Visit Attendance Patterns in Nurse-Family Partnership Community Sites

Abstract

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.

Principles of Precision Prevention Science for Improving Recruitment and Retention of Participants

“…Underlying prevention programs is the belief that the children, youth, and families in the programs need to receive enough dosage of the content or services in order to achieve the outcomes desired (National Research Council and Institute of Medicine 2009;Holland et al 2017). Challenges with low enrollment, retention, and engagement are pervasive through different kinds of prevention programs, particularly when brought to scale (e.g., home visiting, teen pregnancy prevention, youth substance abuse, relationship education programs, parenting programs) (Holland et al 2017;Council 2009).…”

“…Challenges with low enrollment, retention, and engagement are pervasive through different kinds of prevention programs, particularly when brought to scale (e.g., home visiting, teen pregnancy prevention, youth substance abuse, relationship education programs, parenting programs) (Holland et al 2017;Council 2009). Understanding how and why engagement patterns vary may inform efforts to better recruit and engage families.…”

“…Does engagement increase over time if families can see how the program is working in their lives (Holtrop et al 2014)? Does engagement decline if families have a close relationship with the provider and there is provider turnover (Holland et al 2017)? Understanding the reasons for participant engagement across prevention programs can lead to the development of improved program design and targeted enhancements to programs to address the issue.…”

“…Precision medicine andpublic healthresearchare careful todefine subpopulations in more nuanced ways than in the past, segmenting into smaller groups who vary by specific factors such as susceptibility, intersection of risk, or response to specific treatments (Vaithinathan and Asokan 2017). Some prevention science research has begun to examine a broader range of systems level factors for subpopulations that affect engagement, including characteristics of the program delivery or organizational capacity (Holland et al 2017).…”

“…From this, relationships can be formed from listening to what participants have to say, connecting in an authentic way, following through, respectfully communicating, and being adaptable when necessary (OAH 2016). In programs that rely on a close relationship between provider and participant, staff turnover has been regularly shown to increase participant drop out (Holland et al 2017;Latimore et al 2017). Duggan et al (2009) find that the alignment between a provider and parents' attachment type can influence the formation of a close relationship.…”