Engagement in Home Visiting Services during the Transition from Pregnancy to Postpartum: A Prospective Mixed Methods Pilot Study

  • Amy DamashekEmail author
  • Catherine Kothari
  • Ariel Berman
  • Summer Chahin
  • John R. Lutzker
  • Kate Guastaferro
  • Daniel J. Whitaker
  • Jenelle Shanley
  • Shannon Self-Brown
Original Paper



This pilot study used a prospective mixed methods approach to examine predictors of retention in services during the transition from pregnancy to postpartum. Home visiting programs that serve pregnant women are an important means of improving child and maternal well-being. Providing services to women during the transition from pregnancy to postpartum is particularly important, because children under the age of 1 are at high risk for mortality. Morever, mothers face amplified levels of stress during the postpartum period. Unfortunately, home visiting programs in the United States that support pregnant and postpartum women suffer from high rates of attrition. General research on home visiting engagement suggests that the client-provider relationship is an important factor in predicting client engagement in services; however, few studies have examined factors related to maternal engagement during the transition from pregnancy to postpartum.


Measures administered during pregnancy for 39 pregnant women were used to predict attrition up to 15 months postpartum. Semi-structured interviews were conducted at 3 months postpartum with 33 of the original 39 women to qualitatively assess factors related to engagement in services during the transition from pregnancy to postpartum.


Both quantitative and qualitative analyses indicated that clients’ perceptions of the client-provider relationship was a critical factor in maintaining mothers’ engagement in services. Both types of analyses indicated that perceived provider reliability was related to mothers’ engagement in services. Quantitative analyses also found that perceived provider cultural competence predicted engagement in services. Other findings from qualitative analyses indicated that mothers’ perception of the home visitor as trustworthy/supportive, personable/having good communication skills, knowledgeable, and collaborative/flexible, were factors that mothers noted when discussing engagement in services.


These results advance the literature on engagement in home visiting services by overcoming some of the limitations of previous literature and may have implications for home visitor training.


Home visiting services Pregnancy Postpartum Engagement in services 



This research was supported in part from a grant, Coalition for Research on Engagement in Child Welfare, from the Annie E. Casey Foundation #215.0034 to Georgia State University (J.R.L., P.I.) and a subcontract to Western Michigan University (A.L.D., P.I.), # SP00011837-01.

Author Contributions

A.D.: Designed and executed the study, conducted data analyses, and wrote the paper. C.K.: Collaborated on study design, data analysis and interpretation, and manuscript preparation. A.B.: Assisted with data collection, data analysis and interpretation, and manuscript preparation. S.H.: Assisted with data collection and manuscript preparation. J.R.L.: Collaborated on study design and execution. K.G.: Collaborated on study design and consulted on manuscript preparation. D.J.W.: Collaborated on study design and execution. J.S.: Collaborated on study design and execution. S.S.B.: Collaborated on study design and execution.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Review Board approval was provided by Western Michigan University.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Amy Damashek
    • 1
    Email author
  • Catherine Kothari
    • 2
  • Ariel Berman
    • 1
  • Summer Chahin
    • 1
  • John R. Lutzker
    • 3
  • Kate Guastaferro
    • 3
  • Daniel J. Whitaker
    • 3
  • Jenelle Shanley
    • 4
  • Shannon Self-Brown
    • 3
  1. 1.Western Michigan UniversityKalamazooUSA
  2. 2.School of MedicineWestern Michigan UniversityKalamazooUSA
  3. 3.Georgia State UniversityAtlantaUSA
  4. 4.Penn State UniversityUniversity ParkUSA

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