Trial of Intervention to Increase Participant Retention in Home Visiting

Investigators implemented and tested the effectiveness of an autonomy supportive intervention for low-income mothers and visiting nurses.

Dr. Olds has been studying the effects of prenatal and infancy nurse home visits on low-income mothers and children for over three decades. The Nurse-Family Partnership (NFP) is a prenatal and infancy home visitation program for low-income mothers and their first-born children. Generally NFP has had a positive impact on the lives of children and had lasting effects for mothers with sound mental health and other psychological resources. The most significant challenge facing NFP has been participant retention. Olds and his team have analyzed attrition data and have developed an intervention that gives mothers more control over the frequency of the visits and program content to meet their needs. Nurses were trained to coach families in “self-dosing,” or identifying the number and length of nurse visits appropriate for their family. They were then re-trained motivational interviewing, which focuses on motivational processes for the individual and supports change in a manner congruent with a person’s own values and concerns. Initial tests of this intervention were positive, and this grant allowed Olds to test the intervention in a randomized trial in program sites in Pennsylvania (18 sites) and Oklahoma (12 sites), reaching a total of 2,948 mothers. Researchers monitored the degree to which the intervention was implemented through forms completed by the nurses and participant retention was tracked using the Web-based database Clinical Information System (CIS). Although there was unforeseen state- and site-based variability in the implementation of the intervention, Olds found that across all sites, the intervention increased client engagement and that motivational interviewing enhanced their practice. Sites with significantly low retention demonstrated strong improvements in response to the intervention, even when the intervention was not completed. Despite the lack of complete implementation, the investigators believe that this finding indicates the intervention’s potential to have even greater effects. Results also suggested that nurses who were resistant to change or less comfortable with relinquishing control of the NFP into clients’ hands were less likely to engage in the training and to implement the intervention. Many nurses also raised the concern that the training activities were too “academic” and time-consuming. At sites with higher implementation, nurses reported a cohesive commitment to the intervention amongst the staff. At low-implementation sites, nurses did not support one another through the intervention.

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