Mother-child interactions and the associations with child healthcare utilization in low-income urban families

Cross-sector Collaboration Between Public Health, Healthcare and Social Services Improves Retention: Findings from a Nurse Home Visiting Program

The study aimed to examine the association between cross-sector collaboration in Nurse-Family Partnership (NFP), a model home visiting program, and participant retention. We used the 2018 NFP Collaboration Survey that measured agency-level collaboration, operationalized as relational coordination and structural integration, among nine community provider types (including obstetrics care, substance use treatment, child welfare). This dataset was linked to 2014-2018 NFP program implementation data (n = 36,900). We used random-intercept models with nurse-level random effects to examine the associations between provider-specific collaborations and participant retention adjusting for client, nurse, and agency characteristics. The adjusted models suggest that stronger relational coordination between nurses and substance use treatment providers (OR:1.177, 95% CI: 1.09-1.26) and greater structural integration with child welfare (OR: 1.062, CI: 1.04-1.09) were positively associated with participant retention at birth. Stronger structural integration between other home visiting programs and supplemental nutrition for women, infants, and children was negatively associated with participant retention at birth (OR: 0.985, CI: 0.97-0.99). Structural integration with child welfare remained significantly associated with participant retention at 12-month postpartum (OR: 1.032, CI: 1.01-1.05). In terms of client-level characteristics, clients who were unmarried, African-American, or visited by nurses who ceased NFP employment prior to their infant's birth were more likely to drop out of the NFP program. Older clients and high school graduates were more likely to remain in NFP. Visits by a nurse with a master's degree, agency rurality, and healthcare systems that implement the program were associated with participant retention. Cross-sector collaboration in a home visiting setting that bridges healthcare and addresses social determinants of health has potential to improve participant retention. This study sets the groundwork for future research to explore the implications of collaborative activities between preventive services and community providers.

Personal, environmental, and family factors of participation among young children

OBJECTIVE

The purpose of this study is to assess the influences of environment, population characteristics, and service utilization on participation frequency and involvement in the home setting among children 0 to 5 years.

METHOD

Data were collected from parents of 236 children (mean age 3 years and 5 months, SD = 1.30, girls = 152 and boys = 84) using a children's treatment centre in Ontario through an online survey. Two path models measuring home frequency and home involvement were assessed using structural equation modelling. The exogenous factors in the models included child's age, child's sex, child's complexity, number of environmental barriers, income, mother's participation, and service utilization. In addition to participation as the primary outcome, each model explored predictors of service utilization and mother's participation.

RESULTS

The involvement model (R²  = 0.46) explained more variance than the frequency model (R²  = 0.33). Age (0.35, P < 0.001) and barriers (0.07, P = 0.001) predicted participation frequency in the home, χ² (9) = 8.51, P < 0.4, root mean square error of approximation (RMSEA) = 0.00, comparative fit index (CFI) = 1.00. The home involvement model, χ² (6) = 9.79, P < 0.13, RMSEA = 0.06, CFI = 0.97, showed that increasing age (0.09, P < 0.001), lower complexity (0.13, P = 0.001), and higher mother's participation (0.057, P = 0.001) were significantly related to higher participation. An increase in child's age or complexity significantly influenced service utilization across both models. Complexity reduced mother's participation in both the frequency and involvement models.

CONCLUSIONS

This study is one of the first in Canada to examine participation of young children. The aggregation of each unit factor, particularly barriers and complexity, can accrue a large impact on the child's and mother's participation. The potential to mediate this impact by removing environmental barriers and promoting mother's participation merits further study.

The relationship between responsive caregiving and child outcomes: evidence from direct observations of mother-child dyads in Pakistan

BACKGROUND

Responsive caregiving, or interactions in which caregivers give appropriate responses to a child's signals, is linked to improved psychosocial, cognitive and physical outcomes in children. However, much remains unknown about how responsive caregiving affects child development across cultural and socioeconomic contexts. The purpose of this study is to examine predictors of maternal responsive caregiving and investigate how these interactions are associated with children's development.

METHODS

Data for the current analyses came from a longitudinal study designed to follow mothers from the third trimester through the first three years of the child's life. To assess responsive caregiving, the Observation of Mother-Child Interaction (OMCI) measure was used to examine maternal and child behaviors during a 5-min picture book activity at 24 months. Outcomes included child height-for-age z-score and child socioemotional development, using the Ages and Stages Questionnaire-Socioemotional (ASQ-SE) in which lower scores demonstrated better development. Using mean comparisons, the effects of baseline sociodemographic factors and maternal depression on responsive caregiving were tested. Analyses utilized hierarchical linear regressions to examine cross-sectional associations between responsive caregiving and child development outcomes at 24 months. Additional analyses controlled for the Home Observation for Measurement of the Environment (HOME), a common measure in low-income contexts of caregiving, to assess whether OMCI was uniquely predictive of child outcomes.

RESULTS

Higher maternal education attainment, lower number of children, greater socioeconomic assets, and lack of maternal depression were associated with higher levels of observed responsive caregiving behaviors. Higher total OMCI scores were associated with positive child socioemotional outcomes in adjusted models (β: -0.84, 95% CI [- 1.40, - 0.29]). The finding was statistically significant, even after controlling for HOME score (β: -0.83, 95% CI [- 1.38, - 0.27]). There was no association between OMCI scores and child linear growth.

CONCLUSIONS

Responsive caregiving is linked to positive child socioemotional development in rural Pakistan. Our findings suggest that incorporating responsive caregiving into child health interventions in LMIC may have valuable impacts on child socioemotional development. The OMCI may be useful in identifying important pathways for change to responsive caregiving behaviors and may be of service for future interventions that optimize child development through responsive caregiving.

TRIAL REGISTRATION

NCT02111915 (09/18/2015); NCT02658994 (01/22/2016). Trials were prospectively registered.

Parenting Stress and Maternal-Child Interactions Among Preschool Mothers From the Philippines, Korea, and Vietnam: A Cross-Sectional, Comparative Study

BACKGROUND

To promote child development, parenting stress, and maternal-child interactions among mothers of various nationalities must be understood. The purpose of this study was to investigate maternal-child interactions according to the mother's nationality among married immigrant mothers from the Philippines, Vietnam, and Korea.

METHOD

This study employed a descriptive, cross-sectional design. Inclusion criteria were mothers who had children of preschool age.

RESULTS

A total of 348 mothers were interviewed: 142 Korean mothers, 84 immigrant mothers from the Philippines, and 122 immigrant mothers from Vietnam. Parenting stress ( p < .001) and maternal-child interactions ( p = .023) differed according to the mother's nationality.

CONCLUSIONS

By delineating the nurturing characteristics of each country, the results of this study can help immigrant mothers develop maternal-child relationships that aid culturally congruent adjustment to their new culture.

IMPLICATIONS FOR PRACTICE

The characteristics of maternal-child interactions according to the mother's nationality may inform parent education in multicultural societies.

Exploring urban health in Cape Town, South Africa: an interdisciplinary analysis of secondary data

BACKGROUND

With modern information technology, an overwhelming amount of data is available on different aspects of societies. Our research investigated the feasibility of using secondary data sources to get an overview of determinants of health and health outcomes in different population strata of Cape Town, a large city of South Africa.

METHODS

The methodological approach of secondary-data analysis was similar in the different disciplines: Biological Anthropology, Public Health, Environmental Health, Mental Health, Palliative Care, Medical Psychology and Sociology at the University of Freiburg and Public Health at the University of Cape Town. The teams collected information on Cape Town through Internet searches and published articles. The information was extracted, analyzed, condensed, and jointly interpreted.

RESULTS

Data show the typical picture of a population in epidemiological and demographic transition exposed to often difficult social, mental, and physical environmental conditions. Comparison between low and higher socioeconomic districts demonstrated that the former had higher air pollution, poorer water quality, and deficient sanitary conditions in addition to sub-optimal mental health services and palliative care.

CONCLUSION

Although important information gaps were identified, the data draw attention to critical public health interventions required in poor health districts, and to motivate for pro-equity policies.

Maternal depressive symptoms and healthcare expenditures for publicly insured children with chronic health conditions

This study estimated the prevalence of maternal depressive symptoms and tested associations between maternal depressive symptoms and healthcare utilization and expenditures among United States publicly insured children with chronic health conditions (CCHC). A total of 6,060 publicly insured CCHC from the 2004-2009 Medical Expenditure Panel Surveys were analyzed using negative binomial models to compare healthcare utilization for CCHC of mothers with and without depressive symptoms. Annual healthcare expenditures for both groups were compared using a two-part model with a logistic regression and generalized linear model. The prevalence of depressive symptoms among mothers with CCHC was 19 %. There were no differences in annual healthcare utilization for CCHC of mothers with and without depressive symptoms. Maternal depressive symptoms were associated with greater odds of ED expenditures [odds ratio (OR) 1.26; 95 % CI 1.03-1.54] and lesser odds of dental expenditures (OR 0.81; 95 % CI 0.66-0.98) and total expenditures (OR 0.71; 95 % CI 0.51-0.98). Children of symptomatic mothers had lower predicted outpatient expenditures and higher predicted expenditures for total health, prescription medications, dental care; and office based, inpatient and ED visits. Mothers with CCHC were more likely to report depressive symptoms than were mothers with children without chronic health conditions. There were few differences in annual healthcare utilization and expenditures between CCHC of mothers with and without depressive symptoms. However, having a mother with depressive symptoms was associated with higher ED expenditures and higher predicted healthcare expenditures in a population of children who comprise over three-fourths of the top decile of Medicaid spending.

The development and reliability of an observational tool for assessing mother-child interactions in field studies- experience from Pakistan

BACKGROUND

This study describes the development and reliability testing of an observational tool to measure mother-child interactions with toddlers aged 2 years in a rural low-income country setting.

METHODS

The development protocol comprised five phases with iterative revisions: (1) identification of the theoretical framework for responsive behaviours and selection of items; (2) field testing; (3) expert review; (4) training of the data collection team; and (5) piloting. The final tool was a structured live observational measure assessing a 5-min interaction of a shared picture-book-reading activity. Maternal behaviours assessed included affect, touch, verbal statements and language stimulation; child behaviours assessed included affect, communication and attention.

RESULTS

Following development, the mother-child interaction tool was administered on a cohort of 1390 children at 2 years of age. Using a video strategy, inter-observer reliability assessed by the Bland-Altman test for mother-child dyads suggested moderate agreement between expert and field assessors on total scores (r = 0.681**, P < 0.001, n = 154). Significant associations of the total interaction score correlations using Pearson's' correlations were found with the Responsiveness (r = 0.271**, P < 0.001, n = 1345) and Involvement (r = 0.325**, P < 0.001, n = 1345) subscales of the Home Observation for Measurement of Environment-Infant Toddler Inventory, maternal knowledge (r = 0.203**, P < 0.001, n = 1345), maternal depression (r = .-063**, P < 0.001, n = 1345), child cognitive development (r = 0.392**, P < 0.001, n = 1345) and language development (r = 0.620**, P < 0.001, n = 1345) assessed using the Bayley Scales for Infant and Toddler Development, Third Edition.

CONCLUSION

The authors conclude that this tool can be reliably used by trained assessors to measure mother-child interactions in field studies.

Caregiver depression and perceptions of primary care predict clinic attendance in head start children with asthma

OBJECTIVE

The purpose of this study is to evaluate the mediating role of perceptions of primary care (PC) on the association between depression and PC clinic attendance among caregivers of children with asthma. In adults, depression is associated with lower PC clinic attendance and ∼25% of mothers presenting to a pediatric PC clinic will screen positive for depression. Adults' perceptions about their medical care mediate the depression-clinic attendance relation, but this has not been tested in children or in an asthma population.

METHODS

This is a secondary prospective data analysis of 141 caregivers of Head Start children diagnosed with asthma, offered an intervention to reduce barriers to PC. Caregivers rated their depressive symptoms and perceptions of PC (access, provider contextual knowledge, and continuity of care) at baseline. PC clinic attendance was tracked prospectively for 6-months.

RESULTS

At baseline, 26% of caregivers screened positive for depression. Within 6-months, 66% of children attended a PC appointment. A positive depression screen was not associated with PC attendance (p = 0.07) or continuity of care (p = 0.98) but was inversely associated with perceptions of both access (p = 0.03) and provider contextual knowledge (p = 0.02). Though the total indirect effect was not significant, the specific indirect effect of depression on PC attendance through access was significant (95% CI: 0.01, 0.68).

CONCLUSIONS

Providing tangible resources to reduce barriers to PC without addressing perceptions of access may not sufficiently improve PC clinic attendance in pediatric asthma. Screening caregivers for depression may identify families requiring targeted interventions to improve their perceptions of access.