Evaluation of the Implementation of Prenatal Home Visits in Youth Healthcare in the Netherlands: A Mixed Methods Study

Preventing maternal stress is important for the healthy development of a child. Prenatal home visits were introduced as an integral part of the Dutch preventive youth healthcare for this purpose. This study aims to gain insight into the current state of prenatal home visits. Mixed methods explanatory sequential design. Two questionnaires, one for managers and one for nurses, were distributed to all 38 Dutch youth healthcare organisations. These could be filled in from 29 February to 15 April 2024. Respondents were subsequently invited to participate in an explanatory focus group on 12 June 2024, to help interpret the findings. Questionnaire data were analysed descriptively. Focus group data were analysed qualitatively using open inductive coding. Informed consent was obtained through a privacy statement included with the questionnaire. The manager questionnaire had 17 respondents (from 17 organisations), of which 10 participated in the focus group, while the nurse questionnaire had 124 respondents (from 34 organisations), with 8 in the focus group. This study found large differences between youth healthcare organisations regarding collaboration agreements with municipalities, collaboration with referrers, the organisational process and the execution of prenatal home visits in practice. Managers and nurses encounter difficulties with assessing vulnerability in practice and how the intended target group should be reached effectively. While effective collaboration with potential referrers is believed to be essential for achieving accurate and appropriate referrals, the process was experienced as overly complex. No standardised system for documenting data from prenatal home visits was found. Significant variations exist in organisation and implementation of prenatal home visits across youth healthcare organisations in the Netherlands. The unclear definition of 'potential vulnerability' results in an insufficiently defined target group. The lack of standardised data registration hinders the monitoring of the quality, continuity and effectiveness of these visits. Variations in organisation and implementation of prenatal home visits may lead to unequal access to care and support for pregnant women and their unborn children across Dutch regions.The lack of a clear definition for 'potential vulnerability' results in challenges in identifying and reaching the intended target group, potentially excluding individuals who would benefit most from these services. The absence of a standardised system for data documentation prevents systematic monitoring and evaluation, making it difficult to assess the effectiveness of prenatal home visits and identify areas for improvement. This threatens the long-term embedding of prenatal home visits in the Netherlands. Further research should also aim to gain insight into the perspective of parents and midwives. The paper adheres to the Standards for Reporting Qualitative Research (SRQR) and the Good Reporting of a Mixed Methods Study (GRAMMS) checklists. There was no patient or public contribution to our study.