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.