British Columbia Healthy Connections Project Process Evaluation (2013-2018)

In 2010, the British Columbia (BC) Ministry of Health and Ministry of Children and Family Development invited the Children’s Health Policy Centre at Simon Fraser University (SFU) to explore options for evaluating Nurse-Family Partnership® (NFP) in BC, in consultation with a McMaster-Hamilton team and with David Olds, NFP’s founder. At the same time BC convened a Provincial Advisory Committee (PAC) comprising senior representatives from regional Health Authorities and other relevant organizations to seek province-wide consensus on proceeding with a large-scale NFP evaluation. The BC Healthy Connections Project (BCHCP) was then launched in early 2012 – comprising a large, province-wide randomized controlled trial (RCT) evaluating the program among a sample of 739 families.

As an adjunct study to the RCT, a process evaluation (funded by the Public Health Agency of Canada) to document how the NFP program was delivered across five unique regional health authorities was conducted. Across a five-year period (2013-2018) a mixed methods study was conducted to address the following study objectives:

1. To determine the extent to which the intervention was delivered with fidelity to the NFP core model elements;
2. To measure the dose of NFP (delivered and received) and reach (participation rate throughout pregnancy, infancy and toddlerhood);
3. To explore the acceptability of NFP to PHNs, supervisors and senior public health decision-makers;
4. To describe PHNs’ and supervisors’ experiences of the NFP education program and to identify additional content areas needed for further knowledge and skill development;
5. To explore processes used to support NFP PHNs and supervisors through activities including reflective supervision, coaching and mentoring;
6. To identify contextual factors that influence: organizational adoption and implementation of NFP; caseload coordination; location, engagement and retention of NFP clients; sustainability of the NFP in BC; and staff retention;
7. To identify program adaptations needed to support PHNs and supervisors to meet the needs of clients living in suburban, rural and remote communities; and
8. To identify and describe PHNs’ experiences of delivering NFP to clients and their families exposed to mental health problems including substance use, intimate partner violence (IPV), and/or engagement with the child protection system.

Both quantitative data (e.g., team meeting and supervision documentation; case conference forms; program fidelity measures) and qualitative data (e.g., interviews and focus groups with PHNs, supervisors, and public health managers/directors) were analyzed in this evaluation to bring together the strengths of both research traditions to compare, corroborate and explain results and variances across the five health authorities. Findings from the BCHCP process evaluation are also being used to inform ongoing adaptations and refinements to the Canadian NFP program materials.

Project Research Highlights

BCHCP Process Evaluation Final Reports