Semester

Spring

Date of Graduation

2019

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Social and Behavioral Sciences

Committee Chair

Christiaan Abildso

Committee Co-Chair

Christa Lilly

Committee Member

Christa Lilly

Committee Member

Sara Anderson

Committee Member

Danielle Davidov

Committee Member

Peter Giacobbi

Abstract

Background. Many low-income pregnant women receive prenatal physical activity (PA) curricula modules through home visitation programs. However, there is a lack of scientific evidence on the structural capacity, processes, and outcomes relating to these modules. Aims. The objective of this dissertation project was to examine the aforementioned in a single home visitation program model - the Maternal Infant Health Outreach Worker (MIHOW) program. More precisely, the aims of this study were to: (Aim 1) examine home visitors’ (i.e., Outreach Workers [OWs]) competencies in implementing the MIHOW program’s prenatal PA curriculum modules (i.e., structural capacity), (Aim 2) investigate the fidelity with which the MIHOW program’s prenatal PA curriculum modules were delivered to home visitation clients (i.e., processes), and (Aim 3) evaluate the impact of the MIHOW program’s curriculum on home visitation clients’ prenatal moderate-intensity physical activity (MPA) compared to a propensity score matched comparison group (i.e., outcomes). Methods. (Aim 1) A qualitative research design was used. Data from one interview and three focus groups conducted with OWs and five interviews conducted with their Site Leaders (i.e., supervisors) were used for analysis. (Aim 2) A mixed-methods research design was used. Data sources were the interviews and focus groups conducted in Aim 1 and the checklists of curriculum modules completed with 109 clients. These data sources were analyzed separately and then merged. (Aim 3) A nonrandomized quasi-experimental research design was utilized to evaluate how the MIHOW program’s pregnant clients’ (n = 98) absolute MPA metabolic equivalent of task (MET) minutes per week changed relative to a propensity score matched comparison group of pregnant women (n = 56). Physical activity measurements were taken at trimesters one, two and/or three. Generalized linear mixed modeling with a zero inflated negative binomial distribution was used as the statistical analysis strategy. Results. Key findings are shown by each aim. (Aim 1) OWs’ depth of knowledge on prenatal PA information and the modules varied; over half the OWs discussed implementing PA, rapport building, communication, adaptability, and/or problem-solving skills; over half the OWs felt comfortable delivering the modules. (Aim 2) Eight OWs discussed delivering the prenatal PA curriculum modules at multiple, most, or all of the home visits whereas the checklist data revealed that only 19.3% of clients received two or more “prenatal PA” and/or “other” curriculum modules. (Aim 3) The expected log absolute MPA MET minutes per week decreased 1.27 less for the comparison group than for the intervention group by trimester 3 [X2(1) = 4.77, p = .0289]. Conclusion. Taken together, these findings suggest that home visitors’ competencies relating to the prenatal PA curriculum modules and home visitors’ implementation of the prenatal PA curriculum modules have the potential to influence the recipients of these services. Thus, attention needs to be given to these factors when evaluating the effectiveness of home visitation program models’ prenatal PA curricula modules. Insight from this study can be used to enhance how home visitation program models’ prenatal PA curricula modules are implemented and evaluated.

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