Localizing best practices in home visitation: Perspectives from state administrators and local program directors

Background: Although program models of early childhood home visitation focus strongly on implementation fidelity, public health services benefit when best practices in the home visiting field can be identified beyond program models and tailored at the local level. Little is known about how administrators of home visiting models designated as evidence-based conceptualize best practices in home visitation. Methods: Interviews 90-120 minutes in length were conducted in a large Midwestern state with 34 home visiting program administrators and consultants who used one of two established program models. Interviews and field notes were transcribed by the author and analyzed with NVivo 10. Analytic strategies used included open, intuitive, sequenced coding, assertions analysis (content analysis of transcripts and field notes), and pragmatic compression to focus analysis on the research question at hand and give thick description explanatory power. Results: Three primary themes emerged: 1) Rather than cross-model best practices, many respondents identified best practices with specific aspects of their program models, such as one model's list of critical elements. 2) Others identified best practices as detailed, thorough lists of standards that all home visitors should be expected to know. 3) Some respondents emphasized best practices as extra efforts that went beyond the lowest level of implementation fidelity and were not required. Conclusions: Respondents expressed diverse understandings of best practices and often linked best practices to their own specific program model. Public health education that emphasizes tailoring of best practices to local context may increase the cultural competence and relevance of home visiting programs.