Engagement in Home Visiting Services During the Transition From Pregnancy to Postpartum: A Prospective Mixed Methods Pilot Study




Amy Damashek, Catherine Kothari, Ariel Berman, Summer Chahin, John R. Lutzker, Kate Guastaferro, Daniel J. Whitaker, Jenelle Shanley, and Shannon Self-Brown

Brief Type

Journal Publication


  • Nurse-Family Partnership (NFP)
  • Other Models


Objectives: This pilot study used a prospective mixed methods approach to examine predictors of retention in services during the transition from pregnancy to postpartum. Home visiting programs that serve pregnant women are an important means of improving child and maternal well-being. Providing services to women during the transition from pregnancy to postpartum
is particularly important, because children under the age of 1 are at high risk for mortality. Morever, mothers face amplified levels of stress during the postpartum period. Unfortunately, home visiting programs in the United States that support pregnant and postpartum women suffer from high rates of attrition. General research on home visiting engagement suggests
that the client-provider relationship is an important factor in predicting client engagement in services; however, few studies have examined factors related to maternal engagement during the transition from pregnancy to postpartum. Methods: Measures administered during pregnancy for 39 pregnant women were used to predict attrition up to 15 months postpartum. Semi-structured interviews were conducted at 3 months postpartum with 33 of the original 39 women to qualitatively assess factors related to engagement in services during the transition from pregnancy to postpartum. Results: Both quantitative and qualitative analyses indicated that clients’ perceptions of the client-provider relationship was a critical factor in maintaining mothers’ engagement in services. Both types of analyses indicated that perceived provider reliability was related to mothers’ engagement in services. Quantitative analyses also found that perceived provider cultural competence predicted engagement in services. Other findings from qualitative analyses indicated that mothers’ perception of the home visitor as trustworthy/supportive, personable/having good communication skills, knowledgeable, and collaborative/flexible, were factors that mothers noted when discussing engagement in services. Conclusions: These results advance the literature on engagement in home visiting services by overcoming some of the limitations of previous literature and may have implications for home visitor training. (author abstract)

Data Collection Methods

  • Interviews
  • Program administrative record reviews
  • Standardized assessment tools
  • Surveys or questionnaires



For More Information

Damashek, A., Kothari, C., Berman, A., Chahin, S., Lutzker, J. R., Guastaferro, K., Whitaker, D. J., Shanley, J., & Self-Brown, S. (2020). Engagement in home visiting services during the transition from pregnancy to postpartum: A prospective mixed methods pilot study. Journal of Child & Family Studies, 29(1), 11–28. https://doi.org/10.1007/s10826-019-01641-z
Author Contact Information:
Amy Damashek


  • Participant Recruitment, Retention, Engagement, and Dosage