Having the best intentions is necessary but not sufficient: what would increase the efficacy of home visiting for preventing second teen pregnancies?

Objective: Identify ways to increase the impact a well-known home-based intervention--the Nurse Family Partnership (NFP)--has on conception rates among teenage mothers.

Methods: Secondary analysis of data collected on 111, 13-to-19 years old, primiparas who were visited in their homes by nurses during, and for 2 years after pregnancy. Data bearing on assistance with family and career planning were culled from the nurses' records. These were graded on a 3-point scale. Higher scores reflected more active, therapeutic interventions. The primary outcome was repeat pregnancy.

Results: The pregnancy rate at 6, 12, and 24 months was 8.3%, 18.4%, and 28.1%. Teenagers who conceived were less likely to have used contraceptives during the previous six months than those who did not. Almost everyone received the recommended number of visits. However, discussions and active interventions related to lapses in contraceptive use were only documented during 30% of visits. Those who conceived had as many visits and discussions of this type as those who did not. Nurses rarely involved boyfriends and family. Other differences between teens that did and did not conceive support the NFP theoretical framework.

Conclusions: Contrary to the stated aims of the intervention, the nurses rarely documented therapeutic interventions that could make repeated childbearing fit less harmoniously into the teenagers' lives. The best way to strengthen the impact of this program on teen pregnancy rates is to deepen the nurses' training so that they are able to intervene actively enough to bring about behavioral change in family planning.