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Background: Post-partum women are at greater risk for symptoms associated with depression and anxiety. Mothers residing in rural areas have access to fewer mental health supports. With little access to social work services, nurse home visitation programs may fill the resource gap for vulnerable families living in rural areas. Currently, little research exists on the feasibility of a nurse home visitation program as a provider of services for post-partum mothers in rural areas. This study endeavors to explore the feasibility of service area expansion of a nurse home visitation program with an adapted problem-solving intervention specific to post-partum women.
Methods: This study is part of a larger study aimed at decreasing symptoms of stress and depression among post-partum mothers engaged in a nurse home visitation program by providing an adapted problem-solving intervention. The present study consists of a parallel needs assessment and feasibility study in the largest three rural service areas of the twenty served by the partnering nurse home visitation program. The purpose of this analysis was twofold. First, to examine the nurse home visitation programs’ current service linkage and referral practices for post-partum mothers with depression. Second, to explore the internal (organization and client level) and external (community level) factors that may impact the adaptation and delivery of the proposed intervention in rural areas.
The sample consists of all case records from the three largest rural areas served by the nurse home visitation program from 2010-2011(n=433). Both the narrative and thematic analysis of the transcribed nurse interviews used Grounded theory to determine themes and subthemes. Interviews and narrative transcriptions were reviewed and confirmed by four research team members for inter-rater reliability. All analysis was conducted in Atlas TI.
Results: Three themes emerged from the narrative analysis. The first significant theme indicated that post-partum mothers served by the home visitation program experienced high rates of mental illness including anxiety disorders, bipolar disorder, and depressive disorders. The presence of mental health needs was identified by the service providers as affecting the family home environment. A second theme involved mothers’ stress levels, which were reported as high in all three rural counties. Specifically financial stress, transportation issues, and having other children in the home emerged as subthemes contributing to mothers’ stress burden. Adaptations of service delivery specific to rural areas comprised the third theme and included issues of transportation, scheduling and conduction of home visits, and follow through on referrals.
Implications: This study illuminates clear practice and research implications for future program implementation and evaluation of home visitation programs in rural communities. Furthermore, nurse home visitation programs show promise as a provider of mental health support to vulnerable mothers in resource-limited communities. Ultimately, social workers can play a vital role in developing, implementing, and evaluating home visitation programs in rural settings, while providing recommendations for multidisciplinary and best-practice approaches.