Implementation Facilitators and Barriers for Home Visitors Discussing Adverse Childhood Experiences: A Qualitative Study
Julianne Ballard, Carol S. Dawson‐Rose, Catherine M. Waters, Ifeyinwa V. Asiodu, Heather LeutwylerABSTRACT
Aims
To explore facilitators and barriers to the implementation of a novel intervention, the adverse childhood experiences awareness conversation, from the perspectives of home visiting public health nurses and community health workers.
Design
A qualitative interpretive study underpinned by Gadamerian philosophical hermeneutics.
Methods
Semi‐structured interviews were conducted with a purposive sample of 13 home visiting public health nurses and three community health workers across three implementation sites from October 2023 to December 2024. Interpretive analysis employed the Capability, Opportunity, Motivation‐Behaviour model to map implementation facilitators and barriers.
Results
Four themes were identified: (1) initiating adverse childhood experiences conversations, (2) navigating disclosures of adverse childhood experiences, (3) adverse childhood experiences are understood differently across communities and (4) adverse childhood experiences and secondary trauma among home visitors. Relational factors and a strengths‐based focus on positive parenting facilitated implementation, whereas lack of consensus as to what constituted an ACE and uncertainty related to process guidelines impeded implementation. Home visiting public health nurses and community health workers addressed the implementation barrier of unresolved personal and secondary trauma through self‐care, peer support and debriefing.
Conclusion
Discussing adverse childhood experiences during home visits was generally acceptable to the home visitors, yet implementation challenges remain. Providing home visitors with culturally responsive guidance materials and organizational supports to mitigate unresolved personal and secondary trauma can address implementation challenges identified in this study.