Evaluating Fidelity in Home-Visiting Programs a Qualitative Analysis of 1058 Home Visit Case Notes from 105 Families
Evaluating Fidelity in Home-Visiting Programs a Qualitative Analysis of 1058 Home Visit Case Notes from 105 Families
复制标题
DOI：
10.1371/journal.pone.0036915
复制
发表时间：
2012-05-18
期刊：
影响因子：
3.7
通讯作者：
Revah-Levy, Anne
中科院分区：
文献类型：
--
作者：
Saias, Thomas;Lerner, Emilie;Revah-Levy, Anne
目的：执行忠实度是家访计划中的一个关键问题，因为它决定了一个计划在实现其最初目标方面的有效性。本文旨在评估2006年至2011年在法国实施的一项为期27个月的母婴健康计划的忠诚度。方法：为了评估实施忠诚度，采用主题定性和计算机辅助语言分析对家访病例记录进行分析。参观者讨论了怀孕期间的身体变化，以及心理和社会环境问题。讨论移民，不稳定的就业和财务相关问题，家庭关系和动态和产妇服务，而不是预期的，发现在个案说明。相反，怀孕期间的健康，早期儿童发育和产后情绪变化没有被确定为产前病例说明中的主题。在产后期间，干预措施的大部分内容都得到了处理：家访员观察母亲对婴儿的适应情况;评估心理需求和医疗社会网络等常规主题;提供关于社会支持的重要性和适应家庭环境的信息;家访员就父母权威提供咨询，并解决母亲的自尊问题;最后，在必要时，他们还帮助寻找托儿服务。有些主题没有得到处理或只得到部分处理：健康教育、儿童发展、家庭环境、母亲的教育计划和个人日常生活、伙伴支持和与儿童玩耍。其他主题是没有预料到的，但在个案笔记中发现：社会问题，母亲与家庭的关系，与服务的关系，夫妇问题，母亲的行为质量和儿童的语言发展。结论：在这个项目中，家庭访问者遇到了困难，解决一些目标，因为他们优先考虑家庭的迫切需要。这项研究强调了培训家访者的重要性，以使干预措施适应家庭的社会、心理和健康需求。
Objective: Implementation fidelity is a key issue in home-visiting programs as it determines a program's effectiveness in accomplishing its original goals. This paper seeks to evaluate fidelity in a 27-month program addressing maternal and child health which took place in France between 2006 and 2011.Method: To evaluate implementation fidelity, home visit case notes were analyzed using thematic qualitative and computer-assisted linguistic analyses.Results: During the prenatal period, home visitors focused on the social components of the program. Visitors discussed the physical changes in pregnancy, and psychological and social environment issues. Discussing immigration, unstable employment and financial related issues, family relationships and dynamics and maternity services, while not expected, were found in case notes. Conversely, health during pregnancy, early child development and postpartum mood changes were not identified as topics within the prenatal case notes. During the postnatal period, most components of the intervention were addressed: home visitors observed the mother's adaptation to the baby; routine themes such as psychological needs and medical-social networks were evaluated; information on the importance of social support and on adapting the home environment was given; home visitors counseled on parental authority, and addressed mothers' self-esteem issues; finally, they helped to find child care, when necessary. Some themes were not addressed or partially addressed: health education, child development, home environment, mother's education plans and personal routine, partner support and play with the child. Other themes were not expected, but found in the case notes: social issues, mother-family relationship, relation with services, couple issues, quality of maternal behavior and child's language development.Conclusions: In this program, home visitors experienced difficulties addressing some of the objectives because they gave precedence to the families" urgent needs. This research stresses the importance of training home visitors to adapt the intervention to the social, psychological and health needs of families.