Perceived social risk in medical decision-making for physical child abuse: a mixed-methods study

Abstract

BackgroundThe medical literature reports differential decision-making for children with suspected physical abuse based on race and socioeconomic status. Differential evaluation may be related to differences of risk indicators in these populations or differences in physicians’ perceptions of abuse risk. Our objective was to understand the contribution of the child’s social ecology to child abuse pediatricians’ perception of abuse risk and to test whether risk perception influences diagnostic decision-making.MethodsThirty-two child abuse pediatrician participants prospectively contributed 746 consultations from for children referred for physical abuse evaluation (2009–2013). Participants entered consultations to a web-based interface. Participants noted their perception of child race, family SES, abuse diagnosis. Participants rated their perception of social risk for abuse and diagnostic certainty on a 1–100 scale. Consultations (n = 730) meeting inclusion criteria were qualitatively analyzed for social risk indicators, social and non-social cues. Using a linear mixed-effects model, we examined the associations of social risk indicators with participant social risk perception. We reversed social risk indicators in 102 cases whilst leaving all injury mechanism and medical information unchanged. Participants reviewed these reversed cases and recorded their social risk perception, diagnosis and diagnostic certainty.ResultsAfter adjustment for physician characteristics and social risk indicators, social risk perception was highest in the poorest non-minority families (24.9 points, 95%CI: 19.2, 30.6) and minority families (17.9 points, 95%CI, 12.8, 23.0). Diagnostic certainty and perceived social risk were associated: certainty increased as social risk perception increased (Spearman correlation 0.21, p < 0.001) in probable abuse cases; certainty decreased as risk perception increased (Spearman correlation (−)0.19, p = 0.003) in probable not abuse cases. Diagnostic decisions changed in 40% of cases when social risk indicators were reversed.ConclusionsCAP risk perception that poverty is associated with higher abuse risk may explain documented race and class disparities in the medical evaluation and diagnosis of suspected child physical abuse. Social risk perception may act by influencing CAP certainty in their diagnosis.

Factors associated with not receiving HPV vaccine among adolescents by metropolitan statistical area status, United States, National Immunization Survey–Teen, 2016–2017

“…Since the data show that these parents are less likely to accept HPV vaccine for their teen(s), it may be beneficial to develop promotional messages that resonate with parents with higher levels of education, which may also include parents with higher levels of health literacy. Similar to another analysis, 33 our study also suggests that there may be room to customize interventions by MSA status. For example, in suburban areas, we might consider ways we could reach older mothers, especially those of higher socioeconomic status.…”

“…20 Results from an additional study found that non-Hispanic white parents of higher socioeconomic status were less likely to accept HPV vaccine for their children. 33 Another analysis identified not having a well-child visit and lack of provider recommendation as factors associated with noninitiation. 30 Teens in mostly rural areas were less likely to initiate HPV vaccination compared to those in mostly urban areas.…”

“…1 The 9-valent (9vHPV) vaccine, which is currently the only HPV vaccine available in the United States, provides protection against genital warts and precancerous lesions caused by HPV infection. 2 In addition, HPV vaccination is indicated for the prevention of cervical, vulvar, vaginal, and anal cancers caused by high-risk HPV types 16,18,31,33,45,52, and 58. 2 The Centers for Disease Control and Prevention (CDC) estimate that over 90% of these HPV-attributable cancers could be prevented with vaccination.…”

Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature

“…Parents who did not receive a provider recommendation were 2 times more likely to report that they did not intend to vaccinate their child in a national survey. 67 Further, health providers have been found to provide recommendations that were not strong or consistent to their patients, and were more likely to be made to females and older adolescents. 68 In order to understand vaccination rates and its effect on HPV prevalence in the United States, it is important to understand the history of vaccination policy and the ensuing barriers.…”

Parental knowledge gaps and barriers for children receiving human papillomavirus vaccine in the Rio Grande Valley of Texas

“…NIS showed that low HPV vaccine uptake (16%) was due to systemic barriers, such as lack of access to clinics during hours of operation. 58 More frequently reported barriers included vaccine misinformation, worry about safety, and lack of knowledge about the vaccine.…”