TY - JOUR
T1 - Changing the home visiting research paradigm
T2 - models’ perspectives on behavioral pathways and intervention techniques to promote good birth outcomes
AU - Duggan, Anne K.
AU - Bower, Kelly M.
AU - Spinosa, Ciara Z.
AU - O’Neill, Kay
AU - Daro, Deborah
AU - Harding, Kathryn
AU - Ingalls, Allison
AU - Kemner, Allison
AU - Marchesseault, Crista
AU - Thorland, William
N1 - Funding Information:
The authors wish to thank contributions of model leadership and staff who assisted in providing project data and/or feedback on drafts of the manuscript. They include: Arietta Slade, PhD and Lois Sadler, PhD, RN, FAAN, co-founders of Minding the Baby; Kit Patterson, Senior Director of Training and Technical Assistance, Healthy Families America at Prevent Child Abuse America; Elly Yost, RN, MSN, MBA/MHA, Director of Nursing Initiatives, Nurse-Family Partnership; and Melissa Heibel, MSN, RN, Implementation Specialist—Nurse Consultant, Nurse-Family Partnership. The authors also thank HARC Coordinating Center staff Danielle Gaskin, Paris Lowe, and R. Morgan Taylor for assisting with development of data collection instruments and processing of study data.
Funding Information:
This project was funded by a grant from the Pritzker Children’s Initiative (Grant 134163). It was carried out under the auspices of the Home Visiting Applied Research Collaborative (HARC), whose core operations are supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement UD5MC30792, Maternal, Infant and Early Childhood Home Visiting Research and Development Platform. The content and conclusions of this manuscript are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: The US is scaling up evidence-based home visiting to promote health equity in expectant families and families with young children. Persistently small average effects for full models argue for a new research paradigm to understand what interventions within models work best, for which families, in which contexts, why, and how. Historically, the complexity and proprietary nature of most evidence-based models have been barriers to such research. To address this, stakeholders are building the Precision Paradigm, a common framework and language to define and test interventions and their mediators and moderators. This observational study used portions of an early version of the Precision Paradigm to describe models’ intended behavioral pathways to good birth outcomes and their stance on home visitors’ use of specific intervention technique categories to promote families’ progress along intended pathways. Methods: Five evidence-based home visiting models participated. Model representatives independently completed three structured surveys focused on 41 potential behavioral pathways to good birth outcomes, and 23 behavior change technique categories. Survey data were used to describe and compare models’ intended behavioral pathways, explicit endorsement of behavior change technique categories, expectations for home visitors’ relative emphasis in using endorsed technique categories, and consistency in endorsing technique categories across intended pathways. Results: Models differed substantially in nearly all respects: their intended pathways to good birth outcomes (range 16–41); the number of technique categories they endorsed in any intended pathway (range 12–23); the mean number of technique categories they endorsed per intended pathway (range 1.5–20.0); and their consistency in endorsing technique categories across intended pathways (22%-100% consistency). Models were similar in rating nearly all behavior change technique categories as at least compatible with their model, even if not explicitly endorsed. Conclusions: Models successfully used components of the Precision Paradigm to define and differentiate their intended behavioral pathways and their expectations for home visitors’ use of specific technique categories to promote family progress on intended pathways. Use of the Precision Paradigm can accelerate innovative cross-model research to describe current models and to learn which interventions within home visiting work best for which families, in which contexts, why and how.
AB - Background: The US is scaling up evidence-based home visiting to promote health equity in expectant families and families with young children. Persistently small average effects for full models argue for a new research paradigm to understand what interventions within models work best, for which families, in which contexts, why, and how. Historically, the complexity and proprietary nature of most evidence-based models have been barriers to such research. To address this, stakeholders are building the Precision Paradigm, a common framework and language to define and test interventions and their mediators and moderators. This observational study used portions of an early version of the Precision Paradigm to describe models’ intended behavioral pathways to good birth outcomes and their stance on home visitors’ use of specific intervention technique categories to promote families’ progress along intended pathways. Methods: Five evidence-based home visiting models participated. Model representatives independently completed three structured surveys focused on 41 potential behavioral pathways to good birth outcomes, and 23 behavior change technique categories. Survey data were used to describe and compare models’ intended behavioral pathways, explicit endorsement of behavior change technique categories, expectations for home visitors’ relative emphasis in using endorsed technique categories, and consistency in endorsing technique categories across intended pathways. Results: Models differed substantially in nearly all respects: their intended pathways to good birth outcomes (range 16–41); the number of technique categories they endorsed in any intended pathway (range 12–23); the mean number of technique categories they endorsed per intended pathway (range 1.5–20.0); and their consistency in endorsing technique categories across intended pathways (22%-100% consistency). Models were similar in rating nearly all behavior change technique categories as at least compatible with their model, even if not explicitly endorsed. Conclusions: Models successfully used components of the Precision Paradigm to define and differentiate their intended behavioral pathways and their expectations for home visitors’ use of specific technique categories to promote family progress on intended pathways. Use of the Precision Paradigm can accelerate innovative cross-model research to describe current models and to learn which interventions within home visiting work best for which families, in which contexts, why and how.
KW - Birth outcomes
KW - Home visiting
KW - Intervention techniques
KW - Precision services
UR - http://www.scopus.com/inward/record.url?scp=85130371660&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85130371660&partnerID=8YFLogxK
U2 - 10.1186/s12889-022-13010-5
DO - 10.1186/s12889-022-13010-5
M3 - Article
C2 - 35597986
AN - SCOPUS:85130371660
SN - 1471-2458
VL - 22
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 1024
ER -