Quantifying Individualized PHN Interventions: The Development of a ‘Nurse Dose' Measure for use in the Community-based participatory research to Reduce Women's Health Disparities thru Temporary Assistance for Needy Families Study

Background: Public health nursing (PHN) interventions have shown promise in improving outcomes in populations at greatest risk for health disparities. Despite this, research describing the effect of a nursing "dose" on these populations, as well as information on which individuals may require greater doses is lacking.

Methods: This is a descriptive analysis of the nurse dose received by study participants (n=214) in the intervention group of a randomized controlled trial (RCT) studying the effects of PHN case-management on health and functional status outcomes in women receiving public assistance. Nurse dose was calculated in minutes between enrollment in the study and a three-month follow-up appointment with the nurse. It included direct minutes spent with the nurse (visits and phone calls where there was face-to-face contact or the PHN spoke with the participant) and indirect minutes (time spent contacting participants such as leaving a phone message, contact via a letter, etc.). To examine what factors were associated with the amount of nursing dose utilized, a multiple regression approach was applied to the data. Results: Age, number of chronic health conditions, depression score, and social support significantly predicted total number of minutes spent with the PHN (p<0.001 for all), and accounted for approximately 30% of the variance explained in the model (R2 = 0.29). Suprisingly, race, education, and functional status were not significant predictors of nurse dose. Further analyses will be conducted to determine whether an increase in nurse dose is associated with improvements in the overall outcomes measured by the RCT.

Conclusions: A key component in alleviating health disparities in at-risk populations is the utilization of research findings in planning interventions. Understanding the relevance of nurse dose is imperative for planning and implementing successful and cost-effective PHN interventions in vulnerable populations.