Preventing Rural Inequities Through Support of Early Relational Health in Pediatric Primary Care: A Narrative Review

Children living in the rural United States are more likely to live below the poverty line than their urban counterparts, and rural poverty is associated with greater disparities than urban poverty for many indicators of health, behavior, and school readiness. However, rural communities have often been overlooked in research focused on the prevention of disparities in child development. Early Relational Health (ERH), which includes positive parenting practices and parent-child relationship quality, can support family resilience and buffer the consequences of racism, poverty, and related stressors on child development in families across geographical regions. In this narrative review, we describe the unique contextual factors within rural communities that facilitate and impose barriers to ERH and demonstrate the need for implementation and study of interventions that can support ERH in rural families. We describe platforms that have previously been used to deliver interventions in rural settings and recognize pediatric primary care as an underutilized context for supporting ERH and reducing disparities in child development in rural populations. Finally, we provide examples of key strategies that can reduce barriers to population-level delivery of interventions to rural families, including improving access and providing culturally appropriate programming. Additional research is needed to address core gaps in the knowledge base related to the prevention of inequities in rural populations through supporting ERH.