Mixed Methods Analysis of Participant Attrition
in the Nurse-Family Partnership
Ruth A. O’Brien
&
Patricia Moritz
&
Dennis W. Luckey
&
Maureen W. McClatchey
&
Erin M. Ingoldsby
&
David L. Olds
Published online: 4 May 2012
#
Society for Prevention Research 2012
Abstract Participant attrition is a major influence on the
effectiveness of evidence-based interventions. Assessing
predictors of participant attrition and nurse and site charac-
teristics associated with it could lay a foundation for increas-
ing retention and engagement. We examined this issue in the
national expansion of the Nurse-Family Partnership, an
evidence-based program of prenatal and infancy home vis-
iting for low-income, first-time mothers, their children, and
families. Using a mixed methods approach, we examined
participant, nurse, and site predictors of participant attrition
and completed home visits. We used mixed multivariate
regression models to identify participant, nurse, program,
and site predictors of addressable attrition and completed
home visits during pregnancy and the first year of the child’s
life for 10,367 participants at 66 implementation sites. We
then conducted semi-structured interviews with nurse home
visitors and supervisors at selected sites with the highest
(N 05sites)andlowest(N 06 sites) rates of participant
addressable attrition and employed qualitative methods to
synthesize themes that emerged in nurses’ descriptions of
the strategies they used to retain participants. Mothers who
were younger, unmarried, African American, and visited by
nurses who ceased employment had higher rates of attri-
tion and fewer home visits. Hispanic mothers, those
living with partners, and those employed at registration
had lower rates of attrition. Those who were living with
partners and employed had more home visits. Nurses in
high retention sites adapted the program to their clients’
needs, were less directive, and more collaborative with
them. Increasing nurses’ flexibility in adapting this struc-
tured, evidence-based program to families’ needs may
increase participant retention and completed home visits.
Keywords Attrition
.
Retention
.
Dropout
.
Engagement
.
Home visiting
In the past decade, significant progress has been made in
identifying preventive interventions that meet high eviden-
tiary standards and that prevent a range of adverse mental
health, crime, and substance use outcomes (National Re-
search Council and Institute of Medicine 2009). Implement-
ing evidence-based programs with fidelity increases their
public health impact (Durlak and DuPre 2008). One of the
greatest challenges in implementing preventive interven-
tions involves ensuring that the target population partici-
pates in the program to the same degree as those who
participated in the trials (Prinz et al. 2001).
R. A. O’Brien
:
P. Moritz
College of Nursing, University of Colorado,
Anschutz Medical Campus,
13120 E. 19th Ave.,
Aurora, CO 80045, USA
D. W. Luckey
:
M. W. McClatchey
Colorado School of Public Health, Department of Biostatistics and
Informatics, University of Colorado, Anschutz Medical Campus,
13121 E. 17th Ave., Mail Stop #8410,
Aurora, CO 80045, USA
E. M. Ingoldsby
OMNI Institute,
Denver, CO, USA
D. L. Olds (*)
Department of Pediatrics, University of Colorado,
Anschutz Medical Campus,
13121 E. 17th Ave., Mail Stop #8410,
Aurora, CO 80045, USA
e-mail: david.olds@ucdenver.edu
Prev Sci (2012) 13:219–228
DOI 10.1007/s11121-012-0287-0
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