Parent and Primary Care Provider Priorities for Wellness in Early Childhood: A Discrete Choice Experiment

Abstract

Guidelines recommend that primary care clinicians address a broad range of wellness topics, but time constraints limit clinicians' ability to address them in the context of well child visits. A greater understanding of the salience of different wellness topics to families and clinicians may aid in prioritizing topics for practice-based interventions to promote wellness. We aimed to identify and compare parent and primary care clinicians' priorities for early childhood wellness. We conducted a cross-sectional discrete choice experiment with 100 parents/guardians of 2-4-year old children and 27 clinicians from three pediatric primary care practices (two urban, one suburban). Participants rated the relative importance of 24 wellness attributes from six domains: child physical, mental, social, and educational health, family wellness, and community wellness. We compared the rankings of attributes across the parent and clinician samples to understand the differential priorities of the groups and examined the domains of attributes that were highly ranked. In both parent and clinician samples, the highest ranked attributes related to the child or family while community-level attributes were ranked lower. Parents and clinicians both highly prioritized the parent/child relationship and avoiding family substance use. Parents more strongly prioritized child learning while clinicians more strongly prioritized food security and parent mood. Neighborhood social cohesion and parent health problems were of low priority to both groups. Priorities were similar across subgroups of parent race, education, income, and neighborhood poverty. Findings may aid primary care practices and clinicians in prioritizing topics for interventions to promote wellness in pediatric primary care.

Screening tools used in primary health care settings to identify health behaviours in children (birth–16 years); A systematic review of their effectiveness, feasibility and acceptability

“…PHC is often the first point of contact to the health care system for families of young children and is therefore an opportunistic and important setting for promotion of, and early intervention for positive health behaviours in childhood and adolescence. PHC is a trusted, valued and accessible setting for children and their families, with key responsibilities in screening for disease risk factors and providing counselling for families 9–11 . Current recommended practice within PHC is to identify children with or at risk of overweight or obesity, as a proxy for poor health behaviours, based on growth monitoring, with or without brief advice for health behaviours 12–15 .…”

“…PHC is a trusted, valued and accessible setting for children and their families, with key responsibilities in screening for disease risk factors and providing counselling for families. [9][10][11] Current recommended practice within PHC is to identify children with or at risk of overweight or obesity, as a proxy for poor health behaviours, based on growth monitoring, with or without brief advice for health behaviours. [12][13][14][15] However, several international systematic reviews have found a lack of high-level evidence to support the effectiveness of routine growth monitoring as a screening tool in practice, and its benefit on child health.…”

Screening tools used in primary health care settings to identify health behaviours in children (birth – 16 years); A systematic review of their effectiveness, feasibility and acceptability

“…PHC is therefore an opportunistic and important setting for promotion of, and early intervention for positive health behaviours in childhood and adolescence. Primary Health Care is a trusted, valued and accessible setting for children and their families, with key responsibilities in screening for disease risk factors and providing counselling for families 9, 10, 11 . Current recommended practice within PHC is to identify children with or at risk of overweight or obesity, as a proxy for poor health behaviours, based on growth monitoring, with or without brief advice for health behaviours 12, 13, 14, 15 .…”