Urban, Low-Income, African American Well-Child Care: Parent and Provider Experiences and Expectations

Abstract

Background Well-child care (WCC) is the foundation of pediatric health promotion. High-quality WCC in the context of a strong parent-provider relationship can improve child health. However, urban, low-income, African American parents report lower overall primary care quality. A critical review of the literature identified multiple factors impacting the parent-provider relationship for African Americans. Aims For urban, low-income, African American parents and children: (1) Describe parent’s expectations and experiences of WCC, (2) Describe pediatric providers’ perceptions of parenting needs and experiences of providing WCC to the population, and (3) Compare parents’ and providers’ expectations and experiences of WCC. Methods A naturalistic qualitative method was used. The first aim was achieved through focus groups with parents in Milwaukee, Wisconsin, and St. Louis, Missouri. The second aim was achieved through unstructured, narrative, key-informant interviews with pediatric primary care providers. Analysis Conventional content analysis was used to code data. Codes were collapsed into categories. Aim three was achieved by drawing parent and provider data together using qualitative data triangulation and convergence coding. Results Four focus groups were held with 35 parents, and nine individual provider interviews. Parents and providers had similar expectations, but greater dissonance in the perceptions and experiences of WCC. Parent expectations for WCC are not that different between races and income levels, but the experiences of study parents reveal ongoing care disparities. Conclusion Improving care quality for this population requires changes in healthcare practice, research, and policy. Results serve as a foundation for these changes and inform the next action steps.