Urban, Low-Income, African American Parents' Experiences and Expectations of Well-Child Care

Abstract

Purpose: Well-child care is the foundation of pediatric health promotion and disease prevention. Primary care quality is lower for low-income and African American children compared to white children, and social determinants have an increasingly acknowledged impact on child health. Ensuring that high-quality well-child care fulfills its potential to mitigate the negative effects of social determinants on African American children is imperative. This study provides an understanding of urban, low-income, African American well-child care experiences and expectations. Design and methods: A qualitative, focus group method was used. A purposive, volunteer sample of low-income, African American parents with children birth to age five was recruited from St. Louis and Milwaukee. Focus groups were held in convenient, community sites. Data was audio-digitally recorded. Transcribed data were coded and analyzed through inductive content analysis. Results: Thirty-five caregivers, 86% females, participated in four focus groups. Categories (and sub-categories) identified include: Community factors (We want better schools, It's getting more rough where I live); Sources of parenting advice (Google it, Call your parent, Older remedies); System challenges (Cost, Frequent new faces, Politics); Challenges with providers (Couldn't help me, Missed something important, Treated differently, Are you really listening?); Anticipatory guidance (Breastfeeding, Discipline, Vaccines, Development); and What parents desire (Know them, trust). Conclusions: This study reveals the contexts that give rise to health care disparities and provides insight into parent's healthcare behaviors. Practice implications: Results offer providers guidance in providing well-child care for this population to improve pediatric care quality and child health.

‘Space to talk’: a Portuguese focus group study of parents’ experiences, needs and preferences in parenting support during prenatal and well-child care

“…Having a ‘ space to talk ’ specifically in clinical visits was mentioned multiple times and described intensely in both positive and negative vivid examples. The desired confidence, comfort and non-judgement, the expected time, interest and availability, all characteristics recurrently reported,41–43 seem to take shape into what the space where care takes place must be. It also underlines which gestures, stances and behaviours health providers should intentionally choose to be adequate to that end.…”

Conceptualizations of health, ability to act upon those definitions and desire for supports among families from historically marginalized communities

“…These definitions can support families' goal achievement and concern identification in the context of isolation and limited agency and resources. Efforts to provide FCC, outlined in Table 1, will likely reduce parents' experiences of stigma related to their marginalized identities (Brodie et al, 2019; Cosgrove & Flynn, 2005; Keller & McDade, 2000; Koschmann et al, 2021; Lynam & Cowley, 2007; Matthew et al, 2022; O'Donnell et al, 2008; Radecki et al, 2009; Romagnoli & Wall, 2012; Sobo et al, 2006; Yoder & Lopez, 2013).…”

“…Despite ongoing efforts, children and families from historically marginalized communities experience less FCC and more health and healthcare‐related disparities throughout the life course (Berkman, 2009; Castañeda et al, 2015; Decamp & Davis, 2011; Kline, 2020; National Academies of Sciences, Engineering, and Medicine, 2019; Phelan et al, 2010; Prather et al, 2018; Williams & Mohammed, n.d.). Emerging research shows that parents from marginalized communities report stigma related to parenting (Brodie et al, 2019; Cosgrove & Flynn, 2005; Keller & McDade, 2000; Koschmann et al, 2021; Lynam & Cowley, 2007; Matthew et al, 2022; O'Donnell et al, 2008; Radecki et al, 2009; Romagnoli & Wall, 2012; Sobo et al, 2006; Yoder & Lopez, 2013), including being treated as incompetent and perceived as unable to properly raise their children by other parents and professionals (Cosgrove & Flynn, 2005). Despite stigma, parents desire partnerships with experts (Keller & McDade, 2000; Koschmann et al, 2021; Radecki et al, 2009; Yoder & Lopez, 2013) to, for example, assess their child's progress and address developmental milestones (Cosgrove & Flynn, 2005; Koschmann et al, 2021).…”

“…Emerging research shows that parents from marginalized communities report stigma related to parenting (Brodie et al, 2019; Cosgrove & Flynn, 2005; Keller & McDade, 2000; Koschmann et al, 2021; Lynam & Cowley, 2007; Matthew et al, 2022; O'Donnell et al, 2008; Radecki et al, 2009; Romagnoli & Wall, 2012; Sobo et al, 2006; Yoder & Lopez, 2013), including being treated as incompetent and perceived as unable to properly raise their children by other parents and professionals (Cosgrove & Flynn, 2005). Despite stigma, parents desire partnerships with experts (Keller & McDade, 2000; Koschmann et al, 2021; Radecki et al, 2009; Yoder & Lopez, 2013) to, for example, assess their child's progress and address developmental milestones (Cosgrove & Flynn, 2005; Koschmann et al, 2021). Substantial literature has explored conceptualizations and definitions of health, but little of that research has focused on marginalized communities (Bircher, 2005; Gessert et al, 2015; Leonardi, 2018).…”

Factores asociados al seguimiento del cuidado de niños menores de dos años

“…En este estudio se pudo observar que los cuidadores primarios de niños menores de dos años son predominantemente sus madres (95, 7 %), dato que converge con los de otros estudios internacionales (28,29) en entornos de cuidado infantil (conocido internacionalmente como Well-child Care), donde se señala que los cuidadores de menores en esta edad son en su mayoría mujeres, que también son sus madres.…”