Transportation dilemmas in home-based prevention programs: Carbon footprints and workplace stressors

Home visitation has strict implementation fidelity requirements; generally 75% of a program's participants must be receiving home visits weekly or biweekly. Little is known about how home visitors manage the costs of this travel and what greener alternatives might be available. Methods: Interviews approximately 90-120 minutes in length were conducted with 19 administrators of home visiting programs in a large Midwestern state. Interviews and field notes were transcribed by the author and analyzed with NVivo 10. Analytic strategies used included open, intuitive, sequenced coding, assertions analysis (content analysis of transcripts and field notes), and pragmatic compression to focus analysis on the research question at hand and give thick description explanatory power. Results: Respondents suggested that agencies did not reimburse workers at rates that actually covered their costs. Some programs required workers to return to the program office in between home visits. No home visitors in the programs sampled have access to program vehicles for home visits (although some use agency vehicles to transport program participants for group activities), and wear and tear on personal vehicles contributed to staff turnover. Conclusions and Implications: Home visitors are typically members of the low-wage labor market who subsidize the cost of home-based public health prevention services by driving their own vehicles for work. Policies that workers travel unnecessarily are harmful to the environment and to worker dignity. Agency investment in electric or hybrid vehicles would improve workers' lives and reduce the harm to the environment currently caused by high-volume, home-based, public health services.