Effective sustained nurse home visiting: Who benefits, how and why?

Abstract

Background: Early childhood sustained nurse home visiting (SNHV) programs have shown positive impacts on maternal and child health and well-being. How interventions work is still a “black box”, and who benefits and why, is not well understood. Programs have shown benefits for psychologically vulnerable mothers, but how psychological vulnerability manifests in SNHV populations is poorly understood. The aim of this research was to investigate the contribution SNHV makes to achieving mothers’ perceived positive outcomes, particularly for mothers with psychological vulnerability. Research objectives: The research had four objectives: Improved understanding of 1) the meaning of psychological vulnerability and how this may impact on parenting and the effectiveness of SNHV programs; 2) what mothers believe they receive from SNHV; 3) what enables mothers to parent effectively in difficult circumstances; 4) how factors contributing to perceived positive outcomes work together and the contribution of SNHV. Methods: A complementary developmental four stage mixed methods design was utilised. Stages one to three used quantitative and qualitative data. Stage four qualitatively combined and developed findings from stages one to three. Participants were mothers who participated in the Maternal Early Childhood Sustained Home- Visiting trial. Results: Stage 1. Factor analysis of the Edinburgh Depression Scale (EPDS) revealed ‘distress’ and ‘anhedonia’ factors. Mothers with high levels of psychological vulnerability had lower levels of openness to help-seeking. Evidence that psychological vulnerability is a core persistent trait was not strong. Stage 2. Mothers perceived positive impacts on their emotional well-being, confidence and help-seeking behaviour, and the parenting of their program child and older and subsequent children. Most continued to apply program learnings after program completion. Stage 3. Most mothers described emotional reactions to stressors such as fear, anger and sadness. Mothers managed stress by using available services, personal characteristics, practical strategies, support, and enjoying parenting. Stage 4. Varying influences for psychological vulnerability and program participation included: perceived improvement in parenting knowledge and skills through advice, information and support; mindset benefits; service use; and use of proactive strategies. Conclusion: Mothers perceive SNHV to be valuable, and achieving outcomes, when programs respond to what they feel they need and want. This is particularly important for mothers with psychological vulnerability.