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Beyond Family Demographics, Community Risk Influences Maternal Engagement in Home Visiting

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Abstract

The present study investigated the influence of multi-level determinants on home visiting participation outcomes. Home visiting participation was assessed by: (1) duration of participation (i.e., retention); (2) number of home visits completed (i.e., dosage), and (3) number of home visits completed divided by the duration of participation (i.e., intensity). The sample consisted of 1024 mothers (mean age 22.89 years) who participated in home visiting funded through Georgia’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Using hierarchical linear modeling, we investigated both family- and community-level characteristics associated with participation outcomes. Mothers (primary caregivers) were less likely to be retained in the program and more likely to have received fewer visits if they were not living with a main romantic partner or if their household incomes were below poverty level. The mothers were more likely to be actively engaged if their primary language was not English or if their child was relatively younger at enrollment. At the community level, after controlling family characteristics, living in a disadvantaged community (characterized by economic deprivation and elevated child health/safety risks) was associated with shorter and less intense program participation. These findings demonstrate that barriers to active engagement in home visiting programs persisted at multiple ecological levels. Explicitly considering the complexity of the communities in which home visiting programs are implemented may allow for more equitable allocations and expectations in future funding and performance measurement.

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Funding

The research reported in this manuscript was supported by Award Numbers D89MC28283 from the Health Resources and Services Administration in the United States. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Health Resources and Services Administration.

Author Contributions

J.C.: collaborated with the design of the study, conducted statistical analyses, and wrote the paper. D.T.: collaborated with the design of the study, data management, and wrote the paper. R.G.: conducted data management and collaborated with the design and writing of the study. D.B.: conducted statistical analyses and collaborated in the editing of the final manuscript. A.B.: collaborated with the design of the study and editing of the final manuscript.

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Authors and Affiliations

  1. Center for Family Research, University of Georgia, Athens, Georgia

    Junhan Cho, Darcey D. Terris, Rachael E. Glisson, Dayoung Bae & Anita Brown

  2. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

    Junhan Cho

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  1. Junhan Cho
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  2. Darcey D. Terris
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Correspondence to Dayoung Bae.

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The authors declare that they have no competing interests.

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.

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

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Cho, J., Terris, D.D., Glisson, R.E. et al. Beyond Family Demographics, Community Risk Influences Maternal Engagement in Home Visiting. J Child Fam Stud 26, 3203–3213 (2017). https://doi.org/10.1007/s10826-017-0803-8

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