Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and...

Area of Science:

• Maternal and Child Health
• Public Health Nursing
• Health Services Research

Background:

• Home visiting programs are crucial for supporting low-income, first-time parents.
• Understanding the distinct roles of nurses and paraprofessionals in program delivery is essential for optimizing outcomes.
• Variations in implementation may influence program effectiveness and participant engagement.

Purpose of the Study:

• To compare the implementation of a home visiting program by nurses versus paraprofessionals.
• To identify differences in visit characteristics, content, and participant outcomes between nurse- and paraprofessional-led services.
• To analyze factors such as visit frequency, duration, topic focus, dropout rates, and relationship quality.

Main Methods:

• Randomized controlled trial comparing nurse-visited (n=236) and paraprofessional-visited (n=244) groups.
• Data collected on number/length of visits, topics covered, dropout numbers, and relationship with home visitor.
• Statistical analysis to compare outcomes between the two conditions.

Main Results:

• Nurses completed more visits (28 vs 23) and emphasized physical health and parenting.
• Paraprofessionals conducted longer visits, focusing more on environmental health and safety.
• Nurse-led services had significantly lower dropout rates (38% vs 48%) and less staff turnover.

Conclusions:

• Nurses and paraprofessionals implement home visiting programs differently, even within the same model.
• Differences in focus (health vs. safety) and visit frequency may impact program engagement.
• Lower dropout rates in nurse-led programs suggest potential benefits for continuity of care.