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RELATIONS AMONG MOTHER AND HOME VISITOR PERSONALITY TRAITS, RELATIONSHIP QUALITY, AND AMOUNT OF TIME SPENT IN HOME VISITS
Elizabeth A. Sharp, Jean M. Ispa, Kathy R. Thornburg,
and Valerie Lane
University of Missouri-Columbia
Over the past several decades, home visiting models have been developed in response to needs of low-income families with infants and toddlers. The goal of home visiting programs is to promote positive family and child outcomes through the delivery of services in families’ home environments. Research has suggested that regular, frequent visits result in more benefit to families in poverty than less intensive services (Gomby, Culross & Behrman, 1999). Yet, in a variety of programs, home visits fall short of the number prescribed by the program design (Barnard, 1998; Daro & Harding, 1999).
Some investigators and practitioners argue that the quality of relationships that develop between parents and home visitors is central to home visiting (Klass, 1996; Wasik, Bryant, & Lyons, 1990). Although no known investigations have empirically examined home visitor-parent relationship quality as it relates to home visiting, evidence from other helping relationships may be instructive. Theory and research on the factors promoting successful outcomes from counseling and psychotherapy identify client-therapist relationship quality as critical. In particular, client-therapist agreement on therapy goals and strategies and personal feelings for each other have been linked to satisfaction with therapy and with successful therapy outcomes (Bordin, 1979; Horvath & Greenberg, 1989). Similarly, Kiesler and Watkins (1989) found positive associations between patient-therapist interpersonal complementarity and both party's perceptions of their working relationship.
Because personality traits index characteristic ways of thinking about and reacting to people and situations, have relatively high heritability coefficients, and appear to be stable over many years (Caspi, 2000; Tellegen, Lykken, Bouchard, Wilcox, Segal & Rich, 1988), a number of researchers have investigated relations between personality traits and close relationships. In particular, higher-order positive emotionality (a combination of tendencies to experience positive emotional dispositions, to enjoy closeness to others, to want to make positive impacts on others, and to be perseverant and willing to work hard to achieve mastery) predicts outgoing, friendly interpersonal styles and high relationship satisfaction in married and dating couples. Negative emotionality (a combination of aggressive, alienated, and stress-prone tendencies), on the other hand, predicts a propensity to experience negative moods and to be involved in conflictual couple relationships (e.g., Karney & Bradbury, 1997; Larsen & Ketelaar, 1991; Watson, Hubbard & Wiese, 2000).
Evidence linking personality with relationship quality, when combined with evidence showing the importance of client-therapist liking and trust for the success of helping relationships, suggests that it may be useful to explicitly examine links between mothers’ and home visitors’ personality traits, home visitors’ feelings about the relationship, and time spent in home visits. Individuals with personalities high in negative emotionality may have difficulty sustaining the type of positive relationship that has been advanced as fundamental to successful home-visiting models, whereas individuals high in positive emotionality may find it easy to establish and sustain the requisite trust and interpersonal coordination. Accordingly, we hypothesized that home visitors’ feelings about their relationships with individual mothers mediates connections between home visitors’ and mothers’ personality characteristics and time spent in home visits. In other words, we expected to see that home visitors’ and mothers’ personality traits predict relationship quality, which, in turn, predicts home visiting time.
Because individual personality traits give a more specified understanding of personality-home visiting associations than superfactors, we examined relations between components of the Positive Emotionality and Negative Emotionality superfactors and relationship quality and amount of home visit time. The personality instrument administered to participants was Tellegen's (1982) Multidimensional Personality Questionnaire, form NZ (MPQ). We were interested in the Stress Reaction, Alienation, Social Potency, Well-Being, Social Closeness, Achievement, and Control subscales.
The Stress Reaction scale measures an individual's tendencies to worry and to feel nervous and vulnerable in everyday situations. The Alienation scale indexes the individual's propensity to view others with suspicion and mistrust. High Social Potency scores indicate propensities to assume leadership roles and to desire to influence others. High Well-Being scorers are disposed toward cheerfulness and seeing positive aspects of life. High Social Closeness scores denote propensities to enjoy being with people and to turn to people when comfort is needed. The Achievement scale measures tendencies to enjoy demanding work and to be persistent. The Control scale assesses planfulness, reflectiveness, and cautiousness.
We hypothesized that mother-home visitor relationship quality and time spent in home visiting would be negatively associated with home visitors’ and mothers’ scores on the Stress Reaction and Alienation scales, and positively associated with their scores on the Social Potency, Well-Being, Social Closeness, Achievement, and Control subscales. Stress Reaction and Alienation are included in the higher-order Negative Emotionality superfactor (Tellegen & Waller, in press). Following from the above-mentioned findings that negative emotionality is associated with difficulty in establishing and maintaining intimate relationships, we reasoned that it may also predict problems in other types of relationships, such as those between home visitors and mothers. Similar reasoning was behind our hypothesis that home visitors’ and mothers’ Well-Being and Social Closeness scores would be positively associated with relationship satisfaction and time spent in home visits; the research evidence reviewed above points to positive relations between positive emotionality (of which Well-Being and Social Closeness are components) and relationship satisfaction.
In addition, we hypothesized that home visitors’ and mothers’ Social Potency and Achievement scores would be positively associated with relationship quality and time spent home visiting. We reasoned that home visitors with these personality tendencies would want to meet program performance standards, would want to help (i.e., influence) families achieve their goals, and would be willing to dedicate time to this effort. We expected the same of mothers with these traits inasmuch as they might view home visits as a vehicle for personal progress. Similarly, we expected Control to be positively associated with relationship quality and home visit time because propensities to be planful and reflective would seem to predict thoughtful organization and accomplishment of work-related tasks (including the relationship building and investment of time necessary for home visit success).
Method
Participants
The participants included 41 African-American, first-time mothers. The mothers were part of a larger study that included 82 mothers who were enrolled in an Early Head Start program in a large, Midwestern city. The current sample was limited to the mothers with complete data on the instruments used in the present analyses. Compared to mothers not included in the present study, the mothers in our sample did not differ on any of the personality subscales except Social Potency, in which case mothers in the sample scored significantly higher than mothers excluded due to incomplete data. (However, Social Potency was unrelated to time spent in home visits.) Most of the mothers were in their late teens or early 20s (M = 19.3 years, SD = 3.1) and had limited education (50 percent did not have a high school degree or GED). The majority of mothers (96 percent) were unmarried and received some type of public assistance (e.g., Medicaid/Medicare [85 percent]; food stamps [50 percent]; AFDC [31 percent]; WIC [88 percent]). Mothers were served by one of five home visitors, four females and one male.
Procedure
Research assistants administered a battery of instruments to mothers, including the personality questionnaire, in their homes when mothers’ infants were 6 or 12 months old. (Time of administration was unrelated to personality scores.) After each home visit, home visitors recorded the length of the visit. Three years after the program began, home visitors completed questionnaires tapping their own personality characteristics and perceptions of the quality of their relationships with each mother in their caseload.
Measures
Personality. The Multidimensional Personality Questionnaire, Form NZ (MPQ) (Tellegen, 1982) is a measure of “normal” personality characteristics. The MPQ has 10 subscales that tap affective, cognitive, and behavior dimensions of respondents’ personalities. Higher scores indicate higher levels of the specified personality dimension. For the current study, we used seven of the scales: Stress Reaction (alpha = .89), Alienation (alpha = .82), Social Potency (alpha = .60), Well-Being (alpha = .81), Social Closeness (alpha = .78), Achievement (alpha = .56), and Control (alpha = .68). (All alphas are based on mothers' scores.)
Working Alliance. The Working Alliance Inventory (WAI) (Short form), developed by Horvath and Greenburg (1989), assesses the working relationship between a client and clinician. For the present study, the WAI wording was modified to refer to the relationship between parents and home visitors. The WAI emphasizes the level of mutuality between the parent and the home visitor Although the WAI is comprised of three subscales, we used only the Bond subscale because it most adequately captures perceived relationship quality. Bond measures mutual attachment between the mother and home visitor, including trust, acceptance and confidence (sample item: I feel that [mother’s name] appreciates me”). Responses range from 1 (never) to 7 (always) with higher scores indicating higher quality relationships.
Participation in home visiting. Participation in visits, operationalized as the mean number of minutes spent with each mother per month, based on three months to two years of visits, served as the dependent variable. Mean participation time was 106 minutes (SD = 42.9). Participation information was obtained by examining home visit records for each family.
Results
A primary goal of the present study was to test hypotheses that the quality of mothers’ and home visitors’ relationship mediates links between personality characteristics and home visit participation. Support for the hypothesis of statistical mediation would require evidence that (a) personality and home visit participation are significantly related, (b) personality and relationship quality are significantly related, and that (c) the relation between personality and home visit participation is substantially reduced when relationship quality is partialled out (Baron & Kenny, 1986).
To test our hypotheses, we had to consider the fact that, because each home visitor was assigned to multiple mothers, data were nested (i.e., structured hierarchically with mothers nested within home visitor caseloads). It is recommended that an estimate of within-group similarity relative to between-group similarity be calculated when data are arranged in nested fashion. In the present case, within-group similarity refers to homogeneity within caseloads and between-group similarity refers to homogeneity between caseloads. The question asked, in other words, is whether mothers assigned to the same home visitor are more similar to one another than mothers assigned to different home visitors. Therefore, an intraclass correlation coefficient (ICCs; p) was computed to estimate the proportion of variance in participation scores accounted for by the home visitor level. The results indicated that the intraclass correlation coefficient for participation scores was .07, suggesting there was more similarity in maternal participation scores within caseloads than between caseloads. Stated differently, mothers in the same caseload had more similar participation scores than did mothers with different home visitors. This result provided evidence that an analytic method that accounts for structured data should be used. Consequently, hierarchical linear modeling (HLM) was used. HLM is a statistical procedure that takes such complex patterns into account (Bryk & Raudenbush, 1992).
Maternal and Home Visitor Personality as Predictors of Home Visit Participation
A series of random effects HLM models were conducted to investigate whether maternal and home visitor personality variables predicted home visit participation rates. Specifically, seven separate models were run, one for each personality subscale. In each model, maternal personality score was a level 1 variable and home visitor's personality score was a Level 2 variable.
The findings indicated that four maternal and two home visitor personality characteristics were significant predictors of participation. Specifically, maternal personality-based achievement striving, F (1, 34) = 4.93, p = .03, and desire for control, F (1, 35) = 5.62, p = .02, were negatively related to home visit participation. Maternal Stress Reaction, F (1, 34) = 5.24, p = .03, and Alienation, F (1, 34) = 6.87, p = .01, on the other hand, were positive predictors of participation. Maternal Social Potency, Well-Being, and Social Closeness were unrelated to participation. With regard to level two variability, both home visitors' higher Well-Being scores, F (1, 34) = 7.18, p = .01, and lower Stress-Reaction, F (1, 34) = 3.06, p = .08, scores predicted increased home visit participation. Home visitor Alienation, Social Potency, Social Closeness, Achievement, and Control scores were unrelated to participation. For subsequent analyses involving personality, only subscales that were significantly related to participation were used.
Maternal And Home Visitor Personality As Predictors Of Relationship Quality
Next, random effect HLM models were conducted to test the association between the four maternal personality traits that were related to participation (specifically, Achievement, Control, Stress Reaction, and Alienation) and home visitors’ ratings of the quality of the relationships between themselves and mothers (i.e., the Bond subscale of the WAI). Results indicated that maternal Stress Reaction, F (1, 33) = 4.2, p = .05, and Alienation, F (1, 33) = 6.45, p = .02, were positively related to home visitor's assessment of relationship quality.
In a similar manner, HLM models were also run analyzing the relationship between the two home visitor personality characteristics that were related to participation (Well-Being and Stress Reaction) and relationship quality. No significant effects were found. Thus the hypothesis that relationship quality mediates links between home visitor personality and participation was not supported.
Relationship Quality As A Mediator Of Maternal Personality-Participation Links
Tests of the hypothesis that relationship quality mediates links between maternal personality and participation required one more set of analyses. This final step in testing statistical mediation required that maternal personality and home visitor relationship quality be run as simultaneous predictors of participation. Two separate models were conducted, one for maternal Stress Reaction and one for maternal Alienation.
In both models, maternal personality and relationship quality were no longer significant predictors of participation. The reduction in the significance of the relation between the independent and dependent variables when the mediator was added to the model would seem to suggest that statistical mediation exists. However, because the mediator was also not significantly related to participation, such a conclusion cannot be reached. We had to conclude that relationship quality did not mediate relations between maternal personality and home visit participation.
Though the results showed no mediational effect, we thought it important to further explore the data by testing whether home visitors' assessment of relationship quality, when entered separately, predicts participation. Results indicated that home visitor reports of the relationship were indeed related to home visit participation scores, F (1, 40) = 6.82, p = .01. Given that maternal personality and relationship quality were both significant predictors of participation when entered separately, it seems likely that low statistical power made it difficult to detect significant results when they were entered simultaneously.
Discussion
In response to low participation rates in home visit programs, and a dearth of research explaining this phenomenon, the purpose of the current study was to examine personality and mother-home visitor relationship quality as predictors of home visit participation. We speculated that the quality of the home visitor-mother bond would mediate associations between personality and home visit participation. Though the findings did not support our mediational hypotheses, they did indicate that mother and home visitor personality are linked to home visit participation, maternal personality predicts mother-home visitor relationship quality, and that mother-home visitor relationship quality is related to home visit participation.
Four maternal and two home visitor personality characteristics predicted home visit participation. Specifically, maternal personality traits reflecting orientations toward control and achievement were negatively related to home visit time. Conversely, maternal tendencies to be stress-prone and to feel vulnerable and/or taken advantage of (i.e., high Stress Reaction and Alienation scores) were positive predictors of participation scores. Interestingly, home visitor ratings of bond quality were also positively linked to maternal Stress Reaction and Alienation.
One explanation for these findings may be related to how home visitors perceived the needs of mothers in their caseloads. Perhaps home visitors thought home visits are especially important for mothers who are low in planfulness and achievement-striving and who are highly stressed because the services come to the mothers; they do not have to exercise as much initiative to obtain them. Further, if home visitors perceived planful, achievement-oriented mothers as more able to meet their own needs, they may have made fewer attempts to reschedule cancelled visits or to reach mothers when work schedules preclude easy access. Perhaps home visitors tended to think that such mothers would call when they needed visits. Less planful, achievement-oriented mothers might have been perceived as needing the home visitors’ assertive initiation.
Along the same lines, mothers who showed more negative emotionality (higher Alienation and Stress Reaction scores) may have elicited reactions from home visitors that resulted in more and longer visits. Stress-proneness combined with (or partially caused by) the stressors inherent in poverty circumstances would likely lead to “crises” needing a response. In this situation, these mothers may have presented as more needful to home visitors, thereby contributing to higher participation rates. Our findings that maternal Stress Reaction and Alienation scores predicted relationship quality support this notion. With more issues to work on, highly stress-prone mothers may have been more likely to draw the home visitors into personal relationships.
Interestingly, some mothers appear to have been aware of the connection between perceived neediness and provision of services. One mother in this study who was also a participant in a related qualitative study answered our question about Early Head Start by telling us that, “Well, it’s all good but I think you really have to be in a position where you need a lot of help to really get the full benefit of the program.” An alternative explanation comes from anecdotal data that suggest home visits are more difficult to complete with working mothers. It would seem plausible that mothers who are high in control and achievement-orientation, and low in Stress Reaction and Alienation, are more likely to be have sustained employment than are other mothers. The logistical challenge of scheduling visits with such mothers, who are perhaps more likely to work long hours, may interfere with home visiting. One mother who was rarely contacted by her home visitor seemed to accept the home visitor's explanation that she was difficult to reach and didn't need much help anyway. This mother told us that, "I don't see [my home visitor] that much. Right now I don't have time to see her. I've been working overtime. I mean she helped me when I was looking for a job. I don't really need any help with this other stuff." The "other stuff" included parenting and college enrollment issues. Along similar lines, Cole, Kitzman, Olds & Sidera (1998) found that mothers with more problematic intrapersonal skills received more visits from nurse home visitors than higher-functioning mothers. Future studies should investigate the extent to which the amount of stress, or extent of unmet need, experienced by mothers moderates relations between personality and home visit participation.
Home visitor characteristics also helped explain home visit participation rates. In terms of emotionality, the pattern was opposite that of mothers. Home visitor satisfaction with life (higher scores for Well-Being) and low levels of irritability (lower scores for Stress-Reaction) were positively associated with home visit participation. Perhaps these characteristics are related to home visitors' skills in establishing relationships. In addition, it may be that a personality given to positive emotionality is especially important for social service providers whose work takes them into high stress situations. Individuals prone to negative emotionality may find the difficult circumstances of parents such as those in our low-income sample overwhelming. Lower home visit participation may reflect conscious or unconscious desires on the part of home visitors to avoid upsetting themselves. It may be easier for individuals prone to more positive emotionality (as reflected in high Well-Being and low Stress-Reaction scores) to cope with these situations.
Though home visitor assessment of relationship quality did not mediate relations between personality and participation, the link between home visitor assessment of relationship quality and participation merits discussion. The finding is in accord with research showing positive associations between client-therapist perceptions of ability to connect and satisfaction with psychotherapy (Bordin, 1979; Horvath & Greenberg, 1989). It also supports the notion that the success of home visiting interventions depends on the bond between home visitors and parents (Barnard, 1998; Klass, 1996; Wasik et al., 1990). Two implications for practice flow from this study. First, our findings suggest that the needs of mothers who seem to have fewer problems than other mothers may be overlooked in home visiting programs. Particularly in low-income populations, even mothers who are functioning relatively well are likely to benefit from assistance with a variety of life issues, including those related to child development and parents’ education and employment. While some families may need more service than others, staff should be careful to attend to the needs of families who are not in crisis.
In addition, because home visitors indicating overall higher well-being and less stress tended to have higher participation rates than their counterparts, the issue of work environment needs to be addressed. Perhaps program supervisors and administrators need to attend to the stressful conditions home visitors are exposed to and place emphasis on minimizing such conditions and/or helping home visitors cope with the inevitable stressors of their jobs. A system of reflective supervision wherein the home visitor has a supportive relationship with the supervisor may decrease the stressful impact of working with families in poverty. Implementing an employee feedback system whereby home visitors could comment on aspects of their work conditions that induce stress and that, conversely, are conducive for productivity may provide a helpful beginning. Such in-house evaluations have been recommended by other researchers of home visiting programs (The David and Lucile Packard Foundation, 1999).
A limitation of our research concerns the number of analyses conducted. According to Bonferroni's correction, only p values < .01 should be considered significant. However, given the exploratory nature of our study, we consider it more important to possibly risk Type 1 error than to lose the potential for important findings via Type 2 error. Another limitation is related to the small number of mothers, and especially home visitors, in our sample. Future research on larger samples may help determine, for example, if the lack of support for our mediational hypotheses was due to low statistical power. However, the fact that some reliable results were found despite the sample size suggests that those predictors that did emerge as significant are indeed related to home visit participation.
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