Pediatric provider perspectives and practices regarding health policy discussions with families: a mixed methods study

Perspectives from parents and clinicians on an ecology-focused approach to a group well-child care

BACKGROUND

Group well-child care (GWCC) is a novel group-based alternative for pediatric primary care visits that may allow for adaptations that better tailor to the needs of underserved populations. This qualitative study investigates clinician and parent perspectives on the acceptability and feasibility of integrating ecology-focused content in GWCC using semi-structured interviews with GWCC parent-graduates and ecology-focused child clinicians.

METHODS

Ecology-focused child clinicians were purposively sampled via email outreach. GWCC parent graduates were recruited via announcement in private Facebook groups. One-on-one interviews were conducted via videoconference, transcribed, and analyzed using an inductive approach. Parent and clinician thematic analyses were independently conducted to construct shared domains.

RESULTS

Nine GWCC parent-graduates and nine ecology-focused child clinicians were recruited into the study. Four overarching themes were constructed across parent and clinician responses: questions about clinical appropriateness, parent and clinician desires for educational support, influences of perceptions of nature on clinicians, and parent desires to develop independence and autonomy.

CONCLUSION

This study identified nuanced considerations from the perspective of parents and clinicians for the implementation of ecology-focused content in the GWCC setting. Understanding the range of preferences parents and clinicians may have over ecology-focused content can help GWCC clinicians in designing ecology-focused preventive counseling materials.

A Qualitative Study of Caregiver Perspectives on Health Policy Discussions Initiated by Pediatricians

BACKGROUND AND OBJECTIVE

Prior studies suggest that pediatricians believe discussing health policy issues with families is important. Caregiver preferences on these discussions, however, have not been examined. We explored circumstances in which caregivers may be receptive to discussing health policy issues with pediatricians.

METHODS

We conducted 26 semistructured interviews with mostly Black female caregivers at 3 urban academic pediatric primary care practices. Using both structured and open response questions, we explored 4 primary content areas: 1) caregivers' perspectives on discussing health policy issues in pediatricians' offices; 2) which health policy topics caregivers may prefer to discuss; 3) factors that render policy discussions in the clinic inappropriate to caregivers; and 4) which communication modalities caregivers prefer. Interview transcripts were coded and analyzed using content analysis.

RESULTS

Themes that emerged from interviews included: 1) pediatricians are perceived as trusted information sources on health policy; 2) caregivers want to talk with pediatricians about children's health insurance policy changes; 3) time constraints are a barrier to health policy discussions; 4) caregivers prefer to discuss health policy topics during well-child visits; 5) caregivers want the option to opt-out of these conversations; 6) preferred modalities for communicating about health policy issues, including printed materials and health fairs or educational events.

CONCLUSIONS

Caregivers expressed a satisfactory view of pediatricians discussing directly relevant health policy issues, including congressional debates on health insurance, in the primary care setting. Our findings highlight other caregiver preferences for engaging families in health policy discussions, including the timing of these conversations.

Associating school doctor interventions with the benefit of the health check: an observational study

BACKGROUND

The benefits of school doctor interventions conducted at routine general health checks remain insufficiently studied. This study explored the associations of school doctor interventions with the doctor-evaluated and parent-evaluated benefits of routine health checks.

METHODS

Between August 2017 and August 2018, we recruited a random sample of 1341 children from grades 1 and 5 from 21 Finnish elementary schools in 4 municipalities. Doctors routinely examined all children, who were accompanied by parents. The doctor-reported interventions were categorised into six groups: instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals and referrals to specialised care. Doctors evaluated the benefit of the appointment using predetermined criteria, and parents provided their subjective perceptions of benefit. Interventions and reported benefit were compared using multilevel logistic regression.

RESULTS

Doctors reported 52% and parents 87% of the appointments with interventions beneficial. All interventions were independently associated with doctor-evaluated benefit (ORs: 1.91-17.26). Receiving any intervention during the appointment was associated with parent-evaluated benefit (OR: 3.25, 95% CI 2.22 to 4.75). In analyses of different interventions, instructions and/or significant discussions (OR: 1.71, 95% CI 1.20 to 2.44), prescriptions (OR: 7.44, 95% CI 2.32 to 23.91) and laboratory tests and/or medical imaging (OR: 3.38, 95% CI 1.34 to 8.55) were associated with parent-evaluated benefit. Scheduled follow-up appointments and referrals to other professionals showed no significant association with parent-evaluated benefit.

CONCLUSIONS

Doctors and parents valued the appointments with interventions. Parents especially appreciated immediate help and testing from the doctor.

TRIAL REGISTRATION NUMBER

NCT03178331.