Association of Maternal and Community Factors with Enrollment in Home Visiting Among At-Risk, First-Time Mothers

Objectives. We identified individual and contextual factors associated with referral and enrollment in home visiting among at-risk, first-time mothers.

Methods. We retrospectively studied referral and enrollment in a regional home visiting program from 2007 to 2009 in Hamilton County, Ohio. Using linked vital statistics and census tract data, we obtained individual and community measures on first-time mothers meeting eligibility criteria for home visiting (low income, unmarried, or age<18 years). Generalized linear modeling was per- formed to determine factors associated with relative risk (RR) of (1) referral to home visiting among eligible mothers and (2) enrollment after referral.

Results. Of 8187 first-time mothers eligible for home visiting, 2775 were referred and 1543 were enrolled. Among referred women, high school comple- tion (RR=1.10) and any college (RR=1.17) compared with no high school completion were associated with increased enrollment, and enrollment was less likely for those living in communities with higher socioeconomic depriva- tion (RR = 0.71; P < .05).

Conclusions. Barriers to enrollment in home visiting persisted at multiple ecological levels. Ongoing evaluation of enrollment in at-risk populations is critical as home visiting programs are implemented and expanded.