Examination of a Measure to Assess Clients’ Perceptions of the Client-Provider Relationship in Home Visiting Services

Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Amy Damashek, Ph.D.

Second Advisor

Amy Naugle, Ph.D.

Third Advisor

Scott Gaynor, Ph.D.

Fourth Advisor

Catherine Kothari, Ph.D.


Home visiting services are prevention-or intervention-based programs provided to caregivers during the prenatal period through the first few years of a child’s development (Shonkoff & Phillips, 2000). Engagement in services is documented to improve caregivers’ knowledge of child development and parenting practices (e.g., home safety, nutrition; Ammerman et al., 2006). Despite these benefits, programs are challenged with high levels of attrition (Gomby, Culross, & Behrman, 1999). One reliable predictor of client engagement in services is the client-provider relationship. However, measures that have been developed to assess the clients’ perception of their relationship with their home visitor relationship are limited (Girvin et al., 2007). The present study examined the psychometric properties of the Client Perceptions of Home Visitor Questionnaire (CPHVQ), a measure developed to quantitatively assess home visiting clients’ perceptions of their provider (Damashek et al., 2018; Damashek et al., 2022). The measure was administered to clients involved in the child welfare system in Oklahoma (n = 78). The measure was subjected to an exploratory factor analysis, which did not support the existence of separate subscales; thus, the total scale score was used for subsequent analyses. The measure was found to have good internal reliability (a =.84) and test-retest reliability (a = .88). Validity analyses found a moderate correlation (r = .40) with responses on the Working Alliance Inventory – Short Form. In addition, logistic regression analyses found that the CPHVQ predicted completion of non-risk goals (e.g., individualized client goals such as increasing access to needed resources), providing evidence for predictive validity of the measure. Lastly, qualitative data were gathered to examine the impact of COVID-19 and the transition to telehealth on clients’ experience with services. Thematic analyses revealed three themes (1) use of telehealth, (2) benefits and challenges associated with telehealth, and (3) the impact of COVID-19 on clients. Generally, clients reported receiving telehealth services due to COVID-19 safety regulations, which improved accessibility to services for some while it posed challenges for others (e.g., technology issues, loss of access to resources, difficulties completing program-assigned goals). However, post-hoc analyses did not find any significant relationships between clients reported barriers related to telehealth, CPHVQ responses, or goal completion. Overall, the findings support the usefulness of the CPHVQ for assessing the client-provider relationship in home visiting services. Further research is needed to continue assessing the measure, particularly among different communities and home visiting services.

Access Setting

Dissertation-Abstract Only

Restricted to Campus until


This document is currently not available here.