College of Nursing, University of Colorado, Anschutz Medical Campus, 13120 E. 19th Ave., Aurora, CO 80045, USA.
Prev Sci. 2012 Jun;13(3):219-28. doi: 10.1007/s11121-012-0287-0.
Participant attrition is a major influence on the effectiveness of evidence-based interventions. Assessing predictors of participant attrition and nurse and site characteristics associated with it could lay a foundation for increasing retention and engagement. We examined this issue in the national expansion of the Nurse-Family Partnership, an evidence-based program of prenatal and infancy home visiting for low-income, first-time mothers, their children, and families. Using a mixed methods approach, we examined participant, nurse, and site predictors of participant attrition and completed home visits. We used mixed multivariate regression models to identify participant, nurse, program, and site predictors of addressable attrition and completed home visits during pregnancy and the first year of the child's life for 10,367 participants at 66 implementation sites. We then conducted semi-structured interviews with nurse home visitors and supervisors at selected sites with the highest (N = 5 sites) and lowest (N = 6 sites) rates of participant addressable attrition and employed qualitative methods to synthesize themes that emerged in nurses' descriptions of the strategies they used to retain participants. Mothers who were younger, unmarried, African American, and visited by nurses who ceased employment had higher rates of attrition and fewer home visits. Hispanic mothers, those living with partners, and those employed at registration had lower rates of attrition. Those who were living with partners and employed had more home visits. Nurses in high retention sites adapted the program to their clients' needs, were less directive, and more collaborative with them. Increasing nurses' flexibility in adapting this structured, evidence-based program to families' needs may increase participant retention and completed home visits.
参与者流失是影响基于证据的干预措施效果的主要因素。评估参与者流失的预测因素以及与护士和地点相关的特征，可以为增加保留率和参与度奠定基础。我们在国家扩大母婴家庭合作计划（Nurse-Family Partnership，NFP）中研究了这个问题，该计划是一项针对低收入、首次生育的母亲、她们的孩子和家庭的产前和婴儿期家庭访视的基于证据的项目。我们使用混合方法，研究了参与者、护士和地点对参与者流失和完成家访的预测因素。我们使用混合多元回归模型，确定了 66 个实施地点的 10367 名参与者和护士在妊娠和儿童生命的第一年中，可处理的地址流失和完成家访的参与者、护士、计划和地点预测因素。然后，我们对流失率最高（N=5 个地点）和最低（N=6 个地点）的选定地点的护士家访员和主管进行了半结构化访谈，并采用定性方法综合了护士描述他们用于保留参与者的策略时出现的主题。年龄较小、未婚、非裔美国人和由失业护士家访的母亲流失率更高，家访次数也更少。西班牙裔母亲、与伴侣同住和注册时就业的母亲流失率较低。与伴侣同住和就业的母亲家访次数更多。高保留率地点的护士根据客户的需求调整了方案，对客户的指导较少，与客户的合作更多。增加护士在适应这个结构化、基于证据的方案时的灵活性，可能会增加参与者的保留率和完成家访的次数。
