RESUMEN
OBJECTIVE: The American Academy of Pediatrics recommends that pediatric providers screen families for food insecurity and connect them to appropriate resources. However, it is unclear how clinics can best provide families with resources consistent with their needs and preferences. In this study, we elicited caregiver preferences for clinic-based food assistance. METHODS: We conducted a cross-sectional discrete choice experiment in which caregivers at 2 pediatric primary care clinics were asked to choose between hypothetical food programs. Programs varied across 4 categories: 1) resources provided (eg, food delivery, food in clinic, assistance enrolling in benefits); 2) support staff providing resources (eg, social worker, community health worker, physician, or nurse); 3) outreach modality (eg, phone, email, text); and 4) outreach frequency. Multinomial logistic regression was used to assess caregiver preferences within each category and the relative importance of each category to caregiver decisions. RESULTS: We surveyed 142 caregivers who were predominantly Black (87%) and Medicaid-insured (90%). Caregiver preferences for food programs were most strongly influenced by the food resources provided. Caregivers preferred food delivery over other forms of food supports, such as food provided in clinic. They preferred assistance from a benefits enrollment specialist, community health worker, or social worker to assistance from a physician or nurse. CONCLUSIONS: Pediatric clinics serving families at risk of food insecurity should use caregiver preferences to inform the design of family-centered interventions. Clinics should consider connecting caregivers with food delivery programs, and pediatric payors should adopt reimbursement models that support multidisciplinary team-based care to address food insecurity.
Asunto(s)
Cuidadores , Asistencia Alimentaria , Inseguridad Alimentaria , Atención Primaria de Salud , Humanos , Femenino , Estudios Transversales , Cuidadores/psicología , Masculino , Adulto , Niño , Conducta de Elección , Modelos Logísticos , Estados Unidos , Persona de Mediana Edad , MedicaidRESUMEN
BACKGROUND AND OBJECTIVE: In 2019, Pennsylvania launched a Children's Development Account (CDA) program that invests $100 in an education savings account for every child born in the state. However, as of 2021, only 10.6% of families claimed the investment. Low-income communities may stand to benefit most from educational investments, but few studies have assessed barriers and facilitators of uptake in these communities. We sought to examine low-income caregivers' perceptions of and barriers and facilitators to participation in a statewide CDA program and their receptivity to clinic-based financial counseling through a medical financial partnership. METHODS: We surveyed 100 caregivers of Medicaid-insured children from 2 primary care practices serving a predominantly low-income community. From these 100, we purposively sampled 30 caregivers for follow-up interviews. RESULTS: The 100 survey participants were predominantly female (83%), Black or African American (92%), and non-Hispanic or Latino (93%). Twenty-nine percent of survey participants were aware of the CDA program, 4% had enrolled, and 64% were interested in clinic-based financial counseling. In interviews, caregivers identified several barriers to and facilitators of engagement in the CDA program. They also identified several strategies to boost engagement, including simplifying registration, providing additional and personalized program information, expanding the investment amount, and providing clinic- and community-based outreach. CONCLUSIONS: Low-income caregivers identified several barriers to enrollment in a statewide CDA program and strategies to boost enrollment, including clinic-based financial counseling. Future research should examine the effectiveness, cost-effectiveness, and long-term financial and health consequences of clinic-based financial services for low-income families.
Asunto(s)
Cuidadores , Servicios de Salud del Niño , Niño , Estados Unidos , Humanos , Femenino , Masculino , Accesibilidad a los Servicios de Salud , Renta , ConsejoRESUMEN
Over the last 12-months during the pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the Centers for Disease Control and Prevention (CDC) have issued public health instructions with the hope of mitigating the spread of the virus. Through existing relationships established by an academic hospital, we established weekly community conference calls to disseminate such critical information on the pandemic and allow community leaders to discuss struggles and successes. From these calls, we were able to collaborate in a more intimate manner with faith-based organizations, whereby we emphasized and planned the role they could undertake during the pandemic. Such emphasis was made between our medical institution and various faith-based organizations through meetings titled "Congregational COVID-19 Conversations." Over the past 12-months, we held virtual meetings with 38 faith-based organizations: 15 Christian congregations, 21 Jewish synagogues, and 2 Islamic masjids. We describe in detail in this report a narrative summary of the meetings. From these meetings, we discussed several COVID-19-related themes that included how to have their place of worship disseminate public health messaging, aid in preparing buildings for public worship, and insight into preparing their regions for aid in both COVID-19 testing and for potential SARS-CoV-2 vaccine sites. This medical-religious partnership has proven feasible and valuable during the pandemic and warrants emphasis in that it has the potential to serve a vital role in mitigating COVID-19-related disparities in certain communities, as well as potentially ending the COVID-19 pandemic completely.
Asunto(s)
COVID-19 , Pandemias , Prueba de COVID-19 , Vacunas contra la COVID-19 , Humanos , Pandemias/prevención & control , SARS-CoV-2RESUMEN
During the pandemic caused by the severe acute respiratory syndrome coronavirus-2, public health instructions were issued with the hope of curbing the virus' spread. In an effort to assure accordance with these instructions, equitable strategies for at-risk and vulnerable populations and communities are warranted. One such strategy was our community conference calls, implemented to disseminate information on the pandemic and allow community leaders to discuss struggles and successes. Over the first 6 weeks, we held 12 calls, averaging 125 (standard deviation 41) participants. Participants were primarily from congregations and faith-based organizations that had an established relationship with the hospital, but also included school leaders, elected officials, and representatives of housing associations. Issues discussed included reasons for quarantining, mental health, social isolation, health disparities, and ethical concerns regarding hospital resources. Concerns identified by the community leaders as barriers to effective quarantining and adherence to precautions included food access, housing density, and access to screening and testing. Through the calls, ways to solve such challenges were addressed, with novel strategies and resources reaching the community. This medical-religious resource has proven feasible and valuable during the pandemic and warrants discussions on reproducing it for other communities during this and future infectious disease outbreaks.