A Qualitative Approach to Understanding Provider Behaviors that Promote Enrollment, Engagement, and Retention in Home Visiting Services

Home visiting programs are an evidence-based approach to reducing adversity exposure and promoting well-being in children experiencing high-risk factors. Despite decades of research demonstrating the benefits of these programs, barriers continue to impact enrollment, engagement, and retention over time. The present qualitative study explored home visiting providers’ perceptions of the behaviors they use to promote enrollment and engagement and reduced attrition for families. Twenty-one providers of three home visiting models (Nurse-Family Partnership, Parents as Teachers, and SafeCare) completed in-depth, semi-structured interviews to probe into provider behaviors that might improve program outcomes. Qualitative data analysis of interviews was conducted using NVivo software with a template approach used to identify broad themes. Findings indicated differences in provider behaviors across enrollment (provider approach and outreach), engagement (provider support and communication), and retention (provider sharing resources and setting goals). Across all three, providers emphasized the importance of building rapport. Implications suggest that workforce structure and training include behavioral strategies to improve enrollment, engagement, and retention in programs to promote program and familial success. Highlights Provider approach and outreach are related to the promotion of enrollment in home visiting programs focused on families experiencing high-risk factors. Provider support and communication promote the engagement of families in home visiting programs. Sharing resources and setting goals with families were strategies reported by providers to promote the retention of families in home visiting programs.