The challenges of establishing and researching a sustained nurse home visiting programme within the universal child and family health service system

This paper reflects on the challenges and strategies used to conduct a sustained nurse home visiting randomised trial within the universal child and family health service system in Australia. The Maternal Early Childhood Sustained Home-visiting (MECSH) programme is a complex multilevel intervention acting in parallel at the individual and organisational levels, addressing change in individuals and families, as well as the structural and social factors that affect the individuals, particularly families' access to support and services. MECSH is targeted towards 20-25% of the population who are at risk of poorer maternal and child health and development outcomes. Establishing the intervention within the service system and conducting the research trial simultaneously presented many challenges. The researchers encountered both technical and ethical problems. The role of researchers as disinterested, objective scientists was constantly challenged. We argue that the MECSH trial was a hybrid research model, testing both efficacy and effectiveness, in a participatory framework. Hybrid research can help to generate evidence of the effectiveness of multilevel interventions in more timely ways, but requires greater investment in the time and resources to conduct the research. We see that such investment would pay dividends in the simultaneous development, testing and embedding of effective interventions for families and sustainable capacity for services.