Aligning Health and Social Systems to Improve Maternal Behaviors and Birth Outcomes Among Clients Engaged in Evidence-Based Home Visiting.

Abstract

<b>Objectives.</b> To examine the association between system alignment among Nurse-Family Partnership (NFP) home visitors and other community service providers and maternal behaviors and birth outcomes among NFP clients. <b>Methods.</b> NFP implementation data from 2015 to 2021 were matched to the 2018 to 2021 NFP Collaboration Panel Survey (n = 102 690). We used Poisson-based general estimating equations to examine a measure of cross-sector collaboration (based on relational coordination and structural integration) and the relationship with prenatal smoking cessation, breastfeeding, low birth weight, and preterm birth after adjustment for client-, nurse-, and agency-level covariates. <b>Results.</b> Stronger coordination with women's care providers (relative risk [RR] = 1.010; 95% confidence interval [CI] = 1.00, 1.02) and greater integration with mental health providers (RR = 1.002; 95% CI = 1.00, 1.00) were slightly positively associated with initiation of breastfeeding. The slight positive association with greater integration with mental health providers was sustained for continued breastfeeding at 6 months postpartum (RR = 1.004; 95% CI = 1.00, 1.01). System alignment was not related to prenatal smoking cessation, low birth weight, or preterm birth. <b>Conclusions.</b> Future implementation studies should explore whether strategies to increase system alignment result in changes in quantitative measures of cross-sector collaboration and meaningful improvement in maternal and child outcomes at a population level. (<i>Am J Public Health</i>. 2026;116(S3): S181-S191. https://doi.org/10.2105/AJPH.2026.308457).