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A Community Capitals Framework for Identifying Rural Adaptation in Maternal-Child Home Visiting

Whittaker, Jennifer MUP; Kellom, Katherine BA; Matone, Meredith DrPH, MHS; Cronholm, Peter MD, MSCE

Journal of Public Health Management and Practice: July 03, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000001042
Research Full Report: PDF Only

Objective: To understand how maternal and child home-visiting programs are adapted, enhanced, and expanded to meet the unique needs of rural communities.

Design: We explored factors shaping the role of home visiting with data from a 2013-2015 statewide evaluation of Maternal, Infant, and Early Childhood Home Visiting–funded programs. Features unique to a rural experiences were mapped onto the Community Capitals Framework.

Setting: Individual, semistructured interviews were conducted at 11 of 38 home-visiting sites across Pennsylvania.

Participants: Program administrators, home visitors, and clients.

Main Outcome Measure: Program adaptation.

Results: Our analysis represents 150 interviews with 11 program sites serving 14 counties. We document how rural home-visiting programs address community-wide limitations to maternal and child health by adapting program content to better meet the needs of families in rural areas. Data demonstrate how rural home-visiting program's provision of economic and social services reach beyond maternal child health care, building the capacity of individual families and the broader community.

Conclusions: Home-visiting programs should be viewed as a vehicle for improving community well-being beyond health outcomes. These programs have become an integral part of our public health framework and should be leveraged as such.

Robert Wood Johnson Health Policy Research Scholars Program, Robert Wood Johnson Foundation, Princeton, New Jersey (Ms Whittaker); PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Mss Whittaker and Kellom and Dr Matone); Department of City Planning, University of Pennsylvania School of Design, Philadelphia, Pennsylvania (Ms Whittaker); Departments of Pediatrics (Dr Matone) and Family Medicine and Community Health (Dr Cronholm), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania (Drs Matone and Cronholm); and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Ms Whittaker and Drs Matone and Cronholm).

Correspondence: Meredith Matone, DrPH, MHS, PolicyLab, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, Roberts Center for Pediatric Research, 2716 South St, Philadelphia, PA 19146 (

The author contributions are as follows: Jennifer Whittaker, MUP, and Katherine Kellom, BA, carried out the initial analyses, partially drafted the manuscript, provided qualitative support, and approved the final manuscript as submitted; Meredith Matone, DrPH, MHS, conceptualized and designed the study, reviewed and revised the manuscript, and approved the final manuscript as submitted; and Peter Cronholm, MD, MSCE, provided qualitative support, reviewed and revised the manuscript, and approved the final manuscript as submitted.

This study was funded by Pennsylvania Department of Human Services.

The authors declare that they have no conflicts of interest to disclose.

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