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When Maggie Holland, Ph.D., MPH was in graduate school studying health disparities, she had an idea: Wouldn’t it make sense to start reducing the impact and the likelihood of further disparities early in an individual’s life? As she continued her education, and, eventually, began her career, she has found that, more often than not, the answer is yes.

Dr. Holland, whose work continues to focus on maternal and child health, has found that it is typically more effective and less expensive to prevent problems rather than to treat them later. Her research has now earned her a prestigious grant from the , one of the in the U.S. Department of Health and Human Services. It is the second NIH grant in the University’s history. (Her colleague, Karl Minges, Ph.D., MPH, earned one in 2021 for his research focused on skilled nursing facilities).

“This being the second NIH grant in the University's history adds to University's experience with health-related research and builds on our standing in federally funded research,” said Dr. Holland, an assistant professor in the Department of Population Health and Leadership who is beginning her second academic year at the University this fall. “For me, it was great to receive this as I was starting out at the University so that I can get my research program established here.”

‘Fill an important gap in the literature’

The award, for nearly $70,000 each year for two years, is an R03 grant. The NIH awards these grants to support small research projects that can be carried out in a short period of time with limited resources.

“We are excited about Dr. Holland receiving this prestigious R03 grant from the National Institutes of Health,” said Betsy Francis-Connolly, Ph.D., dean of the School of Health Sciences whose own research has focused on mothering. “This is the first NIH R03 that a faculty member in the School of Health Sciences has received.”

"Dr. Holland’s research focusing on telehealth visits with new mothers is both important and timely."Dr. Francis-Connolly (Dean, School of Health Sciences)

Dr. Holland’s research, titled "Telehealth in home visiting for new mothers: Are outcomes different if the first visits are in person?," will focus on home visiting, an evidence-based strategy to support and improve the lives of new parents. Through developing a close relationship with families from pregnancy to a child’s 2^nd birthday, a home visitor offers support that, says Dr. Holland, can offer meaningful benefits, from improved child school readiness to reduced child abuse and neglect. The impact is so great, she says, that home visiting saves society money, supporting federal funding for programs.

“Dr. Holland’s research focusing on telehealth visits with new mothers is both important and timely,” said Dr. Francis-Connolly. “The U.S. is woefully behind other developed countries in supporting new mothers and families, and her research will fill an important gap in the literature on whether the use of telehealth visits with new mothers makes a difference in outcomes for mothers and children.”

‘Allowing flexibility...has helped with retention’

While home-visiting programs have been successful, some healthcare professionals are now taking a second look at what home visiting might look like following the pandemic. Before that, telehealth was only used after the relationship between the home visitor and the family was already established. Healthcare professionals believed that in-person meetings helped establish a better relationship between home visitors and families. But, says Dr. Holland, there is little direct evidence to support this, and she wondered if this might merit further research.

As part of her study, Dr. Holland is examining data from just before and during the pandemic, comparing how home visiting helped families who had those early visits in-person and those who did not. This, she hopes, will enable programs to decide whether they should allow telehealth to continue for early visits, or if they should resume the earlier practice of having them in-person.

“Allowing telehealth during early visits may help some families participate in the program who otherwise might not, if, say, it is difficult for them to attend in-person,” she explains. “It may also help the home visitors because they can save travel time between families, which is especially long in rural communities. Allowing flexibility in other aspects of the visits, such as timing and location, has helped with retention, which is an issue in many programs.”

‘A really big opportunity for me’

The research is enabling Dr. Holland to mentor students as they gain hands-on research experience while learning about everything from home visiting to data management. It has offered students such as Drishtant Regmi ’23 M.S. a unique opportunity to apply what they’ve learned in the classroom in the real world.

“Even though I had some corporate working experience, I was pretty new to research,” he said. “Working with Dr. Holland was my first research experience, and that helped me understand the life cycle of a research project, deliverables, timelines, and my responsibilities as a researcher. This was a great opportunity, as it covered two topics I was interested in: health and data.”

A candidate in the University’s graduate program in data science, Regmi has played an active role in the data analysis and management of the data. He has also been learning about manuscript writing and editing.

“Even though I was an engineering student working for the health department, I had responsibilities that centered around data,” he said. “Handling confidential health data information and being able to work on it was a really big opportunity for me, and it will definitely help in my career in the future.”

Specifically, Regmi and Dr. Holland are focusing on the , a national program that connects nurses with mothers expecting their first child. They are analyzing the data obtained from the NFP’s National Services Office. These data are regularly collected on every family in the program nationwide – more than 200 sites in all. Dr. Holland hopes their work will help home-visiting programs to reach even more families and to enhance their services.

“The NFP National Service Office has been very supportive of our efforts,” said Dr. Holland, who also has expertise in child abuse and neglect-prevention research. “Without their support and cooperation, this project would not be possible.”