Aloe Carlin F, Hall Kelly L, Pérez-Escamilla Rafael, Rosenthal Marjorie S, Fenick Ada M, Sharifi Mona
Department of Pediatrics (CF Aloe, MS Rosenthal, AM Fenick, and M Sharifi), Yale School of Medicine, New Haven, Conn.
Yale School of Public Health (KL Hall, R Pérez-Escamilla, and M Sharifi), New Haven, Conn.
Acad Pediatr. 2023 Sep-Oct;23(7):1376-1384. doi: 10.1016/j.acap.2023.03.004. Epub 2023 Mar 16.
To identify factors associated with participation in group well-child care (GWCC), wherein families share preventive health care visits.
We extracted electronic health record data of mother-infant dyads with infants born 2013-18 at Yale New Haven Hospital and followed at the primary care center. Using chi-square analysis and multivariate logistic regression, we examined the extent to which 1) maternal/infant characteristics and recruitment timing were associated with GWCC initiation and continued engagement and 2) initiation was associated with primary care visits.
Of 2046 eligible mother-infant dyads, 11.6% initiated GWCC. The odds of initiation were higher among mothers with Spanish versus English primary language (odds ratio: 2.36 [95% confidence interval: 1.52-3.66]), with 1 child versus ≥ 3 children (1.58 [1.13-2.22]), and of non-Hispanic Black versus non-Hispanic White infants (2.72 [1.39-5.32]). Initiation was lower among infants born in 2016 (0.53 [0.32-0.88]) and 2018 (0.29 [0.17-0.52]) versus 2013. Among GWCC initiators with follow-up data (n = 217), continued engagement (n = 132, 60.8%) was positively associated with maternal age of 20-29 years (2.85 [1.10-7.34]) and > 30 years (3.46 [1.15-10.43]) compared with< 20 years, and mothers with 1 child versus ≥ 3 (2.28 [1.04-4.98]). GWCC initiators, versus non-initiators, had 5.06 times higher adjusted odds of attending > 9 primary care appointments in the first 18 months (95% confidence interval: 3.74-6.85).
As evidence builds on health and social benefits of GWCC, recruitment efforts may gain from considering multi-level socio-economic, demographic, and cultural factors associated with GWCC participation. Higher participation among systemically marginalized groups may present unique opportunities for family-based health promotion to mitigate health inequities.
确定与参与集体儿童健康保健（GWCC）相关的因素，即在家庭共享预防性医疗保健就诊的情况下。
我们提取了2013年至2018年在耶鲁纽黑文医院出生并在初级保健中心接受随访的母婴二元组的电子健康记录数据。使用卡方分析和多变量逻辑回归，我们研究了以下两个方面的程度：1）母婴特征和招募时间与GWCC启动及持续参与的关联；2）启动与初级保健就诊的关联。
在2046个符合条件的母婴二元组中，11.6%启动了GWCC。以西班牙语为主要语言的母亲相比以英语为主要语言的母亲启动GWCC的几率更高（优势比：2.36 [95%置信区间：1.52 - 3.66]），有1个孩子的母亲相比有≥3个孩子的母亲（1.58 [1.13 - 2.22]），以及非西班牙裔黑人婴儿相比非西班牙裔白人婴儿（2.72 [1.39 - 5.32]）。2016年出生的婴儿（0.53 [0.32 - 0.88]）和2018年出生的婴儿（0.29 [0.17 - 0.52]）启动GWCC的几率低于2013年出生的婴儿。在有随访数据的GWCC启动者中（n = 217），持续参与（n = 132，60.8%）与母亲年龄在20 - 29岁（2.85 [1.10 - 7.34]）和>30岁（3.46 [1.15 - 10.43]）呈正相关，相比<20岁的母亲，以及有1个孩子的母亲相比有≥3个孩子的母亲（2.28 [1.04 - 4.98]）。与未启动者相比，GWCC启动者在最初18个月内就诊>9次初级保健预约的调整后几率高5.06倍（95%置信区间：3.74 - 6.85）。
随着关于GWCC健康和社会效益的证据不断积累，招募工作可能会受益于考虑与GWCC参与相关的多层次社会经济、人口和文化因素。系统性边缘化群体中较高的参与率可能为基于家庭的健康促进提供独特机会，以减轻健康不平等。
