Research
Women's Reasons for Attrition from a Nurse Home Visiting Program

https://doi.org/10.1111/1552-6909.12263Get rights and content

ABSTRACT

Objective

To describe mothers’ reasons for leaving a home visiting program early.

Design

Qualitative descriptive study using semistructured interviews of mothers who dropped out of the Nurse‐Family Partnership (NFP) and two focus groups with nurses and nurse supervisors at an NFP site.

Setting

A New York State site of a NFP home visitation program for low‐income new mothers designed to improve the physical and emotional care of children.

Participants

Participants included 21 mothers, 8 nurses, and 3 nurse‐supervisors.

Methods

Semistructured interviews and focus groups were used to collect data, which were analyzed using content analysis.

Results

The program was not perceived to fit a mother's needs when she was overwhelmed with other responsibilities, the nurse did not meet her expectations, the content was not of interest, or the mother did not desire visits after the infant was born. Nurses and mothers described the need for mothers to have organizational and communication skills, such as keeping track of appointments, calling to reschedule, articulating needs, and asking for assistance. Disruptive external influences included nurse turnover and unstable living situations, including frequent moves and crowded housing. Each of these types of barriers had potential to interact with the others, creating complex combinations of challenges to retention.

Conclusion

NFP retention might be improved by reframing program relevance to individual mothers and increasing maternal organizational and communication skill development.

Section snippets

Methods

This qualitative descriptive study was conducted at an NFP site in a medium‐sized city in New York that served a primarily urban population, which consisted of non‐Hispanic African American (60%), non‐Hispanic White (30%), and Hispanic (10%) women. Data were collected in two phases: interviews of women who dropped out of the NFP and focus groups with NFP nursing staff and supervisors.

Sample Description

We attempted to contact 196 mothers and successfully interviewed 21 (11%). No working telephone number was available for 116 mothers (59%), the available telephone numbers were not answered for 46 mothers (23%), and messages were left for nine mothers. Of the 27 clients we reached, 78% agreed to participate. All participants were at least age 18  by the time of the interview. Mothers were interviewed 9 months to 4 years after leaving the program, and they had been in the program 3 to 30 months,

Discussion

This study provides insight into some reasons why mothers drop out of a home visiting program. If the mother does not see the program as matching her needs, and her organizational and/or communication skills are not well aligned with program expectations, she may not be motivated to overcome the challenges of staying in the program. Communication challenges may make it difficult for the mother to find relevance if she is unable to convey her needs to her nurse. Enhancing a mother's

Conclusion

Mothers, nurses, and nurse supervisors reported similar barriers to continuing engagement of mothers in this longitudinal program. Although external influences beyond the scope of NFP play a role, retention might be improved by implementing new strategies to address program relevance to individual mothers, helping mothers develop organizational and communication skills early in the program, and determining how to keep mothers engaged during or after crises. Other home visiting programs may

Acknowledgement

Supported by the University of Rochester (UR) Center for Community Health, UR School of Nursing, and an NRSA Institutional Research Training Grant (T32 PE12002).

Margaret L. Holland, PhD, MPH, is an associate research scientist in the Yale School of Nursing, West Haven, CT.

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  • Cited by (0)

    Margaret L. Holland, PhD, MPH, is an associate research scientist in the Yale School of Nursing, West Haven, CT.

    Julie J. Christensen, PhD, LMSW, is a senior health project coordinator at the University of Rochester, Rochester, NY.

    Laura P. Shone, MSW, DrPH, is an associate professor in the Department of Pediatrics, University of Rochester, Rochester, NY.

    Margaret H. Kearney, PhD, RN, FAAN, is a professor in the School of Nursing, University of Rochester, Rochester, NY.

    Harriet J. Kitzman, PhD, RN, FAAN, is a professor in the School of Nursing, University of Rochester, Rochester, NY.

    The authors report no conflict of interest or relevant financial relationships.

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