title: Adaptation and implementation of the nurse-family partnership in Canada.
abstract: OBJECTIVE
  International agencies are required to adapt, pilot and then evaluate the effectiveness of the Nurse-Family Partnership (NFP) prior to broad implementation of this public health intervention. The objectives of this qualitative case study were to: 1) determine whether the NFP can be implemented in Canada with fidelity to the US model, and 2) identify the adaptations required to increase the acceptability of the intervention for service providers and families.
  
  
  METHODS
  108 low-income, first-time mothers in Hamilton, Ontario, received the NFP intervention. In-depth interviews were conducted with NFP clients (n=38), family members (n=14) and community professionals (n=24).
  
  
  METHODS
  Hamilton, Ontario.INTERVENTION AND DATA COLLECTION: An intensive nurse home visitation program delivered to women starting early in pregnancy and continuing until the child was two years old. Processes to adapt and implement the NFP were explored across seven focus groups with public health nurses and managers. Eighty documents were reviewed to identify implementation challenges. Data were analyzed using directed content analysis.
  
  
  RESULTS
  The NFP model elements are acceptable to Canadian health care providers, public health nurses and families receiving the intervention. The primary adaptation required was to reduce nurse caseloads from 25 to 20 active clients. Recommendations for adapting and implementing all model elements are described.
  
  
  CONCLUSIONS
  The NFP model requires minor adaptations to increase the acceptability of the intervention to Canadian stakeholders. A consistent approach to adapting the NFP program in Canada is necessary as provincial jurisdictions commit themselves to supporting an experimental evaluation of the effectiveness of the NFP.
authors.affiliation: School of Nursing, McMaster University, Hamilton, Ontario. jacksm@mcmaster.ca
authors.forename: Susan M
authors.initials: SM
authors.lastname: Jack
authors.forename: Dianne
authors.initials: D
authors.lastname: Busser
authors.forename: Debbie
authors.initials: D
authors.lastname: Sheehan
authors.forename: Andrea
authors.initials: A
authors.lastname: Gonzalez
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Zwygers
authors.forename: Harriet L
authors.initials: HL
authors.lastname: Macmillan
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D016389:Maternal-Child Nursing / Q000458:organization & administration*; D016294:Models, Nursing; D017146:Models, Organizational; D009864:Ontario; D019982:Organizational Case Studies; D010865:Pilot Projects; D011247:Pregnancy; D011368:Professional-Family Relations; D015397:Program Evaluation; D011637:Public Health Nursing / Q000458:organization & administration*; D036301:Qualitative Research; D035862:Vulnerable Populations; D055815:Young Adult
keywords: home visits; intervention research; public health nurses; qualitative research