Evaluating Fidelity in Home-Visiting Programs a Qualitative Analysis of 1058 Home Visit Case Notes from 105 Families

Abstract

ObjectiveImplementation fidelity is a key issue in home-visiting programs as it determines a program’s effectiveness in accomplishing its original goals. This paper seeks to evaluate fidelity in a 27-month program addressing maternal and child health which took place in France between 2006 and 2011.MethodTo evaluate implementation fidelity, home visit case notes were analyzed using thematic qualitative and computer-assisted linguistic analyses.ResultsDuring the prenatal period, home visitors focused on the social components of the program. Visitors discussed the physical changes in pregnancy, and psychological and social environment issues. Discussing immigration, unstable employment and financial related issues, family relationships and dynamics and maternity services, while not expected, were found in case notes. Conversely, health during pregnancy, early child development and postpartum mood changes were not identified as topics within the prenatal case notes. During the postnatal period, most components of the intervention were addressed: home visitors observed the mother’s adaptation to the baby; routine themes such as psychological needs and medical-social networks were evaluated; information on the importance of social support and on adapting the home environment was given; home visitors counseled on parental authority, and addressed mothers’ self-esteem issues; finally, they helped to find child care, when necessary. Some themes were not addressed or partially addressed: health education, child development, home environment, mother’s education plans and personal routine, partner support and play with the child. Other themes were not expected, but found in the case notes: social issues, mother-family relationship, relation with services, couple issues, quality of maternal behavior and child’s language development.ConclusionsIn this program, home visitors experienced difficulties addressing some of the objectives because they gave precedence to the families“ urgent needs. This research stresses the importance of training home visitors to adapt the intervention to the social, psychological and health needs of families.

Supporting families in challenging contexts: the CAPEDP project

“…However, health visitors carrying out home visits can be unsettled by the perceived gap between the theoretical content relating to intervention and the social situation of the families (19). In the present study, although a recently published analysis of home visit reports showed that the essential elements planned for the intervention were being delivered to the families in question, these reports also regularly underlined the distance between the attachmentfocused CAPEDP intervention and the pressing social, health and psychological needs of the families participating in the study (20). As Darius Tandon et al (19) and Saïas et al (20) have pointed out, home visitors trained to be health care providers can be unsettled by families' social and economic difficulties, questioning the idea of having a homogeneous team of home visitors in terms of their professional training.…”

Utilizing broad‐based partnerships to design a precision approach to implementing evidence‐based home visiting

“…This type of home‐visitor tailoring has been found in other home visiting programs besides Family Spirit (Donelan‐McCall, Eckenrode, & Olds, ) but has not been systematically studied. However, ad hoc tailoring of the standard model has also been found to decrease fidelity (Saias et al, ). There is a need for home visiting models to provide evidence‐informed flexibility to help guide home visitors in knowing when and how to adapt the intervention and ensure that all families are receiving what we know works (Rotheram‐Fuller et al, ; Saias et al, ).…”

Estratégias de avaliação da visita domiciliar: uma revisão de escopo

“…Saıa T, Lerner E, Greacen T, Simon-Vernier E, Emer A, Pintaux E, Guedeney A, Dugravier R, Tereno S, Falissard B, Tubach F (2012) (23) To assess home visit fidelity through the notebooks of visits.…”