Home-visiting programs during the first 1000 days; A review about the impact of home-visiting interventions on socioeconomic disparities in healthcare access.

Abstract

Background: The first 1000 days of a child’s life are crucial for healthy development and lifelong wellbeing. However, equal access to healthcare during this period remains a challenge, even in Western countries. Home-visiting programs are frequently implemented to support vulnerable individuals during this critical period, yet there is insufficient attention to the accessibility of these interventions. Objective: This rapid review synthesized existing knowledge, providing an overview of evidence regarding the accessibility of home-visiting interventions during the first 1000 days for individuals facing socioeconomic disparities. Methods: A rapid review was conducted, searching the PubMed and Scopus databases. Eligibility criteria were based on the PICOST Framework, including Western children and their parents in the first 1000 days of life (population), home-visiting interventions (intervention), studies with a control group (comparator), outcomes related to accessibility and effectiveness (outcomes), randomized and non-randomized controlled trials (study design), and English, peer-reviewed studies published between 2014 and 2024. Data were analyzed and coded using three theoretical lenses: accessibility framework, socioecological levels, and intersectionality, utilizing a data-extraction sheet and Atlas-TI. Results: 44 studies were included. Findings indicated that home-visiting interventions primarily address supply-side factors and challenges at the interpersonal and intrapersonal levels. However, there is a notable lack of attention to intersectionality and to institutional and structural challenges that influence the accessibility of healthcare during the first 1000 days. Discussion and conclusion: Home-visiting programs predominantly address challenges related to personal development and social interactions, focusing on supply-side factors of the intervention. Consequently, there is less focus on institutional and structural challenges, which often serve as notable barriers to healthcare access for individuals experiencing socioeconomic disadvantages. This review underscores the impact of home-visiting interventions on healthcare access disparities and questions whether the current design of these interventions adequately addresses the underlying institutional and structural challenges contributing to these disparities.