A Qualitative Evaluation of Engagement and Attrition in a Nurse Home Visiting Program: From the Participant and Provider Perspective
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Beginning parenting programs in the prenatal and early postnatal periods have a large potential for impact on later child and maternal outcomes. Home-based parenting programs, such as the Nurse Family Partnership (NFP), have been established to help address this need. Program reach and impact is dependent on successful engagement of expecting mothers with significant risks; however, NFP attrition rates remain high. The current study qualitatively examined engagement and attrition from the perspectives of NFP nurses and mothers in order to identify mechanisms that enhance service engagement. Semi-structured interviews were conducted in focus groups composed of either engaged (27 total mothers) or unengaged (15 total mothers) mothers from the NFP program. NFP nurses (25 total nurses) were recruited for individual semi-structured interviews. Results suggest that understanding engagement in the NFP program requires addressing both initial and sustained engagement. Themes associated with enhanced initial engagement include nurse characteristics (e.g., flexible, supportive, caring) and establishment of a solid nurse-family relationship founded on these characteristics. Factors impacting sustained engagement include nurse characteristics, provision of educational materials on child development, individualized services for families, and available family support. Identified barriers to completing services include competing demands and lack of support. Findings of this study have direct relevance for workforce planning, including hiring and training through integrating results regarding effective nurse characteristics. Additional program supports to enhance parent engagement may be implemented across home-based parenting programs in light of the current study’s findings.
KeywordsHome visiting Engagement Attrition Parenting program
This study was funded by the Maternal, Infant, and Early Childhood Home Visiting Competitive Grant Program by the Health Resources and Services Administration (HRSA; Grant Number: D89MC23154).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Research Involving Human Participants and/or Animals
Statement of Human Rights. All procedures performed in these studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Statement on the Welfare of Animals. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study. Further, informed consent was approved by IRB and given in writing by participants prior to participation in the study. No individual rights were infringed upon as monitored by IRB. All identifying information (names, dates of birth, identity numbers, and other information) was removed prior to analyzing data so that complete anonymity could be achieved.
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