A Community Engagement Approach to Maximizing Design Rigor within a Multi-Site Evaluation of Tribal Home Visiting

Introduction: The Tribal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) program funds Tribal and Urban Indian agencies to promote health and wellness among American Indian and Alaska Native (AI/AN) families. These programs offer prevention-based home visiting services for pregnant women and families with children <5. The Multi-Site Implementation Evaluation of Tribal Home Visiting (MUSE), is a national five-year study investigating the strengths and supports of Tribal MIECHV programs. A central aim of MUSE is to engage community, program, and related partners as equal stakeholders in the study design process with the goal of developing rigorous research protocols and delivering meaningful results.

Methods: The MUSE research team has taken an innovative approach to not only examining maternal and child health promotion services across diverse AI/AN communities, but to substantively partnering with key stakeholders throughout the study design process. An integral study component is a community-engaged evaluation design framework based in relationship building, bi-directional knowledge sharing, and ethical research principles. This framework was utilized in the iterative processes of developing and refining the MUSE conceptual model, evaluation aims and questions, and data collection methods. Webinars, in-person meetings, one-on-one consultations, and informal communication were utilized throughout a year-long planning period from which the study design took shape.

Results: Design priorities resulting from the stakeholder engagement process included maximizing the use of existing data sources to reduce program staff burden, utilizing strengths-based measures throughout the study, emphasizing qualitative data and sophisticated triangulation between qualitative and quantitative data sources, focusing on community-defined success in equal measure with existing metrics of home visiting quality, and upholding a high standard of necessity for the inclusion of each proposed data element. The resulting design consists of 9 data collection tools, utilizes a dynamic mixed-methods approach, and is both relevant to participating communities and scientifically rigorous as an investigation of health equity promotion among AI/AN families.

Conclusions: The strategies employed in MUSE are effective for collaboratively designing a study with community partners and increasing stakeholder investment. This investment cultivates greater interest in incorporating study findings into the broader work of promoting AI/AN maternal and child health equity. Lessons learned from this community-engaged evaluation study have implications for other researchers seeking to meaningfully incorporate the voices of community and other key project stakeholders.