“I had to change my attitude”: narratives of most significant change explore the experience of universal home visits to pregnant women and their spouses in Bauchi State, Nigeria

Background Universal home visits to pregnant women and their spouses in Bauchi State, northern Nigeria, discussed local evidence about maternal and child health risks actionable by households. The expected results chain for improved health behaviours resulting from the visits was based on the CASCADA model, which includes Conscious knowledge, Attitudes, Subjective norms, intention to Change, Agency to change, Discussion of options, and Action to change. Previous quantitative analysis confirmed the impact of the visits on maternal and child outcomes. To explore the mechanisms of the quantitative improvements, we analysed participants’ narratives of changes in their lives they attributed to the visits. Methods Local researchers collected stories of change from 23 women and 21 men in households who had received home visits, from eight male and eight female home visitors, and from four government officers attached to the home visits program. We used a deductive thematic analysis based on the CASCADA results chain to analyze stories from women and men in households, and an inductive thematic approach to analyze stories from home visitors and government officials. Results The stories from the visited women and men illustrated all steps in the CASCADA results chain. Almost all stories described increases in knowledge. Stories also described marked changes in attitudes and positive deviations from harmful subjective norms. Most stories recounted a change in behaviour attributed to the home visits, and many went on to mention a beneficial outcome of the behaviour change. Men, as well as women, described significant changes. The home visitors’ stories described increases in knowledge, increased self-confidence and status in the community, and, among women, financial empowerment. Conclusions The narratives of change gave insights into likely mechanisms of impact of the home visits, at least in the Bauchi setting. The compatibility of our findings with the CASCADA results chain supports the use of this model in designing and analysing similar interventions in other settings. The indication that the home visits changed male engagement has broader relevance and contributes to the ongoing debate about how to increase male involvement in reproductive health.

Empowering Public Health Nurses and Community Home Visitors through Effective Communication Relationships

Home visiting programs for marginalized families have included both Public Health Nurses (PHNs) and Community Home Visitors (CHV). Support for families requires health care providers to implement effective communication and collaboration practices; however, few studies have examined how this is carried out. The purpose of this qualitative research study was to explore how an Enhanced Home Visiting (EHV) program in Nova Scotia Canada was organized, delivered through the experiences of PHNs and CHVs. Feminist post-structuralism informed by discourse analysis was used to understand how their experiences were socially and institutionally constructed. Individual semi-structured interviews were conducted with 6 PHNs and 8 CHVs and one focus group was held with 10 of the participants. A social discourse on mothering layered within a social discourse of working with a vulnerable population added a deeper understanding of how communication was constructed through the everyday practices of PHNs and CHVs. Findings may be used to inform reporting and communication practices between health care providers who work with marginalized families.

Feasibility and acceptability of integrating SMS into a postpartum depression preventive intervention delivered in home visitation programs (Preprint)

BACKGROUND The Mothers and Babies Course (MB) was recognized by the U.S. Preventive Services Task Force as an evidence-based prevention of postpartum depression (PPD) intervention that should be recommended to pregnant women at risk for PPD. OBJECTIVE This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention with the addition of 36 short message service (SMS) text messages that targeted three areas: reinforcement of skills, between session homework reminders, and responding to self-monitoring texts (MB-TXT). METHODS In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (M=25.6 weeks, SD=9.0) received the MB-TXT. Feasibility was defined by home visitors’ adherence to logging into the HealthySMS platform to enter session data and trigger text messages within seven days of the in-person session. Acceptability of MB-TXT was measured by participants’ usefulness and understanding ratings of the text messages and responses to the self-monitoring text messages. RESULTS On average, home visitors followed the study protocol and entered session-specific data between 5.50-61.17 days following MB 1-on-1 sessions and indicated that participants completed the between session homework almost half the time (M=5.36, SD=3.71). Participants responded to self-monitoring texts at a high level (89.3%) and rated the text message content as very useful and understandable. CONCLUSIONS This report contributes to a growing line of research focused on digital adaptations of MB. SMS is a low-cost, accessible digital tool that can be easily integrated into existing interventions, and implemented in community-based organizations and healthcare systems that serve women at risk for PPD. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT03420755

The Individualization of the Little Talks Intervention: Implications for Modular Treatment Designs

Modular treatment designs enable interventionists to adapt intervention content to individual clients, a process referred to as individualization. Little is known about individualization processes and its effects on outcomes in early childhood services. This exploratory study investigated individualization processes undertaken by Early Head Start home visitors as they provided Little Talks, a modularized book-sharing intervention for families. It also examined the effect of individualization on parent involvement in early learning activities. Two indicators of individualization were calculated in this study: (a) the proportion of change in the Little Talks’ lessons sequence and (b) the pace of delivery. Findings showed that most home visitors individualized Little Talks, with the most frequent change being the repetition of lessons. Exploratory regression analysis showed an inverse relationship between home visitors’ individualization behavior and parent involvement, highlighting the need to examine the quality of individualization. Implications for advancing the implementation and study of individualization processes in home visiting are discussed.