Evaluating fidelity in home-visiting programs a qualitative analysis of 1058 home visit case notes from 105 families.
OBJECTIVE
Implementation fidelity is a key issue in home-visiting programs as it determines a program's effectiveness in accomplishing its original goals. This paper seeks to evaluate fidelity in a 27-month program addressing maternal and child health which took place in France between 2006 and 2011.


METHODS
To evaluate implementation fidelity, home visit case notes were analyzed using thematic qualitative and computer-assisted linguistic analyses.


RESULTS
During the prenatal period, home visitors focused on the social components of the program. Visitors discussed the physical changes in pregnancy, and psychological and social environment issues. Discussing immigration, unstable employment and financial related issues, family relationships and dynamics and maternity services, while not expected, were found in case notes. Conversely, health during pregnancy, early child development and postpartum mood changes were not identified as topics within the prenatal case notes. During the postnatal period, most components of the intervention were addressed: home visitors observed the mother's adaptation to the baby; routine themes such as psychological needs and medical-social networks were evaluated; information on the importance of social support and on adapting the home environment was given; home visitors counseled on parental authority, and addressed mothers' self-esteem issues; finally, they helped to find child care, when necessary. Some themes were not addressed or partially addressed: health education, child development, home environment, mother's education plans and personal routine, partner support and play with the child. Other themes were not expected, but found in the case notes: social issues, mother-family relationship, relation with services, couple issues, quality of maternal behavior and child's language development.


CONCLUSIONS
In this program, home visitors experienced difficulties addressing some of the objectives because they gave precedence to the families' urgent needs. This research stresses the importance of training home visitors to adapt the intervention to the social, psychological and health needs of families.
Laboratoire de Recherche, Etablissement Public de Santé Maison Blanche, Paris, France. th.saias@gmail.com
Thomas
T
Saïas
Emilie
E
Lerner
Tim
T
Greacen
Elodie
E
Simon-Vernier
Alessandra
A
Emer
Eléonore
E
Pintaux
Antoine
A
Guédeney
Romain
R
Dugravier
Susana
S
Tereno
Bruno
B
Falissard
Florence
F
Tubach
Anne
A
Revah-Levy
D002648:Child; D002657:Child Development; D002669:Child Welfare; D005195:Family Relations; D005260:Female; D005602:France; D006266:Health Education; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D049590:Postpartum Period; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D015397:Program Evaluation; D036301:Qualitative Research; D012944:Social Support