Early Childhood Wellness Priorities of Urban Parents and Pediatric Primary Care Providers

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ESPR355
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Abstract: :

Background: Early childhood is a critical period when health trajectories develop and prevention-focused intervention may be particularly effective. The AAP's Bright Futures Guidelines recommend that a broad array of wellness topics be addressed in pediatric primary care, but time constraints limit clinicians' ability to address all topics. A greater understanding of the wellness topics that are most salient to families and clinicians is needed to target wellness promotion and clinical care, yet little is known about how families and primary care pediatricians prioritize wellness topics. 


Objective: To identify the most salient aspects of early childhood wellness to parents and clinicians at pediatric primary care practices in urban, underserved communities. 


Design/Methods: We administered a cross-sectional discrete choice experiment to a convenience sample of 66 parents/guardians of 2-4-year old children and 16 pediatric clinicians from two urban primary care practices in Philadelphia (Figure 1). Participants rated the relative importance of 24 wellness attributes from across 6 domains based on a social-ecological model: child wellness – physical (e.g. diet), mental (e.g. behavior), social (e.g. relationships), and educational (e.g. learning); family wellness (e.g. parent/household factors); and community wellness (e.g. neighborhood factors). Participants responded to the prompt: "Which of the following is most important for [your child (parents)/young children (clinicians)] to be well?" We used a hierarchical Bayes model to calculate individual-level importance scores for each attribute and ranked attributes according to their average importance score separately for parents and clinicians.  


Results: Parents (mean age 34, 82% female, 67% black, 80% Medicaid-enrolled) and clinicians (74% female, 90% pediatricians, 10% nurse practitioners) both highly prioritized the parent/child relationship and avoiding family substance use (Figure 2). Parents more strongly prioritized child development and having health insurance while clinicians more strongly prioritized family food security and parents' mood. Neighborhood social cohesion, limiting screen time, child exercise, and parent health problems were of low priority to both groups. 


Conclusion: This study provides an evidence-based approach for considering which wellness-related topics might be most salient to families and clinicians for young children as a part of clinical care. Results suggest the parent/child relationship and preventing family substance use as potential areas of focus. 

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Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia

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