Lay home visitors' and clinicians' experiences of supervision, programme efficacy, rewards and challenges in the Ububele mother-baby home visiting project

Abstract

Extensive literature emphasises that good quality maternal care is crucial for infants to develop secure attachments which positively shapes their future mental health. In a developing society such as South Africa where many mothers are raising children in contexts of multiple adversities, interventions which focus on improving the quality of maternal care are vital. Home visiting programmes are an effective way to support mother-baby dyads. In South Africa, it has been found that lay women from local communities trained to work as home visitors can make a significant difference to these mother-infant relationships. Ongoing supportive supervision has been found to be particularly important for lay home visitors. The evaluation and improvement of these intervention programmes is recommended. One aspect of programme evaluation is the investigation of the programme staff experiences. Currently, there is a dearth of research focusing on the experiences and supervision of lay community health care workers, internationally as well as in South Africa. The Ububele Mother Baby Home Visiting Project, run in the Alexandra Township in Johannesburg, is one such intervention and no evaluation of this intervention from the perspective of the staff has, as yet, been conducted. It was felt that research into the experiences of the home visitors and their supervisors would be beneficial in gaining clarity regarding which aspects of the project they perceive to have been effective and those that have been challenging, as well as to assist the team in developing their intervention further. The current research aimed to gain insight into these experiences and to gain an understanding of the main concerns. The form of data included 10 semi-structured in-depth interviews with the staff of the programme: the home visitors, the supervising psychologists and the director of the project. An interpretive thematic analysis was used to interpret the results. The findings indicated that the staff’s experience included a mixture of positive and challenging experiences. The staff all agreed on their passion for the project and their belief in the effectiveness of their work in improving the bonds between mothers and babies in the community. The challenges included working in a community faced with multiple adversities, as well working in a team divided by education level, race, culture and socioeconomic class. Suggestions for the Ububele Mother Baby Home Visiting Project team are also provided.