Beyond Family Demographics, Community Risk Influences Maternal Engagement in Home Visiting.

The present study investigated the influence of multi-level determinants on home visiting participation outcomes. Home visiting participation was assessed by: (1) duration of participation (i.e., retention); (2) number of home visits completed (i.e., dosage), and (3) number of home visits completed divided by the duration of participation (i.e., intensity). The sample consisted of 1024 mothers (mean age 22.89 years) who participated in home visiting funded through Georgia's Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Using hierarchical linear modeling, we investigated both family- and community-level characteristics associated with participation outcomes. Mothers (primary caregivers) were less likely to be retained in the program and more likely to have received fewer visits if they were not living with a main romantic partner or if their household incomes were below poverty level. The mothers were more likely to be actively engaged if their primary language was not English or if their child was relatively younger at enrollment. At the community level, after controlling family characteristics, living in a disadvantaged community (characterized by economic deprivation and elevated child health/safety risks) was associated with shorter and less intense program participation. These findings demonstrate that barriers to active engagement in home visiting programs persisted at multiple ecological levels. Explicitly considering the complexity of the communities in which home visiting programs are implemented may allow for more equitable allocations and expectations in future funding and performance measurement. [ABSTRACT FROM AUTHOR]