Engagement in Doula Home Visiting Services: Relationship-Drive or Needs-drive? A Person-Oriented Approach to Supportive Relationships

• In Event: Engaging Families in Home Visiting Programs – A Relationship Perspective and Approach

Abstract

Background: Social support and personal relationships can affect mothers’ engagement with home-visiting services. One argument is that home-visiting engagement is relationship-driven: Mothers who lack supportive relationships have difficulty trusting service providers and have low uptake of services. An alternative hypothesis is that engagement is needs-driven: Mothers with low social support perceive a greater need for services and have stronger engagement. This study aims to test the alternative hypotheses by examining patterns of mothers’ past and current relationships and associations with mothers’ working alliances with doulas and use of doula services.

Method: Data were collected from young, low-income pregnant women (n=147) who participated in doula-enhanced home-visiting services. Doulas provide home visits starting in pregnancy until six weeks postpartum and provide support at the birth at the hospital. At enrollment before receiving services (mid-pregnancy), mothers reported the quality of relationships (trust, communication, alienation, and support) with their current parent figure (usually their mother; PF) and the father of their baby (FOB), childhood rejection by their caregiver, and general closeness in relationships. At 37-weeks of pregnancy and 3-weeks postpartum, mothers reported on their working alliances with doulas (i.e., bonding, agreement on tasks/goals). Data on doula services were retrieved from administrative systems, including the number of prenatal and postpartum doula visits, whether doulas attended birth, and whether mothers discontinued services before 6-weeks postpartum.

Results: Latent profile analysis identified four relationship profiles: strong support from PF, FOB and others (27%), moderate support overall (40%), moderate support from FOB but alienation with PF (15%), and moderate support from PF but alienation with FOB (18%). The four classes did not differ on bonding with doulas. Mothers in the strong support class reported the highest agreement on tasks/goals with doulas both prenatally and postpartum. Compared to the strong support class, mothers in the alienation with PF class reported a similar level of tasks/goals agreement at 37-weeks of pregnancy, but experienced sharp decrease and a significantly lower level at 3-weeks postpartum. Mothers in the alienation with PF class were less likely to have doulas attend childbirth compared to the moderate support class, and they received fewer doula home visits prenatally compared to the other three classes. The number of doula visits decreased for the other three groups postpartum, however, it remained stable for mothers in the alienation with PF class. The four groups did not differ on the number of postpartum doula home visits or early discontinuation of services.

Conclusion/Implication: There is heterogeneity among young mothers regarding the quality and structure of their past and current relationships. The relationship-driven hypothesis was supported by the higher levels of agreement on tasks/goals among mothers who already had the experience of strong relationships. The needs-driven hypothesis was supported by the increased levels of postpartum engagement among mothers who experienced parental rejection in childhood and alienation from their current parent figure. Home visitors may engage young mothers more effectively if they are aware of mothers’ relationships with key people in their lives and how these relationships might impact service uptake.

Authors

• Yudong Zhang, New York University
  Presenting Author

• Renee Clare Edwards, University of Chicago
  Non-Presenting Author

• Sydney L Hans, University of Chicago
  Non-Presenting Author