摘要：We used data from a home visiting trial to examine low-income women's perceptions of services received from nurses (the community care [CC] group) and from a nurse–community health worker (CHW) team. More mothers in the nurse–CHW group than in the CC group reported receiving help in all of the categories assessed. For both groups, assistance with health education ranked highest among the types of assistance received. A higher percentage of women in the nurse–CHW group than the CC group reported that they received psychosocial help. Low-income pregnant and postpartum women are disproportionately exposed to stressors that have negative consequences for their mental and physical health and make it difficult for them to participate in programs that could provide help. 1,2 Home visits, primarily delivered by nurses 3 or community health workers (CHWs), 4,5 are a strategy used to provide additional services to low-income women. However, few reported home visiting programs have teamed nurses with CHWs. 6,7 We developed a nurse–CHW team intervention in the context of a Medicaid, state-sponsored enhanced prenatal and infant services (EPS) home visiting program in Michigan. Given low enrollment in EPS during pregnancy (only 28% of Medicaid-enrolled women in Michigan participated in EPS), the team intervention was designed to use CHWs to improve engagement, increase service delivery, and address stress and mental health. 8 Trained CHWs used empowerment strategies to provide intensive, relationship-based support; deliver health education; and help with service navigation. 9 The team model was tested in a trial comparing usual community care (CC)—that is, EPS delivered by nurses—and EPS delivered by a nurse–CHW team. Previous findings from the same study sample indicated that the nurse–CHW teams were able to engage more women and deliver more services. 10 Furthermore, women in the team group had significantly fewer depressive symptoms 11 than did the CC group, 12 with trends for higher levels of mastery 13 and lower perceived stress. 14 However, little is known about how mothers perceive the type of help they receive in home visits, whether mothers’ perceptions of help are consistent with program evaluations, or whether there are differences in perceptions of help based on type of home visiting provider. 15 Therefore, we assessed mothers’ perceptions of the help they received from each provider group and then ranked types of help based on frequency of endorsement.
