Association Between Engagement In A Community-Based Home Visitation Program And Birth Spacing Between First And Second Children

Hing Ting Connie Li

This thesis is restricted to Yale network users only. It will be made publicly available on 08/28/2020


OBJECTIVE: To identify patterns in engagement in the Connecticut-based home visitation program, Nurturing Families Network (NFN), and to determine whether associations exist between various engagement patterns and birth-to-pregnancy intervals between first and second children.

METHODS: Repeated measures latent class analysis was employed to identify patterns in program engagement among 5,248 families enrolled in NFN with available home visit information. Maternal socio-demographic characteristics were examined to identify potential predictors of engagement patterns. Propensity score matching was used to identify firstborn children of families in Connecticut with comparable eligibility and tendency to enroll in NFN. Survival analysis was conducted to assess the association between engagement patterns and birth-to-pregnancy intervals for 19,489 firstborn children both enrolled and not enrolled in NFN.

RESULTS: Five engagement patterns were identified. A large proportion of NFN participants is comprised of “High, late drop attenders” (22%), who maintain high levels of engagement for at least 9 months before gradually dropping out of the program, and “High, early drop attenders” (21%), who have near perfect home visit attendance in the first couple of months but begin to drop out at around 3 to 6 months. Engagement patterns are associated with interpregnancy intervals, but are not significantly associated with narrow interpregnancy intervals of <18 months. Engagement patterns are significantly associated with characteristics of the>mother, such as age, race, and socioeconomic status.

CONCLUSIONS: Distinct patterns exist in program engagement by participants enrolled in home visitation programs. Maternal socio-demographic characteristics can influence how and when participants engage in home visitation relative to first child’s birth. Engagement patterns are shown to be associated with interpregnancy intervals; in particular, “Not enrolled” and “Low attendance” families were observed to have increased risk of more narrow interpregnancy intervals. Further investigation of home visit attendance records is necessary to confirm findings in engagement patterns.