Participant engagement in home visits: A missing piece in the puzzle of evidence based programs and implementation science?

摘要

Within the social services field, researchers, policy makers, and practitioners are paying increasing attention to the concept of `evidence based' home visiting program models. However, a singular focus on evidence based programs continues a tradition of limited and vague understandings of how programs are actually implemented. The field of implementation science offers a framework for expanding this focus to more fully understand how home visiting programs are implemented. A key dimension of implementation is participant responsiveness. The field of home visiting lacks a coherent and standard conceptualization of participant responsiveness. As one might expect, it also lacks standard measurement of participant responsiveness. While research is sparse on many components of participant responsiveness, the component of participant engagement may be an especially beneficial component to initially concentrate on. Participant engagement in home visiting, as conceptualized in this study, includes the amount and quality of participant's interest, involvement, and participation during home visits. It is only through participant engagement in home visits and sustained engagement across home visits that meaningful participant outcomes are likely to be obtained. Existing measures of participant engagement in home visits are limited to global measures of engagement rated by either external observers or home visitors, or self-reports by participants. As designed, these measures capture only general impressions of participant engagement and fail to capture time-sensitive, specific instances of participant engagement. This failure limits the ability to explore causal relationships between strategies on the part of home visitors and participant engagement. The proposed study is designed to address these limitations and answer the following research questions: 1) Do home visitors feel engagement in home visits impacts their work? 2) Do home visiting programs monitor participant engagement during home visits? 3) Do home visitors receive training on engaging participants? Do home visitors feel a need for additional training and/or preparation on participant engagement? 4) Are there notable differences between global measures of engagement and frequency counts of specific indicators of engagement and disengagement? 5) Do home visitor strategies relate to participant engagement? Likewise, do home visitor strategies relate to participant disengagement?