BackgroundGuidance from economic evaluations on which implementation strategies represent the best return on investment will be critical to advancing the Triple Aim of health care: improving patient care and population health while minimizing per-capita cost. The results of traditional (quantitative) economic evaluations are limited by a remaining “qualitative residual” of contextual information and stakeholders perspectives, which cannot be captured by monetary values alone and is particularly prevalent in implementation science research. The emergence of qualitative methods for economic evaluation offers a promising solution.Main bodyTo maximize the contributions of economic evaluations to implementation science, we recommend that researchers embrace a mixed-methods research agenda that merges traditional quantitative approaches with innovative, contextually grounded qualitative methods. Such studies are exceedingly rare at present. To assist implementation scientists in making use of mixed methods in this research context, we present an adapted taxonomy of mixed-method studies relevant to economic evaluation. We then illustrate the application of mixed methods in a recently completed cost-effectiveness evaluation, making use of an adapted version of reporting standards for economic evaluations.ConclusionsBy incorporating qualitative methods, implementation researchers can enrich their economic evaluations with detailed, context-specific information that tells the full story of the costs and impacts of implementation. We end by providing suggestions for building a research agenda in mixed-method economic evaluation, along with more resources and training to support investigators who wish to answer our call to action.

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Adverse childhood experiences affect our bodies, brains, and behavior. Fortunately, decades of developmental science point to nurturing relationships and supportive resources that can counter the negative effects of ACEs. This article presents a model that incorporates developmental, clinical, public health, and biological science and describes potential developmental trajectories of both risk and resilience resulting from early life experiences. Interventions that promote resilience and recovery are described.

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.

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Objectives: Previous findings on the relationship between acculturation and depression have been mixed, such that acculturation has been demonstrated as a protective factor, risk factor, and neutral factor for depressive symptomology. The current study sought to clarify this association by examining the roles of acculturation and enculturation (retention of traditional values and practices) on depression while incorporating contextual variables such as social support and resource adequacy. Method: This study utilized archived data from 308 Latina mothers who participated in a randomized clinical trial evaluating the effectiveness of a home-based child maltreatment prevention model that was culturally adapted for a midwestern Latino/a community. Results: Findings from this study suggest that although enculturation was negatively associated with depression, this impact was no longer significant when multiple factors were examined. Rather, increased family resources and social support were related to fewer depressive symptoms. Furthermore, social support and family resources both demonstrated mediating roles between the relation of acculturation and depression. Family resources also mediated the relation between enculturation and depression. Conclusions: Findings highlight the importance of assessing access to resources and interpersonal connections when working with Latina mothers experiencing depression.

Intimate partner violence (IPV) is a public health concern found across genders, socioeconomic strata, cultures, and ethnicities. While IPV is traditionally examined from either the victim or initiator role, it is also important to consider relationships in which both partners experience and demonstrate violence. The current study examined the relation between IPV chronicity and depression among 403 female caregivers with young children. Specifically, the current study examined the association between bidirectional IPV and depression. Furthermore, the impact of social support on depression levels among those caregivers was assessed. Results suggest that of those couples who experienced violence, bidirectional IPV was reported significantly more frequently than unidirectional IPV only. No significant differences in depression were found between those reporting bidirectional versus unidirectional IPV. Among those involved in bidirectional IPV, having greater social support was associated with significantly lower depression levels. Findings suggest that both initiation and experiences of IPV should be assessed among caregivers of vulnerable children. The potential impact of social support was also identified in this study. Clinicians may consider assessing family violence broadly, including bidirectional IPV, particularly among parents of young children with other adverse life conditions. Development and sustainment of healthy relationships through social support may facilitate adjustment for the caregivers.