| Learning Objective #1: Describe the process of engagement experienced by mothers of at-risk children who participate in a blended home-visiting program | |||
| Learning Objective #2: Identify three nursing interventions that will facilitate access to and engagement with families who are hard to reach |
Problem: Home visiting by public health nurses (PHNs) and family visitors (FVs) is an effective intervention for enhancing parent and child development. Mothers of children at-risk for developmental delays tend to be the most difficult to access and engage and commonly drop out of home visiting programs prematurely.
Study Purpose: To develop a theory that describes the process by which mothers of children at-risk engage with PHNs and FVs in a blended home visiting program.
Methods: Grounded theory was used to systematically guide the collection, recording, organization and analysis of the data. A purposeful sample of 20 mothers receiving PHN and FV home visits as part of the Healthy Babies, Healthy Children program were recruited from a public health unit in Southern Ontario. Data were collected through client chart reviews and 29 in-depth interviews that explored participants’ experiences, beliefs and expectations related to engagement. Data were analyzed using open, selective and theoretical coding. Data collection and analysis continued until all categories were saturated.
Results: Mothers felt vulnerable and frequently powerless when they allowed the service providers into their home. Mothers with children at-risk engage with PHNs and FVs through a basic social process of limiting family vulnerability, which has three phases: (1) overcoming fear, (2) building trust, and (3) seeking mutuality. The personal characteristics, values, experiences and actions of the PHN, FV and mother influence the speed at which each phase is successfully negotiated and the ability to develop a connected relationship.
Implications: PHNs working with families at-risk need to identify client fears and perceptions related to home visiting and explain the role of the PHN/FV to all family members. Given the importance that mothers place on the development of an interpersonal relationship, it is important for home visitors to continually assess the quality of their relationships with clients.
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