Study offers ways to boost participation in program promoting healthy pregnancies, infant growth

Home visiting programs are effective in promoting healthy pregnancies, birth outcomes and infant growth and development—and new University of Michigan research offers ways to increase participation among eligible families.

The findings are published in the journal Social Service Review.

Michigan's Maternal and Infant Health Program—the largest evidence-based home visiting program in the state—reaches just 30% of the roughly 41,000 Medicaid-eligible pregnant people in the state qualified to participate.

A randomized control trial conducted by researchers from U-M's Youth Policy Lab evaluated an enhanced outreach strategy utilizing community health workers to reach eligible MIHP participants. The study grew out of a long partnership with the Michigan Department of Health and Human Services to try to identify and remove barriers to enrollment in MIHP.

The researchers designed the intervention to deal with significant barriers found in prior studies: awareness and trust.

"It's rewarding to conduct research that demonstrates such positive impacts and has actionable findings," said Robin Jacob, research professor and co-director of YPL. "We are excited to continue our partnership with MDHHS to identify and test innovative strategies to increase participation in home visiting programs."

Typically, families enroll in the health program when a referral is made to one of the nearly 70 agencies across Michigan who deliver those home-visiting services. Multidisciplinary teams of nurses, social workers, lactation consultants and nutritionists then follow up, enroll families in the program, and provide information and coaching to parents during pregnancy and infancy.

In this study, YPL researchers used community health workers to devote more staff time to outreach activities, as well as additional attempts to contact families multiple and in multiple ways over an extended period.

Enhanced outreach efforts by community health workers resulted in an almost 11-percentage-point increase in enrollment overall, and at one site, it increased enrollment by 17 percentage points over typical practice.

"The increase in enrollment was driven almost exclusively by community health workers' efforts to make more contact attempts, use more modalities, and persist over a longer period than the standard outreach provided at participating agencies," the researchers wrote. "Once contacted, the community health workers were not substantially better than typical agency staff in persuading families to enroll in the program."

Findings suggest enhanced outreach was successful in reducing awareness barriers by increasing the likelihood a birthing parent would be contacted and invited to participate in the program, though it does not appear to have increased trust. The authors conclude various professionals and paraprofessionals could increase participation by conducting additional outreach activities.

"Enhanced outreach has the potential to increase uptake of health-related programs among eligible families," the authors wrote. "Reaching out more often, in more ways, and over a longer period resulted in an increased likelihood of reaching eligible MIHP beneficiaries."