Journal Article

Engaging Community in Prioritizing Outcomes to Improve Family Health in Evidence-Based Nurse Home Visiting: Using a Modified e-Delphi Method

Allison, Mandy, Marshall, Jennifer, Williams, Venice Ng, Richey, Mirine

2024

Overview

BackgroundEvidence-based home visiting programs are designed to improve maternal child health. Nurse-Family Partnership (NFP) is a model evidence-based home visiting program, shown to improve pregnancy outcomes, child development, and economic self-sufficiency for first-time mothers and their families experiencing social and economic adversities, enrolling them early in pregnancy. Recently, NFP has expanded its services to multiparous women (previous live births) and enrolling women past 28 weeks gestation (late registrants) in selected agencies in Florida since 2021.ObjectiveTo study the process and impacts of expanding NFP to expanded populations (multiparous and/or late registrants), we convened a diverse Advisory Committee to guide the NFP expansion evaluation in Florida.MethodsThis study employed a modified e-Delphi method with three rounds of data collection, to engage diverse partners to identify process and impact outcomes for the NFP expansion evaluation.ResultsChild maltreatment was identified as the highest priority outcome. Process outcomes included program reach, client enrollment, and client engagement, while impact outcomes included maternal physical health, maternal mental health and substance use, birth outcomes, and breastfeeding practices. The Advisory Committee further identified potential data sources to measure these outcomes.Conclusions for PracticeIdentifying and selecting key process and impact outcomes using a community-engaged process is necessary to ensure equal buy-in from all partners and to inform rigorous program evaluation. This study showed that using methods such as e-Delphi is feasible and effective for achieving thoughtful and rigorous decision-making, even in times of uncertainty like the COVID-19 pandemic.SignificanceWhat is Already Known on this Subject? Home visiting programs range widely in terms of goals, scope, intended population, and evidence base, but are increasingly recognized as a unique and impactful resource for improving maternal child health. The expansion of these programs to new intended populations must be evaluated to ensure that the original program as designed remains effective.What this Study adds? We highlight a systematic process used to identify and select key process and impact outcomes, through a community-engaged process to inform rigorous program evaluation in the context of perinatal and early childhood home visiting program. We demonstrated that effective transdisciplinary engagement, collaboration, and decision-making is feasible in a remote environment.

• Publisher: Springer Nature B.V
• Subject: Breast feeding / Childrens health / Data collection / Decision making / Delphi method / Economics / Health visiting / Mental health / Pandemics / Pregnancy / Substance use