Change over time in young mothers' engagement with a community-based doula home visiting program

Families' low engagement has been a common challenge of many early prevention programs, but the phenomenon and its associated factors have not been well studied, especially from a longitudinal perspective. This study examines the change over time in young, African-American mothers' engagement with a pregnancy and perinatal doula home visiting program. One hundred and twenty-three participants were involved, with an average age of 18.2 years old. Mothers were in pregnancy for an average of 26.6 weeks by the time of study, and were primarily first-time mothers. The mothers were visited approximately weekly, beginning in the last three months of pregnancy and extending through the first three months after birth. Doulas rated the mothers' engagement after each visit based on their involvement with the visits and understanding of materials. Longitudinal analysis using hierarchical linear modeling techniques showed that, overall, mothers' engagement increased over time linearly, with some deceleration after the babies' birth, and with individual differences in both initial levels and rates of change. Mothers' psychosocial characteristics were more likely to be associated with their initial engagement levels, while time-varying measures of visit length and settings showed much stronger associations with the rate of engagement change over time. In addition, the home visitors themselves showed individual variation that was predictive both of initial engagement and rate of growth over time. The results suggest that participant engagement is a dynamic process that varies over time in complex ways, and it is associated with participant and program factors.