Author ORCID Identifier

Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Health Sciences


Rehabilitation Sciences

First Advisor

Dr. Dana Howell

Second Advisor

Dr. Judith Page


Home-based, early intervention programs as a preferred delivery model are widely endorsed, heavily funded and highly utilized as prevention and remediation initiatives for families with young children (Eckenrode, et al., 2010; Karoly, Killion, & Cannon, 2005). Of concern, is that while an estimated 40 billion dollars are spent annually between federally funded programs and private foundations, a significant number of families disengage from services before the end of a child’s eligibility period (Stevens, Ammerman, Putnam, Gannon, & van Ginkel, 2005). Several meta-analyses indicate only modest effectiveness of home-based services (Tandon, et al., 2008). It is estimated that well over 500,000 families enroll in home-based services each year; however, retaining these enrollees in consistent and prolonged intervention is a definite challenge (Ammerman et al, 2006). While home-based services are widely recommended to families, the families’ perspective about having program personnel come to their home several times per month has not been well represented in the literature on home-based services. The purpose of this qualitative, grounded theory study was to discover a central theory that explains the decisions young, low-income, rural mothers make about engagement in home-based, early intervention services. Nine women who were custodial parents of children enrolled in an early literacy, home-based program participated in in-depth interviews conducted over multiple sessions. A semi-structured interview and graphical interview elicitation method of drawing a timeline were used to collect data. Line by line coding using participants’ words was utilized during open coding. Axial coding helped make apparent 69 categories. Using selective coding, five primary themes and a core category emerged. Verification of findings was accomplished by use of multiple sources of data, a clear audit trail and thick, rich description. The data revealed that young, low income mothers may not be prepared for the responsibilities that come with assuming the mothering role and are ambivalent about letting strangers into their homes. As the home visitors formed positive relationships with the child and the mother, the women in this study made the decision to continue with services because the child enjoyed the home visitor and the activities and because the home visitor also fulfilled the mothers’ needs for social contact and a connection to community resources. By interacting and partnering with home visitors, the mothers came to believe that being a mother helped them grow into a better person. Mothers expressed a desire for a better future for their children than they themselves were currently experiencing. Part of carving out that better future for the children necessitated that they allow home visitors help with the education of their children even though some mothers did not necessarily like making their home space more public. The results indicate for these mothers, part of becoming a mother entailed delaying their own dreams and goals until their children were older but that they also held onto hope for a future more focused on themselves.

Digital Object Identifier (DOI)