Context

What is Context in Home Visiting? 

Context is the social ecosystem in which home visiting participants and programs exist. Contextual factors include characteristics arising from systems, communities, organizations, families, and individuals that may influence families’ experiences with home visiting, such as their interactions with their home visitor and how a program meets their needs. Context influences home visiting access, implementation quality, intervention effectiveness, and outcomes in a myriad of ways.

Why is Context Important in Designing and Studying Home Visiting Interventions?

Context is a key element of understanding what works for different people in different situations.​ The literature acknowledges that context may impact both service delivery and outcomes, but there is little known about the specific elements of context and the nature of their relationship to the home visiting intervention and the (MoAs), selected behaviors, and overall outcomes.

The Precision Paradigm shows how context plays a role in the casual pathway from intervention to outcomes in three important ways:

• Context moderates the impact of the home visiting interventions on intended outcomes, by influencing how well services affect MoAs. For example, an intervention designed to promote a specific behavior through building knowledge using a smartphone app may not result in increased knowledge if the participant does not feel comfortable using smartphones or does not have reliable access to a smartphone. A researcher might ask, how does participant technological literacy and access to technology moderate the impact of educational efforts?
• Context moderates the impact of the home visiting interventions on intended outcomes, by influencing how well MoAs lead to selected behaviors. For example, a home visiting program that aims to prevent child injury might provide safety measures like stair gates and outlet covers. Providing resources to alter the home environment offers an opportunity for the caregiver to take precautions to improve home safety for the child, however landlord restrictions might prevent the caregiver from properly installing safety measures. A researcher might ask, how do housing policies moderate the impact of efforts to modify the home environment?
• Context influences home visiting usage. For example, a participant who feels that their home visitor has a strong understanding or appreciation of their cultural values around parenting may feel more connected with the home visitor and more satisfied with services, overall. A researcher might ask, how does participant experience of discrimination influence attentiveness to and acceptance of information on community services?

Advancing Precision Home Visiting Research by Exploring Context

Understanding context—the circumstances or conditions in which home visiting occurs—is central to HARC’s Precision Paradigm. To deepen our understanding, HARC conducted a small qualitative study focused on how contextual factors influence the work of home visitors. This effort represents an important step toward building evidence that explains what works, for whom, and under what conditions.

Our approach in this study included:

• Centering practitioner voice: We held five virtual focus groups with home visitors and supervisors from different states and models to capture real-world experiences.
• Using a socioecological lens: Data were organized across five levels of context—individual, interpersonal, organizational, community, and structures/systems—to reflect the complexity of influences on home visiting.
• Exploring both challenges and enabling factors: We examined how contextual elements can either support or hinder engagement, service delivery, and outcomes.
• Applying iterative thematic analysis: Findings were coded deductively and inductively to identify patterns and themes that inform future research and practice.

This work lays the foundation for more nuanced studies that incorporate contextual factors into research design and interpretation, ultimately advancing precision home visiting.

Next Steps

Building on these findings, HARC will:

• Develop a contextual factors taxonomy to help research teams intentionally select variables for study and identify gaps where new research is needed.
• Examine the literature to understand how context is currently considered and measured in home visiting research, including identifying common approaches and gaps.
• Engage partners—including parent leaders, home visitors, model representatives, and researchers—to refine the taxonomy and co-create studies that address priority contextual factors.

[1] Brownson, R.C., Shelton, R.C., Geng, E.H., & Glasgow, R.E. (2022). Revisiting concepts of evidence in implementation science. Implementation Science, 17(26). https://doi.org/10.1186/s13012-022-01201-y