Adapting Current Strategies to Implement Evidence-Based Prevention Programs for Paraprofessional Home Visiting

Abstract

This paper describes a strategy for using evidence-based interventions (EBI) that does not require replication and fidelity. Eight parents, identified as positive role models, conducted home visits for 101 low-income Latina and Korean pregnant women. The home visitors, called mentor mothers (MM), were trained in 10 of the practice elements common to 80% of child-focused EBI and how to apply these skills to support mothers in obesity prevention, to increase the duration of breastfeeding, and to reduce depression. MM reported the content and skills utilized on each home visit on mobile phones. Each MM made an average of 153 home visits (SD = 173.3), with 28 of these visits being phone contacts. Body mass index (BMI) at 6 months was significantly associated with the frequency of MM focused on coping with depression (r = .24), but was not related to practice elements used by MM. The duration of breastfeeding was significantly related to the frequency with which MM focused on the topic of breastfeeding (r = .28) and parenting (r = .3), and MM use of attending (r = .24) and relaxation (r = .27). Depression was significantly correlated with the frequency of addressing depression (r = .27), but not to practice elements. MM did use different strategies in the first 150 visits compared to their last 150 visits, reflecting data-informed supervision. Evidence synthesized from EBI was used as a novel training method, with real-time monitoring and data-informed supervision providing evidence of iterative quality improvements in MM behaviors over time, as well as a way for linking implementation processes to outcomes.

The home visit communication skills inventory: Piloting a tool to measure community health worker fidelity to training in rural South Africa

“…Adhering to a traditional, didactic training format has been shown to inhibit critical thinking skills and learning (Glenton et al, ). Supervision strategies must be sensitive and responsive to differences in the dosage, quality, and style of support given (Rotheram‐Fuller et al, ). As such, extra opportunities for training and support, as well as differential support, should ideally be accessible and built into program models.…”

Replicating Evidence-Based Practices with Flexibility for Perinatal Home Visiting by Paraprofessionals

“…Overall MM conducted 1431 home visits with an average of 14.9 contacts per mother in the home visiting condition with contacts lasting about 31 min each. The topics discussed, the practice elements used and the relationship between these process measures and outcomes have been reported previously (Rotheram-Fuller et al 2017 ).…”

Peer support for disadvantaged parents: a narrative review of strategies used in home visiting health interventions in high-income countries

“…Recruitment by disadvantaged socioeconomic groups were based on ethnicity [32][33][34][35][40][41][42][43] and age [32][33][34][35]42]. The ethnic minority groups in question were Hispanics [40,41,43], Koreans [40], Native Americans [42] and African Americans [32][33][34][35]. McLeish and Redshaw used HIV diagnosis rather than ethnicity as a basis for recruitment, but the large majority of their participants were immigrant women with a Sub-Saharan African background [44].…”

“…Other interventions determined eligibility primarily based on residence in a deprived area, but this could be difficult to separate from criteria of personal adversity or minority group status. Rotheram-Fuller et al recruited women living in an area outside of Los Angeles, where practically all inhabitants were Hispanic or Korean and all had incomes below 200% of the federal poverty level [40]. Five interventions targeted women living in deprived areas in the U.K., without using any individual factors as criteria [45][46][47][48][49].…”

“…Both these studies used doulas as peer supporters both prenatally, during birth and postnatally, which no other of the breastfeeding studies did. Another study [40] measured the correlation between the time peer supporters spent on various strategies and topics of discussion with mothers and the duration of their breastfeeding, reporting a significant correlation to discussing breastfeeding (r = .28) and parenting (r = .30). Other significant correlations were between the use of relaxation (r = .27) and attending (r = .24) as strategies and breastfeeding duration.…”