Background: Nurse-Family Partnership (NFP) is an evidence-based nurse home visitation program for first-time mothers experiencing poverty. We conducted a formative study of NFP for multiparous mothers (women with previous births) from August 2017 to December 2020 at 31 sites across the U.S. Our objectives were to assess NFP implementation among multiparous mothers, assess enrolled mothers’ characteristics and needs, and describe program adaptations.

Methods: We used an exploratory concurrent mixed-methods approach including descriptive statistics to characterize program implementation and population served and a qualitative investigation of NFP nurse and other key informant experiences in serving multiparous mothers (n=120).

Results: The 31 sites enrolled 2,156 multiparous mothers with the following characteristics: 75% unmarried; 26% with < high school completed; 25% Latina, 39% Black, and 49% white; 17% with self-reported tobacco use during pregnancy; and 50% with depression and 27% with anxiety based on validated screeners. Multiparous mothers experienced more nurse-assessed risks and were referred to services more frequently compared to primiparous mothers. Nurses described the critical importance of care coordination and community partnerships. Despite experiencing more risks, program retention was higher for multiparous mothers than primiparous mothers, with 81% retention through pregnancy, 63% through child age 6 months, and 53% through 12 months. NFP nurses and community partners perceived that the program was beneficial for multiparous mothers.

Conclusions: NFP can be adapted to meet the higher acuity and overlapping needs of multiparous mothers including through enhancing collaboration with community partners. We are currently conducting research to assess NFP impact on multiparous mothers.