Reference Catalog

A Comprehensive Evaluation of a Home Visitation Program Model’s Prenatal Physical Activity Curriculum Modules Delivered Primarily to Low-Income Women

Angela M. Dyer

• Other Models

Background. Many low-income pregnant women receive prenatal physical activity (PA)
curricula modules through home visitation programs. However, there is a lack of scientific
evidence on the structural capacity, processes, and outcomes relating to these modules. Aims.
The objective of this dissertation project was to examine the aforementioned in a single home
visitation program model - the Maternal Infant Health Outreach Worker (MIHOW) program.
More precisely, the aims of this study were to: (Aim 1) examine home visitors’ (i.e., Outreach
Workers [OWs]) competencies in implementing the MIHOW program’s prenatal PA curriculum
modules (i.e., structural capacity), (Aim 2) investigate the fidelity with which the MIHOW
program’s prenatal PA curriculum modules were delivered to home visitation clients (i.e.,
processes), and (Aim 3) evaluate the impact of the MIHOW program’s curriculum on home
visitation clients’ prenatal moderate-intensity physical activity (MPA) compared to a propensity
score matched comparison group (i.e., outcomes). Methods. (Aim 1) A qualitative research
design was used. Data from one interview and three focus groups conducted with OWs and five
interviews conducted with their Site Leaders (i.e., supervisors) were used for analysis. (Aim 2) A
mixed-methods research design was used. Data sources were the interviews and focus groups
conducted in Aim 1 and the checklists of curriculum modules completed with 109 clients. These
data sources were analyzed separately and then merged. (Aim 3) A non-randomized quasi-experimental research design was utilized to evaluate how the MIHOW program’s pregnant
clients’ (n = 98) absolute MPA metabolic equivalent of task (MET) minutes per week changed
relative to a propensity score matched comparison group of pregnant women (n = 56). Physical
activity measurements were taken at trimesters one, two and/or three. Generalized linear mixed
modeling with a zero inflated negative binomial distribution was used as the statistical analysis
strategy. Results. Key findings are shown by each aim. (Aim 1) OWs’ depth of knowledge on
prenatal PA information and the modules varied; over half the OWs discussed implementing PA,
rapport building, communication, adaptability, and/or problem-solving skills; over half the OWs felt comfortable delivering the modules. (Aim 2) Eight OWs discussed delivering the prenatal PA curriculum modules at multiple, most, or all of the home visits whereas the checklist data revealed that only 19.3% of clients received two or more “prenatal PA” and/or “other” curriculum modules. (Aim 3) The expected log absolute MPA MET minutes per week decreased 1.27 less for the comparison group than for the intervention group by trimester 3 [χ2(1) = 4.77, p= .0289]. Conclusion. Taken together, these findings suggest that home visitors’ competencies relating to the prenatal PA curriculum modules and home visitors’ implementation of the prenatal PA curriculum modules have the potential to influence the recipients of these services. Thus, attention needs to be given to these factors when evaluating the effectiveness of home visitation program models’ prenatal PA curricula modules. Insight from this study can be used to enhance how home visitation program models’ prenatal PA curricula modules are implemented and evaluated. (author abstract)

Finished

• Participant, Family, and Program Outcomes
• Program Quality, Continuous Quality Improvement, and Fidelity