Barriers, Facilitators, and Cultural Elements in Rural Home Visiting Programs: Experiences of Professionals during the COVID-19 Pandemic

Background and Purpose: Home visiting services have recently transitioned to virtual modalities to maintain quality care for families in rural settings. Despite the feasibility and increased engagement of virtual home visits, research is scarce on rural home visiting programs' barriers, facilitators, and cultural elements. This study aims to address these gaps by examining home-visiting professionals' experiences serving rural communities and exploring the impact of virtual services on rural home visiting programs during the COVID-19 pandemic.

Methods: A secondary qualitative data analysis was conducted using data from the Office of Early Childhood Home Visiting Investment Taskforce project evaluation. The study focused on the experiences of home-visiting professionals serving rural communities in Colorado during COVID-19. An interpretative phenomenological analysis (IPA) was employed to explore participants' lived experiences. The final sample consisted of 22 home-visiting professionals recruited through convenience and snowballing sampling. Data were collected through audio-recorded semi-structured interviews via telephone or Zoom in May and June 2022.

Results: Four themes were identified: experiences of culturally diverse rural families during the transition to virtual home visiting programs, drawbacks of virtual home visiting programs, ease for the provider, and how COVID-19 changed the landscape of home visiting. Findings suggest that virtual home visiting programs offer many benefits, but they may not fully replace the personal connections and rapport built through in-person visits. Challenges include limited access to technology infrastructure and the need for culturally sensitive and competent virtual home visiting programs that consider different cultural practices, customs, and languages.

Conclusions and Implications: Home visiting programs should incorporate technology-based approaches to improve access to care for rural families and develop culturally responsive and anti-racist programs to ensure equitable and effective services. Further research is needed to explore the effectiveness and feasibility of virtual home visiting services for diverse rural communities and identify best practices for developing culturally responsive and anti-racist programs. Such research can inform evidence-based policies and practices promoting positive outcomes for rural families and reducing health disparities, while considering the unique challenges and opportunities presented by the COVID-19 pandemic.