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Multilevel Interaction Effects of Family and Community Factors on Mothers' Engagement in Evidence-Based Home Visiting

Bae, Dayoung, PhD; Cho, Junhan, PhD; Terris, Darcey D., PhD; Glisson, Rachael E., MPH; Brown, Anita, PhD; Nelson, Twanna, MCH

doi: 10.1097/FCH.0000000000000231
Original Articles

Informed by ecological and family system frameworks, our study investigated the relationship between family- and community-level factors, and their cross-level interactions, with evidence-based home visiting program participation in a sample of 2409 mothers (mean age: 24.15 years). Using 2-level hierarchical linear modeling, we observed that mothers living in disadvantaged communities demonstrated less active engagement in evidence-based home visiting. Cross-level interaction effects revealed that mothers' unstable living conditions and psychiatric problems amplified the negative influence of disadvantaged communities on program engagement. Conversely, mothers who were first-time parents showed higher levels of participation in family support programs when they resided in disadvantaged communities.

Center for Family Research, University of Georgia, Athens (Drs Bae, Terris, and Brown and Ms Glisson); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Dr Cho); and Georgia Department of Public Health, Atlanta (Ms Nelson).

Correspondence: Dayoung Bae, PhD, Center for Family Research, University of Georgia, 1095 College Station Rd, Athens, GA 30602 (

The research reported in this article was supported by award numbers D89MC28283 from the Health Resources and Services Administration in the United States. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Health Resources and Services Administration.

All authors have indicated they have no potential conflicts of interest to disclose.

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