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A Qualitative Study of Mothers’ Perspectives on Enrolling and Engaging in an Evidence-Based Nurse Home Visiting Program

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Abstract

Prevention programs like Nurse-Family Partnership® (NFP) must enroll and retain clients of the intended population to maximize program impact. NFP is an evidence-based nurse home visitation program shown in randomized trials to improve maternal and child health and life course outcomes for first-time parents experiencing economic adversity, particularly for mothers with limited psychological resources. The purpose of this study was to understand enrollment and engagement experiences of mothers with previous live births referred to NFP in a formative study of the program for this population, but did not enroll or dropped out before program graduation. We used a grounded theory approach and purposively selected three NFP sites with variation in enrollment rates. We conducted telephone interviews with 23 mothers who were either referred to NFP and declined enrollment or former clients who dropped out before graduation. All interviews were conducted in English, recorded, transcribed, and validated. We developed an iterative codebook with multiple coders to analyze our data in NVivo11 and wrote thematic memos to synthesize data across study sites. Mothers described experiencing overlapping risk factors including physical and behavioral health conditions, child welfare involvement, and housing insecurity. Mothers from all sites discussed how they were referred to the NFP program, their experience of the enrollment process, reasons for enrolling or not enrolling, and reasons for dropping out after initial enrollment. Key themes that influenced mothers’ decision-making were: perceptions of program value, not needing the program, their living situation or being too busy as a deterrence, and past experiences including a distrust of health care. Reasons for attrition were related to no longer needing the service, being assigned a new nurse, being too tired postpartum, and moving out of the service area. One way to support home visiting nurses in family enrollment and engagement is to build their professional capacity to implement trauma-informed strategies given mothers’ life experiences.

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Funding

This study was supported by funds from the Nurse-Family Partnership® National Service Office through the Blue Meridian Partners.

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Authors and Affiliations

  1. Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, 13121 E 17th Ave, MS 8410, CO, 80045, Aurora, USA

    Venice Ng Williams, Carol Yvette Franco, Connie Cignetti Lopez, Mandy Atlee Allison & David Lee Olds

  2. Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, USA

    Mandy Atlee Allison

  3. Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, USA

    Gregory Jackson Tung

Authors
  1. Venice Ng Williams
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  2. Carol Yvette Franco
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  3. Connie Cignetti Lopez
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  4. Mandy Atlee Allison
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  5. David Lee Olds
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  6. Gregory Jackson Tung
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Correspondence to Venice Ng Williams.

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Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Colorado Multiple Institutional Review Board.

Consent to Participate and to Publish

All human participants provided verbal informed consent to participate in qualitative interviews and regarding publishing their data in aggregate form that was documented by audio recording.

Conflict of Interest

DO is supported by the National Service Office as a consultant. All other authors declare no competing or financial interests.

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The funders had no role in the design of the study, collection, analysis, and interpretation of data, writing of the manuscript, or the decision to submit the manuscript for publication.

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Williams, V.N., Franco, C.Y., Lopez, C.C. et al. A Qualitative Study of Mothers’ Perspectives on Enrolling and Engaging in an Evidence-Based Nurse Home Visiting Program. Prev Sci 22, 845–855 (2021). https://doi.org/10.1007/s11121-021-01260-5

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