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Engaging Community in Prioritizing Outcomes to Improve Family Health in Evidence-Based Nurse Home Visiting: Using a Modified e-Delphi Method

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Abstract

Background

Evidence-based home visiting programs are designed to improve maternal child health. Nurse-Family Partnership (NFP) is a model evidence-based home visiting program, shown to improve pregnancy outcomes, child development, and economic self-sufficiency for first-time mothers and their families experiencing social and economic adversities, enrolling them early in pregnancy. Recently, NFP has expanded its services to multiparous women (previous live births) and enrolling women past 28 weeks gestation (late registrants) in selected agencies in Florida since 2021.

Objective

To study the process and impacts of expanding NFP to expanded populations (multiparous and/or late registrants), we convened a diverse Advisory Committee to guide the NFP expansion evaluation in Florida.

Methods

This study employed a modified e-Delphi method with three rounds of data collection, to engage diverse partners to identify process and impact outcomes for the NFP expansion evaluation.

Results

Child maltreatment was identified as the highest priority outcome. Process outcomes included program reach, client enrollment, and client engagement, while impact outcomes included maternal physical health, maternal mental health and substance use, birth outcomes, and breastfeeding practices. The Advisory Committee further identified potential data sources to measure these outcomes.

Conclusions for Practice

Identifying and selecting key process and impact outcomes using a community-engaged process is necessary to ensure equal buy-in from all partners and to inform rigorous program evaluation. This study showed that using methods such as e-Delphi is feasible and effective for achieving thoughtful and rigorous decision-making, even in times of uncertainty like the COVID-19 pandemic.

Significance

What is Already Known on this Subject? Home visiting programs range widely in terms of goals, scope, intended population, and evidence base, but are increasingly recognized as a unique and impactful resource for improving maternal child health. The expansion of these programs to new intended populations must be evaluated to ensure that the original program as designed remains effective.

What this Study adds? We highlight a systematic process used to identify and select key process and impact outcomes, through a community-engaged process to inform rigorous program evaluation in the context of perinatal and early childhood home visiting program. We demonstrated that effective transdisciplinary engagement, collaboration, and decision-making is feasible in a remote environment.

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Data Availability

The data that support the findings of this study are available from the corresponding author, VW, upon reasonable request.

References

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Acknowledgements

Thanks are due to the Florida Advisory Committee for Evaluation of Expanded Populations for Nurse-Family Partnership, the nurse home visitors who work tirelessly to implement the program, their community partners, as well as the Nurse-Family Partnership National Service Office for supporting this research.

Funding

This study was supported by funds from the Nurse-Family Partnership® (NFP) National Service Office. The funders had no role in the design of the study; collection, analysis, and interpretation of data; writing the manuscript; or the decision to submit the manuscript for publication.

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Authors and Affiliations

Authors

Contributions

The authors confirm contribution to the paper as follows: study conception and design: VW and MA; data collection: VW and MA; analysis and interpretation of results: VW, JM, MR, and MA; draft manuscript preparation: VW, JM, MR, and MA. Author. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Venice Ng Williams.

Ethics declarations

Ethical Approval

This study did not require ethics review under the Colorado Multiple Institutional Review Board as it is not required for non-human subjects research activities such as program evaluation.

Consent to Participate

All participants consented to participate by means of completing the surveys for data collection and engagement in consensus discussion meetings.

Consent for Publication

N/A.

Conflicts of interest

All authors declare no competing or financial interests.

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Williams, V.N., Marshall, J., Richey, M. et al. Engaging Community in Prioritizing Outcomes to Improve Family Health in Evidence-Based Nurse Home Visiting: Using a Modified e-Delphi Method. Matern Child Health J 28, 333–343 (2024). https://doi.org/10.1007/s10995-023-03839-6

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  • DOI: https://doi.org/10.1007/s10995-023-03839-6

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