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?

How HARC is Developing the Contextual Factors Taxonomy

As a starting place for conversations about context in home visiting, HARC is developing a contextual factors . The purpose of the taxonomy is to help research partners be more intentional in their consideration and selection of contextual variables to include in research studies. Creating the taxonomy will also help us begin to understand where there are gaps in knowledge regarding the context in home visiting and co-create research studies that will begin to address those gaps. To do this we have:

• started with a recent list of context factors identified by Brownson et al. (2022)[1]
• expanded the list through a high-level literature scan
• consulted with home visiting parent leaders to better understand how context influenced their experiences in home visiting
• Future work:
  • engage home visiting partners, such as parent leaders, home visitors, model representatives, and researchers to understand contextual factors and their effects on home visiting experiences and outcomes
  • continue revising the context factor list based on learnings from partner engagement

[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