Mothers' Perspectives on Participation and Disengagement from Doula Home Visiting Services

Background/Purpose: Home visitation for low-income mothers can have positive impacts on maternal and child health and development, and has received significant federal support through the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV). However, sustained participation is an important ingredient in program success and early dropout is not uncommon. Understanding what mothers value most about home visits and why they stop receiving services can help service providers effectively modify their programs to encourage parent engagement. This longitudinal study draws on qualitative data from mother interviews to address questions of why mothers engage and disengage from doula-home-visiting services.

Method: 312 young, low income mothers participated in a RCT of doula-home-visiting services, of which 156 were assigned to receive the intervention. Intervention mothers were offered weekly home visits from a doula and home visitor from mid-pregnancy through several years postpartum. Mothers were interviewed in their homes at various times about parenting, health, relationships, and the intervention. At 37 weeks of pregnancy and 3 weeks postpartum, mothers were asked open-ended questions about how the doula was most helpful during pregnancy, labor and early postpartum. At 13 months, mothers reported on how the home visitor had been most helpful. At 13 and 30 months, mothers who were no longer receiving services reported on why home visits stopped. Coding schemes were developed based on the literature and mother responses. Each item was coded by a 2-person team trained by the first author. The coders rated responses individually and then met to agree upon final codes.

Results: Of the 128 mothers with follow-up data, 53% (n=68) and 18% (n=23) were still receiving home visits at 13 and 30 months respectively. The primary ways mothers felt the doula was most helpful included sharing information and advice during pregnancy, providing physical and emotional support during labor, and giving information, support, especially around breastfeeding, and supplies after birth. Mothers reported that home visitors were most helpful by teaching about infant development, giving emotional support, and providing supplies. Among mothers who stopped receiving visits by 13 months, the main reasons included being too busy, doula/home visitor not being available or scheduling conflicts, no longer wanting services, and moving. Among mothers who stopped visits between 13-30 months postpartum, the majority reported that they became too busy or moved.

Implications: The purpose of the doula-home-visiting program is to provide mothers with support and information around pregnancy, childbirth, breastfeeding, and infant care and development, which mothers endorse as aspects of the program they found most helpful. Although provision of free supplies, such as diapers and bus cards, is not a central part of the program, it is valued by mothers and may be an additional way to keep families engaged. Conflicting schedules between mother and service provider suggests that as mothers return to work and/or school, home visits may need to be offered outside of typical hours. Finally, since programs have defined service boundaries, more efforts could be made to link mothers who move to similar programs in their new neighborhoods.