Group Well-Child Care and Health Services Utilization: A Bilingual Qualitative Analysis of Parents’ Perspectives

Maternal and Child Health Journal - Objective Alternative primary care structures such as group well-child care (GWCC) may enhance care for families, particularly those subject to structural...     

Parents’ Nonstandard Work Schedules and Child Well-Being: A Critical Review of the Literature

This paper provides a comprehensive review of empirical evidence linking parental nonstandard work schedules to four main child developmental outcomes: internalizing and externalizing problems, cognitive development, and body mass index. We evaluated the studies based on theory and methodological rigor (longitudinal data, representative samples, consideration of selection and information bias, confounders, moderators, and mediators). Of 23 studies published between 1980 and 2012 that met the selection criteria, 21 reported significant associations between nonstandard work schedules and an adverse child developmental outcome. The associations were partially mediated through parental depressive symptoms, low quality parenting, reduced parent–child interaction and closeness, and a less supportive home environment. These associations were more pronounced in disadvantaged families and when parents worked such schedules full time. We discuss the nuance, strengths, and limitations of the existing studies, and propose recommendations for future research.     

A Qualitative Exploration of Parents’ Food Choices During Early Childhood

ObjectiveTo explore parents’ accounts of the goals they seek when choosing foods for their young children through the lens of goal-systems theory.DesignIn-depth interviews with parents of children aged from 6 months to 5 years.SettingMontevideo, Uruguay.ParticipantsForty-two parents (aged 19–44 years, 90% female).Phenomenon of InterestParents’ personal experiences, feelings, and opinions related to how they choose foods for their children.AnalysisContent analysis based on deductive-inductive coding.ResultsParents’ accounts confirmed they intended to pursue different goals when choosing foods for their children. Health-related goals mainly motivated the selection of healthy foods, but they also drove the selection of some ultra-processed products because of misconceptions about their healthiness. Pleasure and enjoyment motivated the selection of ultra-processed products, whereas stress avoidance was associated with selecting convenient foods. The selection of unhealthy foods raised conflicts between goals, which were solved using goal shielding, changes in risk perception and/or compensatory health beliefs.Conclusions and ImplicationsResults point to the need for communication campaigns and community-based interventions to introduce changes in how ultra-processed products are conceptualized and increase the associations between healthy foods and children's pleasure and enjoyment to promote healthier eating patterns during infancy and early childhood.     

Health and Safety of Child Care Centers: An Analysis of Licensing Specialists’ Reports of Routine,Unannounced Inspections

Objectives. We assessed the prevalence of regulatory noncompliance of licensed child care centers and identified factors associated with improved compliance.Methods. We analyzed 676 routine, unannounced reports of child care centers collected by the Connecticut Department of Public Health licensing specialists over a 2-year time period, included characteristics of centers, and created categories of regulations.Results. The sample included 41% of licensed child care centers. Of the 13 categories of regulations in the analyses, 7 categories (outdoor safety, indoor safety, indoor health, child and staff documentation, emergency preparedness, infant-toddler indoor health, and infant-toddler indoor safety) had regulations with center noncompliance greater than 10%. Playground hazard-free was the regulation with the highest frequency (48.4%) of noncompliance. Compliance with the regulation for 20 hours of continuing education per year for child care providers was the characteristic most frequently associated with regulations compliance.Conclusions. Efforts to support continuing education of child care providers are essential to improve and sustain healthy and safe early-care and education programs. Analyses of state child care licensing inspection reports provide valuable data and findings for strategic planning efforts.Attendance in out-of-home child care is a necessity for many children and poses both risks and benefits. Approximately 60% of children younger than 6 years both in Connecticut and nationally have mothers in the workforce.1,2 In Connecticut, about 85 000 young children are cared for in approximately 1600 licensed child care centers and group homes.3 When the quality of child care or early care and education (ECE) is suboptimal, children are at greater risk for infectious diseases, injuries, and inadequate nurturing.4–6 However, high quality ECE offers several benefits, including developmentally appropriate care, fewer illnesses and injuries, greater likelihood of health care access, health screenings, early identification and referral for health, developmental and behavioral concerns, and care for children with special health care needs.6,7 Quality ECE is a critical component of a healthy trajectory necessary for children’s readiness to learn and is associated with long-term health and well-being.8–10Initiatives to improve health and safety for children in ECE are occurring on both national and state levels. To promote access to healthy, safe, and developmentally appropriate ECE programs, the US Department of Health and Human Services Maternal Child Health Bureau, in partnership with the American Public Health Association and the American Academy of Pediatrics, has supported national health and safety standards (Caring for Our Children ([CFOC]),11 state grants, and resource centers for information, technical assistance, and training.12 Furthermore, the National Association for the Education of Young Children (NAEYC), the professional organization of early childhood professionals, has aligned their accreditation standards with CFOC health and safety standards.13 Simultaneously, as states launch universal preschool initiatives to better prepare children for kindergarten14 many are recognizing that children’s health status during the preschool years influences their readiness to learn.8,15Although efforts are under way to promote quality ECE through implementation of national health and safety standards and accreditation, state child care regulations represent the minimum requirements below which a program should not operate.11 The intent of regulations is to ensure a basic level of acceptable care. Because state regulations vary widely, there are limited comparisons of child care health and safety across states. In a 1995 study researchers measured child care quality in center classrooms in 4 states, including Connecticut, using the Infant-Toddler and the Early Childhood Environment Rating Scales, instruments which were initially designed to assess quality in early care programs for research purposes.16 Connecticut ranked highest in health and safety items, which the researchers attributed to strong regulations. Nevertheless, even in Connecticut only 24% of the classrooms were rated as good quality, that is, developmentally appropriate, healthy, and safe. No summary data on the health and safety status of Connecticut child care centers have been reported since that study, and no comprehensive report of routine, unannounced inspections, which measure minimal health and safety rather than quality, has been released.All states require periodic, routine, unannounced inspections of ECE facilities to monitor compliance with state child care regulations.17 CFOC recommends that all ECE programs should be inspected at least semiannually.11 Connecticut child care regulations require every other year, unannounced, random inspections of child care centers caring for 13 or more children and group family care homes caring for 7 to 12 children.18 However, the findings are not analyzed or published.This study addressed the following research questions. (1) What is the frequency of regulatory noncompliance of child care centers as determined by unannounced, random inspections? (2) Is there an association of regulatory compliance with the following child care center factors: (a) NAEYC accreditation, (b) source of funding (state-funded child care, School Readiness [public pre-K)] programs, Head Start), (c) access to a trained child care health consultant (CCHC), (d) compliance with continuing education of child care providers, and (e) median household income of child care center location?As university-based researchers, we received funding from a private foundation to conduct this study. We used data collected by the Connecticut Department of Public Health (DPH) Child Care Licensing Specialists and other data sets to explore these questions and provide the first aggregate report of the health and safety status of Connecticut licensed child care centers.     

Parents’ Perceptions of 5210 Nutrition Messaging and Child Weight Status

ObjectiveTo explore parent perceptions of child weight status and 5210 nutrition messaging recommendations, including daily consumption of 5 fruits and vegetables, limiting child screen time to ≤2 hours, incorporating 1 hour of daily physical activity, and no consumption of sugary, sweetened beverages.MethodsUsing the Convergence Model of Communication as a framework, qualitative focus groups (n = 5) were conducted at 4 Head Start sites across 1 Ohio County. Twenty-eight parents aged 20–60 years comprised the groups. A deductive analysis technique with respondent validation was used.ResultsParents have limited understanding of 5210 messages delivered by the program. Parent food preferences, family finances, and children's picky eating were identified as barriers to integrating healthy eating habits at home. Parents prefer practical strategies regarding how to integrate healthy eating habits into the home environment. Participants expressed concern about children's psychological health and happiness vs weight status.Conclusions and ImplicationsUnderstanding parental perceptions of 5210 messaging and program-reported weight status may assist Head Start programs in addressing childhood obesity through focused parent education and support.     

Predictors of Parent Engagement Based on Child Care Providers’ Perspectives

Objective

Determine the predictors of child care providers’ parent engagement regarding child nutrition in child care centers (CCCs) and family child care homes (FCCHs).

Understanding Women’s Choices: How Women’s Perceptions of Quality of Care Influences Place of Delivery in a Rural Sub-County in Kenya. A Qualitative Study

Maternal and Child Health Journal - Maternal mortality is still unacceptably high in Kenya. The Kenyan Government introduced a free maternity service to overcome financial barriers to access. This...     

Residential Staff’s Changing Attitudes Toward Parents of Children in their Care: Rationale and Healing Effects on Children,Parents, and Staff

A pilot project in Israel, regarding parent’s involvement in their children’s education in residential care was evaluated. The dual goals were changing staff’s attitudes toward parents, and empowering parents. During the school year, parents were invited to participate in bi-weekly dynamic group workshops in the residence (parents only and parents–children), and to 3–4 “Family Days,” in addition to sharing special parent–child summer camps. Results indicate considerable success: children, parents, and staff felt that the project had improved their ability to deal successfully with their everyday challenges, with parents viewing themselves as having been most rewarded.

Ranking the ‘Balance’ of State Long-Term Care Systems: A Comparative Exposition of the SMARTER and CaRBS Techniques

The use of attribute sets to rank units of health provision (e.g., states, organizations) against policy goals is an essential task within decision-making and analysis. This paper elucidates and compares two techniques, SMARTER (Simple Multiattribute Rating Technique Exploiting Ranks) and CaRBS (Classification and Ranking Belief Simplex), within an expositional ranking of US states long-term care (LTC) systems against the policy goal of providing a balance between (traditionally dominant) institutional care, and alternative home and community-based services (HCBS). While the (more established) SMARTER technique is used primarily for comparative purposes, greater emphasis is placed on elucidating CaRBS which is based on the Dempster-Shafer theory of evidence. It is shown that CaRBS offers four appealing features for health policy analysis: (1) the capacity to rank using either of two confidence measures (DST-related belief and plausibility values), (2) a systematic approach to managing missing data, (3) the production of stable rankings, and (4) the simplex plot method of data representation. In addition to discussing the LTC policy implications of the study findings, the issues of rank order stability and the management of missing data are discussed with respect to the two techniques employed.     

Advertising Placement in Digital Game Design Influences Children’s Choices of Advertised Snacks: A Randomized Trial

BackgroundChildren are inhabitants of a media-rich environment rife in extensive, sophisticated, and persistent techniques that are used to market unhealthy food. Exposure is known to influence children’s attitudes, choices, and consumption, yet further research is required to explore the influence of contemporary techniques within online games.ObjectiveTo explore the influence of modern advertising on children’s attitudes, choices, and consumption, techniques (ie, banner advertising, advergame, and rewarded video advertising) were used to promote an unfamiliar confectionery brand within an online game.DesignA between-subjects randomized experimental study.Participants/settingChildren (aged 7 to 12 years [n=156]) were recruited in New South Wales, Australia, between September and November 2017.InterventionChildren were required to play a 4-minute online game, complete some questionnaires, and choose one snack to consume afterward. Children were randomly assigned to one of four conditions: a control group with no advertising, and three experimental conditions that promoted an unfamiliar confectionery brand via a banner advertisement, advergame, or rewarded video advertisement.Main outcome measuresQuestionnaires included the assessment of attitudes to the test brand before and after the game, enjoyment of the game, and children’s awareness of advertising. Food choice was recorded and food consumption was measured by weighing the snack in grams, which was translated into kilocalories.Statistical analyses performedStatistical tests included analyses of variance, Kruskal-Wallis test, and χ² test.ResultsAttitudes toward the perception of fun (P=0.06) and taste (P=0.21) of the test brand were not influenced by condition. Children who were exposed to the rewarded video advertising chose the test brand significantly more than children in the other three conditions (P<0.002). Condition did not influence overall energy intake measured in grams (P=0.78) or kilocalories (P=0.46).ConclusionsChildren’s choice of the test brand was significantly influenced by the rewarded video advertising condition (compared with control, banner advertising, and advergame conditions). This technique is prevalent across online and application games that children play yet the effects of using rewarded video advertising to promote food brands have not been explored from a public health perspective. This study contributes to the understanding of modern strategies used to market unhealthy foods to children.     

Sexual Coercion in Intimate Relationships: A Comparative Analysis of the Effects of Women’s Infidelity and Men’s Dominance and Control

Researchers studying the proximate (or immediate) causes of sexual coercion have proposed that partner rape is motivated by a man’s attempt to dominate and control his partner and that this expression of power is the product of men’s social roles. Researchers studying the ultimate (or evolutionary) causes, in contrast, have proposed that partner rape may function as an anti-cuckoldry tactic, with its occurrence related to a man’s suspicions of his partner’s sexual infidelity. In two studies, we collected data relevant to both perspectives to explore how these variables interact with men’s sexual coercion in an intimate relationship. Regression analyses from Study 1 (self-reports from 256 men) and Study 2 (partner-reports from 290 women) indicated that men’s sexual coercion of their partners was consistently predicted by female infidelity and men’s controlling behavior, suggesting that both variables are necessary to explain men’s sexual coercion. Discussion addressed limitations of the current research and highlighted the importance of integrating multiple levels of analysis when studying men’s sexual coercion of their intimate partners.     

The Associations of Parents’ and Children’s Anxiety Sensitivity with Child Anxiety and Somatic-Hypochondriac Symptoms

Background

The clinical relevance of Anxiety Sensitivity (AS) is well established, as well as the association between parents’ and children’s AS. However, there is little data data on the indirect relation between parents’ AS and children’s anxiety and somatic-hypochondriac symptoms through children’s AS, and the few findings available are inconsistent.

Objective

The study examined, in a community sample, whether children’s AS was associated to their anxiety and somatic-hypochondriac symptoms, and tested whether children’s AS mediated the link between parents’ AS and children’s anxiety and somatic-hypochondriac symptoms.

Methods

A total of 392 children and one of their parents completed a battery of questionnaires.

Results

Children’s AS mediated the links between parents’ AS and children’s anxiety and somatic-hypochondriac symptoms. These pathways were moderated by the child’s age, in that they were significant for older children (ages 11–17 years old), but not for younger ones (ages 8–10 years old).

Conclusions

The findings advance understanding of how parental AS might be implicated in children’s AS and clinical symptoms.

     

Association between Parents’ Social Capital and Physical Status in Preschool Children in Japan: A Cross-Sectional Multicentre Study

Maternal and Child Health Journal - According to a World Health Organization report, in 2016, 41 million young children globally were overweight or obese. The connection between parents’...     

Family Child Care Providers’ Nutrition Practices and Policies: Happy Healthy Homes

ObjectiveDetermine the impact of family child care home providers’ nutrition knowledge, confidence, and perceived barriers on program nutrition best practices and written nutrition policies.MethodsCross-sectional analysis of self-reported surveys of 49 female providers in Oklahoma City analyzed with Spearman correlation, multivariate linear and logistic regression (α < 0.05).ResultsConfidence and barriers were significantly correlated (r_s(47) = −0.4, P = 0.004). Independent variables explained 36% of practices (r² = 0.357). Nutrition knowledge (standard β = 0.442, P = 0.001) and confidence (standard β = 0.358, P = 0.008) were significantly associated with practices; barriers were not. No significant association between independent variables and written policies resulted.Conclusions and ImplicationsProvider nutrition knowledge and confidence appear to be suitable targets to improve nutrition practices. Further research can evaluate possible influences on the presence and quality of family child care home written nutrition policies and specific nutrition policy topics associated with healthier nutrition practices.     

Sociocultural and Environmental Influences on Brazilian Immigrant Mothers’ Beliefs and Practices Related to Child Feeding and Weight Status

Background Length of residence in the United States (US), changes in dietary and physical activity behaviors, and economic and social barriers contribute to high childhood obesity rates among children from immigrant families in the US. Brazilians comprise a fast-growing immigrant population group in the US, yet little research has focused on health issues affecting Brazilian children in immigrant families. Understanding sociocultural and environmental influences on parents’ beliefs and practices related to child feeding and weight status is essential to altering obesity trends in this group. Methods Qualitative study consisting of five focus groups with a convenience sample of 29 Brazilian immigrant mothers. Results Analyses revealed that the sociocultural and environment transitions faced by Brazilian immigrant mothers’ influence their beliefs and practices related to child feeding and weight status. Additionally, acculturation emerged as a factor affecting mothers’ feeding practices and their children’s eating habits, with mothers preferring Brazilian food environments and that their children preferring American food environments. Mothers viewed themselves as being responsible for promoting and maintaining their children’s healthy eating and feeding behaviors, but changes in their social and cultural environments due to immigration and the pressures and demands of raising a family in a new country make this difficult. Conclusions Health promotion interventions to improve healthful eating and feeding practices of Brazilian children in immigrant families must account for social and cultural changes and daily life demands due to immigration as well as potential variation in the levels of acculturation between mothers and their children.     

Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England

BackgroundThe availability of a COVID-19 vaccine has been heralded as key to controlling the COVID-19 pandemic. COVID-19 vaccination programme success will rely on public willingness to be vaccinated.MethodsWe used a multi-methods approach - involving an online cross-sectional survey and semi-structured interviews - to investigate parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine. 1252 parents and guardians (aged 16 + years) who reported living in England with a child aged 18 months or under completed the survey. Nineteen survey participants were interviewed.FindingsMost survey participants reported they would likely accept a COVID-19 vaccine for themselves (Definitely 55.8%; Unsure but leaning towards yes 34.3%) and their child/children (Definitely 48.2%; Unsure but leaning towards yes 40.9%). Less than 4% of survey participants reported that they would definitely not accept a COVID-19 vaccine. Survey participants were more likely to accept a COVID-19 vaccine for themselves than their child/children. Participants that self-reported as Black, Asian, Chinese, Mixed or Other ethnicity were almost 3 times more likely to reject a COVID-19 vaccine for themselves and their children than White British, White Irish and White Other participants. Survey participants from lower-income households were also more likely to reject a COVID-19 vaccine. In open-text survey responses and interviews, self-protection from COVID-19 was reported as the main reason for vaccine acceptance. Common concerns identified in open-text responses and interviews were around COVID-19 vaccine safety and effectiveness, mostly prompted by the newness and rapid development of the vaccine.ConclusionInformation on how COVID-19 vaccines are developed and tested, including their safety and efficacy, must be communicated clearly to the public. To prevent inequalities in uptake, it is crucial to understand and address factors that may affect COVID-19 vaccine acceptability in ethnic minority and lower-income groups who are disproportionately affected by COVID-19.     

Effects of the Caregiver Interaction Profile Training on Caregiver–Child Interactions in Dutch Child Care Centers: A Randomized Controlled Trial

Background

Previous studies underscore the need to improve caregiver–child interactions in early child care centers.

Objective

In this study we used a randomized controlled trial to examine whether a 5-week video feedback training can improve six key interactive skills of caregivers in early child care centers: Sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions.

Method

A total of 139 caregivers from 68 early child care groups for 0- to 4-year-old children in Dutch child care centers participated in this RCT, 69 in the intervention condition and 70 in the control condition. Caregiver interactive skills during everyday interactions with the children were rated from videotape using the Caregiver Interaction Profile (CIP) scales at pretest, posttest, and follow-up 3 months after the posttest.

Results

Results at posttest indicate a significant positive training effect on all six caregiver interactive skills. Effect sizes of the CIP training range between d = 0.35 and d = 0.79. Three months after the posttest, caregivers in the intervention group still scored significantly higher on sensitive responsiveness, respect for autonomy, verbal communication, and fostering positive peer interactions than caregivers in the control group with effect sizes ranging between d = 0.47 and d = 0.70.

Conclusions

This study shows that the quality of caregiver–child interactions can be improved for all six important caregiver skills, with a relatively short training program. Possible ways to further improve the training and to implement it in practice and education are discussed.

     

“You Can Carry the Torch Now:” A Qualitative Analysis of Parents’ Experiences Caring for a Child with Trisomy 13 or 18

Trisomy 13 and 18 (T 13/18) are rare chromosomal abnormalities associated with high morbidity and mortality. Improved survival rates and increased prevalence of aggressive medical intervention have resulted in families and physicians holding different perspectives regarding the appropriate management of children with T 13/18. Families were invited for open-ended interviews regarding their experiences with the medical care of a child with T 13/18 over the past 5 years. Seven of 33 invited families were surveyed; those who had spent more than 40 days in the hospital were most likely to accept the invitation (OR 8.8, p = 0.02). Grounded theory technique was used to analyze the interviews. This method elicited four key themes regarding family perspectives on children with T 13/18: (1) they are unique and significant, (2) they transform the lives of others, (3) their families can feel overwhelmed and powerless in the medical setting, (4) their families are motivated to “carry the torch” and tell their story. Families also emphasized ways in which Internet support groups can provide both positive and negative perspectives. The ensuing discussion explores the difficulties of parents and physicians in forecasting the impact that T 13/18 will have on families and emphasizes a narrative approach to elicit a map of the things that matter to them. The paper concludes that while over-reliance on dire prognostic data can alienate families, examining the voice, character and plot of patient stories can be a powerful way for physicians to foster shared decision-making with families.