Prevention Science

, Volume 19, Issue 4, pp 516–527 | Cite as

Visit Attendance Patterns in Nurse-Family Partnership Community Sites

  • Margaret L. Holland
  • David L. Olds
  • Ann M. Dozier
  • Harriet J. Kitzman


We examined visit attendance patterns of mothers enrolled in the Nurse-Family Partnership (NFP) home visitation program and associations between these patterns and characteristics of the families and sites, with the goal of increasing participant engagement. We utilized repeated measures latent class analysis to identify attendance patterns among 66,967 mothers in NFP sites across the USA. Mothers enrolled from 1996 to 2010. Data were collected by home visitors and aggregated by the NFP National Service Office. Five visit attendance patterns were identified. Consistent attenders (22%) remained engaged for the full program and attended 51.3 visits on average. Inconsistent attenders (9%) remained engaged but missed many visits, with an average of 36.4 visits. The remaining patterns were characterized by when participants left the program: early (28%; 6.7 visits), gradually (27%; 19.4 visits), or late (15%; 35.3 visits). Consistent and inconsistent attenders were less likely to use English as their primary language than other participants (R = 0.12; p < .001). Participants with more nurse changes per visit attended were more likely to drop out early (R = 0.11; p < .001). Sites with a higher percent of missing data had smaller portions of mothers who remained consistently engaged in the program over time (b = − 0.032; p < .01) and greater portions in the late (b = 0.007; p < .04) and gradual attrition classes (b = 0.018; p < .01). The large number of participants who dropped out early is concerning. Further exploration of this group may optimize use of resources by improving either retention or targeting of potential participants.


Home visiting Attrition Retention Dose 


Compliance with Ethical Standards


Dr. Holland acknowledges funding from the University of Rochester CTSA award number KL2 RR024136 from the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health. Dr. Olds and Dr. Kitzman report grants from the US National Institute of Mental Health and the US Office of Juvenile Justice and Delinquency Prevention, during the conduct of the study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of Interest

The Prevention Research Center for Family and Child Health, directed by Dr. Olds at the University of Colorado School of Medicine, has a contract with the Nurse-Family Partnership (NFP) to conduct research to improve the NFP program and its implementation. Dr. Olds was employed by this center at the time the study was conducted. Dr. Olds is the founder of the NFP.

Ethical Approval

This study was approved by the University of Rochester Research Subjects Review Board. 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.

Informed Consent

All program participants provide consent for their data to be used for purposes of program improvement.

Supplementary material

11121_2017_829_MOESM1_ESM.docx (26 kb)
Supplementary Table 1 (DOCX 26 kb).
11121_2017_829_MOESM2_ESM.docx (28 kb)
Supplementary Table 2 (DOCX 27 kb).


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Copyright information

© Society for Prevention Research 2017

Authors and Affiliations

  • Margaret L. Holland
    • 1
  • David L. Olds
    • 2
  • Ann M. Dozier
    • 3
  • Harriet J. Kitzman
    • 4
  1. 1.School of NursingYale UniversityOrangeUSA
  2. 2.Department of PediatricsUniversity of Colorado DenverAuroraUSA
  3. 3.Department of Public Health SciencesUniversity of RochesterRochesterUSA
  4. 4.University of Rochester School of NursingRochesterUSA

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