Improving Access to Preventive Services for Marginalized Families During Early Childhood: An Integrative Review of Inter-organizational Integration Interventions

Abstract

Marginalized populations exhibit low rates of preventive service use, often avoiding use of non-urgent services. Poor access to preventive and health promoting care serves to maintain inequities in health experienced by many marginalized populations. Of particular concern are marginalized families with young children below the age of school entry, when physical, emotional and psychological foundations for lifelong health are being established. Many community based organizations recognize the need to improve families' access and use of preventive services. However, they are faced with a gap in understanding what inter-organizational interventions could be implemented to improve integration of services particularly focused on addressing experiences of marginalized families. Therefore, we used the integrative review method to identify and describe inter-organizational (I-O) interventions in the literature that aim to improve access to preventive services by marginalized families. As per integrative review methods, the literature was searched for research studies using qualitative, quantitative or mixed method designs, and investigating I-O interventions aiming to improve access to preventive services through increased service integration. Three levels of screening and relevance review identified fourteen articles. A conceptual model informed by socio-ecological theory was used to classify interventions as relational or structural. Results show that reports of rigorously conducted studies of I-O interventions are relatively sparse, and emphasize structural factors such as shared leadership, shared review or development of policies/protocols, changes to referral mechanisms and geographical/caseload matching. Interorganizational interventions that influence relational factors were rare but have included: joint training/education, facilitated communication, addition of an integration role, and strategic partnerships. We suggest that combining both structural-and relational-focused strategies in inter-organizational integration intervention design may have greater impact on improving access to preventive services for marginalized families, with increased use of early childhood preventive services contributing to reducing health disparities.

Conceptualizations of health, ability to act upon those definitions and desire for supports among families from historically marginalized communities

“…Partnering to address instrumental supports, such as connecting parents to housing, food and other resources, positions the clinical team to support families' health and well‐being goals. One potential benefit is that instrumental support may engender greater trust and stronger partnership between parents and providers (Hardeman et al, 2016; Smith et al, 2009; Trent et al, 2019). Our sample included mostly mothers; future research should purposefully engage fathers from marginalized communities to identify opportunities for clinicians to partner with fathers and provide FCC.…”

Health Equity in Developing Countries: A Need for Effective and Responsive Public Service Delivery to Improve Access to Health Services

“…T towards making available necessary and timely health interventions in early childhood period [4]. This would reduce the high child mortality and morbidity rates in developing countries.…”

“…The reference [4] in his study, talked about, "InterOrganisation Integration (I-O system)", as a mechanism to improve health access for the marginalised sections of society. Through this mechanism, he believed that both essential (curative) and non-urgent (preventive) health services in a form of integrated care could be made accessible to the marginalised sections.…”