Susan Jack

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Clinical Health Sciences (Nursing)


Alba DiCenso




This sandwich thesis summarizes the findings from two qualitative studies exploring the process of engagement among mothers with children at-risk for developmental delays, public health nurses (PHN) and family visitors (FV) in a blended home visiting program. The purpose of the phenomenological study (study #1) was to identify and describe factors which influence the establishment of a working relationship between FVs and at risk families. In-depth, semi-structured interviews were conducted with a purposeful sample of six FVs and six PHNs. The analytic process revealed that PHNs have an important role in marketing home visiting programs and facilitating FV access into the home. Family visitor-client engagement occurred through "finding common ground" and "building trust." The purpose of the grounded theory study (study #2) was to explore the process of engagement from the client's perspective. In-depth, semi-structured interviews were conducted with a purposeful sample of 20 mothers who were receiving PHN and FV home visits. Clients engage with home visitors through a basic social psychological process of limiting family vulnerability. This process has three phases: (1) overcoming fear, (2) building trust, and (3) seeking mutuality. The personal characteristics, values, experiences, and actions of the PHN, FV, and mother influence the speed at which each phase is successfully negotiated and the ability to develop a connected relationship. Client characteristics that influence engagement include: preconceptions of PHNs and FVs, past experiences with service providers, motivation to participate, client attachment style, and the identification of specific health related needs. Remaining engaged in home visiting is influenced by family beliefs about the value of the visits and the client's ability to identify short-term benefits related to working with either the PHN and/or FV. Increased understanding of these factors will assist both PHNs and FVs access those families who are hard-to-reach and resist support and services.


[missing pages 18 and 96]

McMaster University Library

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