Article Figures & Data
Tables
Participant and Theme Code Definition Quotation Caregiver Vaccines Immunizations, vaccinations, or “shots” “She needs her check-ups to let me know if she’s sick or if everything’s okay, what shots she needs, make sure she is able to go to school.” “Some of those vaccines that she gets, it helps prevent other kids from getting sick.” Growth and development Monitoring of growth; monitoring of verbal, gross, or fine motor development, or development in general “It’s reassurance for me that he was on track developmentally and socially, and hitting all of the milestones that I know he needs to be hitting at this point.” Health promotion Counseling in social, behavioral, dietary, or dental domains “You’re looking at, you know, developmental habits. You know, do they have a television in their bedroom or are they drinking a ton of juice and rotting their teeth out.” Literacy promotion Encouragement of reading or other literacy skills “I also like the new theme of how they allow the child to take a book home. Um, it promotes that healthy relationship and that ongoing relationship with not only the facility and the child, but also when the physician sees a child with a book, they can mention it.” Detection of illness Detection of acute or chronic illness through history, physical examination, laboratory tests, or imaging “Obviously if there is something more severe it’s normally caught at well visits; if it’s caught early, if not, then it’s caught during an emergent visit because it’s gone on too long.” “He can check for anything that could be wrong or going wrong.” Language Communication with clinician or staff; use of non-English language or interpretation “I like to bring my son to the clinic because they speak in Spanish and understand me well.” Clinician Vaccines Immunizations, vaccinations, or “shots” “I think that part of the big incentive for a lot of families—so I think one of the reasons that they do make it, rather than that they don’t make it—so, the reason that they can’t get there, there are lots of them; but I think one of the key reasons is that it comes down to shots and the fact that the public school system requires vaccines. So that essentially created an extra incentive, an extra incentive for parents to make and keep well-check appointments because they couldn’t get their shots otherwise.” Growth and development Monitoring of growth; monitoring of verbal, gross, or fine motor development, or development in general “Pretty much growth and development for most kids is where we’re going to focus.” Participant and Theme Code Definition Quotation Caregiver Transportation Method of getting to clinic, including cars, ride-sharing services, buses, walking, bicycling, and other means “I had to miss [a well-child visit] because of transportation...me and my fiancé—or husband now—we only had 1 car. And, um, he had to use it for work, so, and I just did not want to take the bus to get there, or it cost too much for the cab to get from where we lived.” Financial stress Money, finances, resources, cash, income, or poverty “I just have to pay to park, and sometimes I have to scrape up money to park because of the situation, because I’m not a wealthy individual.” “One day I had to borrow money from the parking attendant to get my car out of the lot because I didn’t have the money.” “Overworked, underpaid, not enough money to pay your bills, worry about food, your kids, and just everything in general.” “I’m on a fixed income…and the child support is not enough. Then I’m fighting trying to make sure we have food stamps.” Time off from work Inability to leave work (either paid time off or unpaid time off), difficulty arranging schedule with employment or employer “I’ve actually had to reschedule some of her appointments just because they won’t allow me to take off to come take her.” Child care Care of other children in household, need to pick children up from school “…when you’re juggling multiple kids and you’re trying to find a time that’s going to work…” Clinician Transportation Method of getting to clinic, including cars, ride-sharing services, buses, walking, bicycling, and other means “I think the barrier tends to be more with, um, prioritizing, transportation, and just that there’s a lot of other personal stressors that, um, bubble to the top, um, for these people.” Financial stress Money, finances, resources, cash, income or poverty “…taking their kid to their well-child [visit] is maybe not as deserving of your attention when you’re figuring out, um, how you’re going to put food on the table or whatnot…” Time off from work Inability to leave work (either paid time off or unpaid time off), difficulty arranging schedule with employment or employer “…[they’ve] missed too many days off from work because one of their kids has been sick and this is a preventative visit, that they might miss that preventative visit until they can reschedule for a day that might not have work.” Lack of vaccinations Included services within well-child visit “When I tell someone they’re coming back for vaccines, that’s very clear to me. But, for example, at the 9-month well-child check, we don’t have vaccines, and the 2-year or 3-year [visits] often don’t require, unless you happen to fall within the winter season. So we’re not actually physically giving some-one something. And I think there is a sense that some of our patients that if we’re not giving a prescription or not giving a vaccine, and we’re just talking and weighing and measuring them, that we’re not doing ‘anything.’” Immigration Status of immigration or citizenship, fear of immigration authorities “I think people who are undocumented are afraid to seek medical care. So a lot of the parents of our patients are undocumented, so I think they may hesitate to come in because often they need to show an ID for their children to be seen.” “If you’re an illegal immigrant or whatever, there is a lot of anxiety around coming to systems in America where you are worried you might get found out.” Language Communication with provider or staff, use of non-English language or interpretation “For many of the patients I work with is that there’s a language barrier, um, not understanding when the next appointment is. A lot of them are Spanish speaking so, um, not understanding when the next appointment time is, um, getting that mixed up.”
Additional Files
The Article in Brief
Caregiver and Clinician Perspectives on Missed Well-Child Visits
Elizabeth R. Wolf , and colleagues
Background Despite the benefits of well-child care visits (WCV), up to half of WCVs are missed. Little is known about why children miss these visits.
What This Study Found A team of researchers and pediatricians at Virginia Commonwealth University, University of Washington, and the University of Vermont sought to understand the challenges that prevent families from attending their child's scheduled appointment. They interviewed English and Spanish-speaking caregivers of children who had missed WCVs as well as family and pediatric physicians from a large safety-net health system in Richmond, Virginia. Caregivers and physicians alike identified social and structural factors as key barriers to attendance, including transportation, difficulty taking time off from work, childcare, and underlying financial stressors. Clinicians also thought that caregivers may prioritize attending WCVs in which vaccinations are typically given. Clinicians expressed concern that immigration and language differences may be barriers to attendance. Spanish-speaking caregivers thought that availability of language services made them more interested in attending WCVs.
Implications
- The researchers conclude, "Our findings suggest there is a need to further explore the potential relationship between well-child visit attendance and social determinants of health. ...Future research emphasis could be placed on understanding and helping the children missing the greatest number of visits."
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