Article Text

Download PDFPDF
Families First Home Visiting programme reduces population-level child health and social inequities
  1. Mariette Chartier1,
  2. Nathan C Nickel1,
  3. Dan Chateau1,
  4. Jennifer E Enns1,
  5. Michael R Isaac2,
  6. Alan Katz1,3,
  7. Joykrishna Sarkar1,
  8. Elaine Burland1,
  9. Carole Taylor1,
  10. Marni Brownell1
  1. 1 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  2. 2 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  3. 3 Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Mariette Chartier, Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada; Mariette_Chartier{at}


Background Home visiting has been shown to reduce child maltreatment and improve child health outcomes. In this observational study, we explored whether Families First, a home visiting programme in Manitoba, Canada, decreased population-level inequities in children being taken into care of child welfare and receiving complete childhood immunisations.

Methods De-identified administrative health and social services data for children born 2003–2009 in Manitoba were linked to home visiting programme data. Programme eligibility was determined by screening for family risk factors. We compared probabilities of being taken into care and receiving immunisations among programme children (n=4575), eligible children who did not receive the programme (n=5186) and the general child population (n=87 897) and tested inequities using differences of risk differences (DRDs) and ratios of risk ratios (RRRs).

Results Programme children were less likely to be taken into care (probability (95% CI) at age 1, programme 7.5 (7.0 to 8.0) vs non-programme 10.0 (10.0 to 10.1)) and more likely to receive complete immunisations (probability at age 1, programme 77.3 (76.5 to 78.0) vs non-programme 73.2 (72.1 to 74.3)). Inequities between programme children and the general population were reduced for both outcomes (being taken into care at age 1, DRD −2.5 (−3.7 to 1.2) and RRR 0.8 (0.7 to 0.9); complete immunisation at age 1, DRD 4.1 (2.2 to 6.0) and RRR 1.1 (1.0 to 1.1)); these inequities were also significantly reduced at age 2.

Conclusion Home visiting programmes should be recognised as effective strategies for improving child outcomes and reducing population-level health and social inequities.

  • child health
  • health inequalities
  • social inequalities
  • health services

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors The study was conceived by MC, NCN, DC, AK, EB and MB as part of a larger programme of research. The analyses were conducted by JS and CT. All authors, including MI and JEE, participated in interpreting the findings. JEE and MC drafted the manuscript, and all other authors critically reviewed it before submission.

  • Funding This study was conducted as part of the Pathways to Health and Social Equity for Children programmatic grant supported by the Canadian Institutes of Health Research (grant no. FRN 115206) and the Heart and Stroke Foundation of Canada (grant no. PG-12-0534).

  • Competing interests None declared.

  • Ethics approval The Health Research Ethics Board at the University of Manitoba.

  • Provenance and peer review Not commissioned; externally peer reviewed.