Challenges experienced by home visitors: A qualitative study of program implementation

While randomized trials that test the effectiveness of different types of home visitation have increased our understanding of the structural features of programs that promote positive outcomes, we know much less about program processes necessary to achieve success. In spite of increasing emphasis on the importance of adapting programs to suit the needs and characteristics of populations served (Yutrzenka, 1995), little evidence exists about how such adaptations affect the success of program delivery. The purpose of the current work was to examine common challenges faced by home visitors in delivering a program of prenatal and early childhood home visitation while it was studied in a large (N = 1139) randomized trial conducted in Memphis, Tennessee with a primarily African American sample (Olds, 1987). We employed qualitative analyses to explore common challenges identified by the nurses in their implementation of the program. Many of these challenges grew out of the nurses' efforts to address the unique needs of the families that they served, while simultaneously addressing the broad interrelated goals and objectives of the program. (C) 1997 John Wiley & Sons, Inc.