Addressing inequities in maternal health through postpartum nurse home visiting: a mixed methods evaluation.

BACKGROUND: The First Five Yolo Welcome Baby (WB) program, initiated in 2021, is a nurse home visiting initiative funded by local and federal dollars. It aims to address postpartum health in low-income, uninsured, or Medi-Cal insured families in Yolo County, California. Amid persisting inequities in maternal health, especially in low-income and historically marginalized communities, WB was designed to overcome barriers to postpartum care access and provide essential support for social, emotional, and physical wellbeing for mothers and their families. The purpose of this study was to evaluate this program in terms of key outcomes, including participant and provider experience and perceptions. METHODS: This mixed-methods study examined quantitative and qualitative data from 541 WB program participants between March 2022 and February 2024. Quantitative data included service utilization, demographic information, mental health screenings, and breastfeeding outcomes. Qualitative data, gathered through semi-structured interviews with 30 participants (15 English-speaking and 15 Spanish-speaking) and 15 providers explored participant and provider perceptions of program benefits and challenges. Thematic analysis was used to categorize qualitative data, and results were integrated with quantitative findings. RESULTS: Most program participants identified as Hispanic/Latino (58%) and over half had a language preference other than English (48.8%), primarily Spanish. Quantitative results revealed high postpartum visit completion (74.5% for both two- and six-week visits) and a breastfeeding continuation rate of 75.2% at three months. Depression and anxiety screenings indicated substantial mental health needs, with 13.9% screening positive for depression and 19.4% screening positive for anxiety. Qualitative findings highlighted six themes, including the importance of access to social support and community resources, overcoming logistical barriers for low-income families, and facilitating healthcare continuity for mothers and infants. Participants emphasized the role of nurse home visitors in bridging gaps in healthcare access and providing emotional support, particularly for families with a language preference other than English. CONCLUSIONS: This study underscores the critical role of postpartum nurse home visiting programs in addressing social and structural determinants of health and reducing inequities in maternal health outcomes. By connecting low-income families with healthcare and community resources, WB has shown promise in promoting maternal and infant health. Further research on similar programs in diverse and larger populations could enhance our understanding of their long-term impact on health equity.