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Predictors of Acceptance of a Postpartum Public Health Nurse Home Visit

Findings from an Ontario Survey

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Abstract

Objectives: To determine 1) rates of offer and uptake of a home visit provided through Ontario’s universal Hospital Stay and Postpartum Home Visiting Program, and 2) predictors of acceptance of a home visit.

Methods: Women were eligible to participate if they had given birth vaginally to a live singleton infant, were being discharged with the infant to their care, were competent to give consent, and could communicate in one of the four study languages. A self-report questionnaire was used to collect data from 1,250 women recruited from five hospitals across the province; 890 (71.2%) women completed a structured telephone interview 4 weeks following discharge.

Results: Most women (81.4% to 97.8%) reported having received a telephone call from a public health nurse, although not necessarily within 48 hours of discharge. While the offer of a home visit reportedly was high across sites, there were statistically significant differences in rates of acceptance (40.8% to 76.2%). Important predictors of acceptance were first live birth, lower social support, lower maternal rating of services in labour and delivery, poorer maternal self-reported health, probable postpartum depression, lower maternal rating of services on the postpartum unit, and breastfeeding initiation.

Conclusion: The home visiting component of the universal program is reaching most women through telephone follow-up. However, rates of acceptance of a home visit differed greatly across study sites. The findings suggest that it is women with specific problems or needs who are accepting a visit. Further research is necessary to guide the development of evidence-based programs and policies regarding postpartum nurse home visits.

Résumé

p ]Objectifs: 1) Déterminer l’offre et la demande des visites à domicile fournies par l’entremise d’un programme universel de l’Ontario appelé Hospital Stay and Postpartum Home Visiting Program, et 2) cerner les variables prédictives de l’acceptation, par les mères venant d’accoucher, d’une visite à domicile.

Méthode: Le programme s’adressait aux femmes ayant accouché par voie vaginale d’un bébé unique né vivant, ayant reçu leur congé de l’hôpital avec leur nourrisson, capables de donner un consentement, et pouvant communiquer dans l’une des quatre langues de l’étude. Au moyen d’un questionnaire d’auto-évaluation, nous avons recueilli des données auprès de 1 250 femmes recrutées dans cinq hôpitaux de la province; 890 femmes (71,2 %) ont répondu à une entrevue téléphonique semi-structurée quatre semaines après leur sortie de l’hôpital.

Résultats: La plupart des femmes (entre 81,4 % et 97,8 %) ont dit avoir reçu un appel téléphonique d’une infirmière hygiéniste, mais pas nécessairement dans un délai de 48 heures après leur sortie. L’offre d’une visite à domicile était uniformément élevée, mais nous avons constaté des écarts significatifs dans les taux d’acceptation (qui variaient entre 40,8 % et 76,2 %). Les principales variables prédictives de l’acceptation d’une visite à domicile étaient la naissance d’un premier enfant vivant, la faiblesse du soutien social, l’opinion maternelle relativement mauvaise des services reçus pendant le travail et l’accouchement, un état de santé maternel relativement mauvais selon l’intéressée, la probabilité de dépression du post-partum, l’opinion maternelle relativement mauvaise des services offerts par l’unité post-partum, et le taux d’allaitement maternel.

Conclusion: Le volet des visites à domicile de ce programme universel est mis à la portée de la plupart des femmes par le biais d’un suivi téléphonique. Cependant, les taux d’acceptation des visites varient beaucoup d’un endroit à l’autre. Cela donne à penser que les femmes qui éprouvent des problèmes ou qui ont des besoins particuliers sont celles qui acceptent qu’on leur rende visite. Il faudrait pousser la recherche pour orienter l’élaboration de programmes et de politiques fondés sur les résultats en ce qui concerne les visites à domicile post-partum effectuées par des infirmières.

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Authors and Affiliations

  1. School of Nursing HSc 3H48B, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada

    Wendy A. Sword PhD, Paul D. Krueger PhD & M. Susan Watt DSW

  2. Hamilton Public Health and Community Services Department, Public Health Research, Education and Development (PHRED) Program, Canada

    Wendy A. Sword PhD

  3. St. Joseph’s Health System Research Network, Hamilton, Canada

    Paul D. Krueger PhD

Authors
  1. Wendy A. Sword PhD
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  2. Paul D. Krueger PhD
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  3. M. Susan Watt DSW
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Correspondence to Wendy A. Sword PhD.

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Acknowledgement: This research was funded by the Canadian Institutes of Health Research.

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Sword, W.A., Krueger, P.D. & Watt, M.S. Predictors of Acceptance of a Postpartum Public Health Nurse Home Visit. Can J Public Health 97, 191–196 (2006). https://doi.org/10.1007/BF03405582

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