Evaluating the Impact of Home Visiting Interventions with High Risk Families: Methodological Issues

Sharon Tucker, DNSc, RN, Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, MN, USA, Richard Olsen, MD, Department of Pediatrics, Division of Development and Behavioral Pediatrics, Mayo Clinic, Rochester, MN, USA, and Gayle P. Olsen, RN, MS, C-PNP, College of Nursing and Health Sciences, Winona State University, Rochester, MN, USA.

Objectives: 1. Describe methodological challenges in evaluating of the effectiveness of home visiting program for high risk families 2. Discuss strategies to improve data collection.

Population, Sample, Setting, Years: As part of an innovative partnership between a baccalaureate nursing program, a county public health department and a large private multispecialty medical clinic, 56 nursing students visited 43 high risk families located in a midwestern county in the US over a two year period (2001-2003).

Intervention and Outcome Variables: Interventions with families included assessment, and screening, as well as education and support. Outcome measures included: screening for maternal depression, number and intensity of child behavior problems, child development quotient, community and social support, videotape of parent-child interaction, and family satisfaction,

Methods: Nursing students, under the supervision of faculty, visited one high risk family throughout their senior year. Standardized family assessments were planned for the beginning and end of each academic year.

Findings: Due to a variety of issues including language barriers, chaotic family lives, missed visits, and an inherent conflict between providing naturalistic care and conducting research, missing data were a major limitation. In addition, different families received different numbers of visits making interpretation difficult. Finally, since students collected some of the outcome data, bias may have been present.

Conclusions: Multiple challenges make evaluation of the effectiveness of early intervention programs difficult. Strategies to address specific barriers to effective data collection need to developed and implemented.

Implications: Based on problems in data collection, a variety of strategies have been implemented to improve completeness of data.