Abstract
Objectives
Home visiting is a popular approach to improving the health and well-being of families with infants and young children in the United States; but, to date, no home visiting program has achieved population impact for families in rural communities. The current report includes evaluation results from the dissemination of a brief, universal postpartum home visiting program to four high-poverty rural counties.
Methods
The study utilized a quasi-experimental design. From Sept. 1, 2014–Dec. 31, 2015, families of all 994 resident births in four rural eastern North Carolina counties were assigned to receive Family Connects (FC; intervention group). A representative subsample of families participated in impact evaluation when the infants were 6 months old: 392 intervention group families and 126 families with infants born between Feb. 1, 2014–July 31, 2014 (natural comparison group). Data were analyzed preliminarily for reporting to funders in 2016 and, more comprehensively, using propensity score matching in 2020.
Results
Of FC-eligible families, 78% initiated participation; 83% of participating families completed the program (net completion = 65%). At age 6 months, intervention parents reported more community connections, more frequent use of community services, greater social support, and greater success with infants sleeping on their backs. Intervention infants had fewer total emergency department and urgent care visits. Intervention parents had more total emergency department and urgent care visits and (marginally) fewer overnights in the hospital.
Conclusions for practice
FC can be implemented successfully in high-poverty rural communities with broad reach and positive benefits for infants and families.
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Acknowledgements
The authors acknowledge the contributions of many staff members in implementing Family Connects and its evaluation. The authors thank Dr. Nissa Towe-Goodman and three anonymous reviewers for their helpful comments on previous versions of this manuscript. Funding for the evaluation was provided by The North Carolina Department of Health and Human Services, The Duke Endowment, and grant R01HD069981 from the Eunice Kennedy Shiver National Institute for Child Health and Human Development. The design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication are the responsibility of the authors with no influence by any funder. The views expressed are those of the authors and do not necessarily reflect the views of funders. The first author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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The authors acknowledge that they are disseminating the Family Connects program and report no other conflict of interest in the study reported here.
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The authors acknowledge they have no financial interest in the findings reported in this manuscript. They occasionally give lectures about the research for a modest stipend.
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Goodman, W.B., Dodge, K.A., Bai, Y. et al. Evaluation of a Family Connects Dissemination to Four High-Poverty Rural Counties. Matern Child Health J 26, 1067–1076 (2022). https://doi.org/10.1007/s10995-021-03297-y
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DOI: https://doi.org/10.1007/s10995-021-03297-y