Usage

What is Usage in Home Visiting?

Usage includes reach and engagement.

Reach focuses on “coverage” of home visiting programs and whether families who might benefit from home visiting can enroll and participate if they choose to do so. Elements of reach include availability, accessibility, awareness, and eligibility.

Engagement focuses on families’ thoughts and feelings(internal states) and behaviors(external states) regarding their home visiting providers and the service provided.

Internal states of engagement include families’:

• Interest, motivation, and commitment to participate in home visiting
• Receptiveness to and readiness for change
• Perceptions of home visiting relevance and “goodness of fit” with what families want and need
• Perceptions of home visiting effectiveness for achieving meaningful goals
• Satisfaction with home visiting providers and services
• Perceptions of their home visiting providers
• Perceptions of their relationship with their home visiting providers

External states of engagement include families’ enrollment, attendance, and retention in home visiting; collaboration with their home visiting providers; participation in activities during and between home visits; and use of skills gained through home visiting.

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

Usage influences overall home visiting effectiveness. Even more important, it influences whether home visiting reduces or exacerbates inequities in outcomes across diverse families and communities. To optimize benefits for diverse families and communities, we need to design interventions that optimize reach and engagement across diverse families and communities with the end goal of achieving health equity. This requires understanding and being responsive to family and community assets, preferences, and concerns.

HARC is building out the usage box in the Precision Paradigm to promote shared learning regarding usage and its role in promoting equity – for example, how usage is influenced by intervention design and context, and how usage influences whether and how home visiting provides benefits for diverse families and communities.

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

• Usage 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 skill building using practice and feedback may not result in skill achievement if the participant does not believe that they need the skill.
• The home visiting intervention itself – content and methods of delivery – influences usage. For example, a virtual mode of delivery will be ineffective in engaging a family that does not have reliable internet access.
• Context – people, settings, systems, and structures – 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.

How HARC is Advancing our Understanding of Usage in Home Visiting

HARC aims to leverage research that helps us learn how to optimize outcomes across diverse families and communities through effective reach and engagement. To do this, the HARC research team is:

• Conceptualizing engagement in home visiting
  • We developed a conceptualization of family engagement in home visiting focusing on internal and external engagement (details forthcoming).
  • We are piloting this conceptualization with the MIECHV Coordinated State Evaluation (CSE) Family Engagement and Health Equity Peer Network.
• Using existing data to assess usage
  • We plan to work with models and states to learn how best to use existing data to monitor and improve reach and engagement.
  • We published a compendium of measures of reach and engagement that can be used in research and evaluation.
• Identifying and validating a subset of intervention techniques that promote reach and engagement