than the comparison group.

“We think that because the MIHOW moms and MIHOW peer mentors shared their native language and cultural background, the moms may have been more receptive and motivated to follow through on service referrals,” said Lutenbacher. “MIHOW is a low-cost intervention, and in addition provides jobs to women in their community, so also increases community capacity.”

“We are so grateful to Catholic Charities, who partnered with us on this study,” Elkins said. “They were a big part of our ability to carry out the project successfully. And we thank our Catholic Charities co-author Anais Riggs.”

In summary, the findings demonstrated that a well-trained and supervised peer-to-peer home visiting model like MIHOW has beneficial effects on a sample of Hispanic mothers and infants. They also show the effectiveness of the MIHOW program, which has established standards of practice, a curriculum that is research-based, an accreditation component, and over three decades experience in multiple states.

Lutenbacher, M., Elkins, T., Dietrich, M. S., & Riggs, A. (2018). The efficacy of using peer mentors to improve maternal and infant health outcomes in Hispanic families: Findings from a randomized clinical trial. Maternal and Child Health Journal, 2018 May 31 [Epub ahead of print. PMID 298555840]

Jan Rosemergy is VKC director of Communications and Dissemination.

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