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Engaging families to improve high-risk infant follow-up participation: a mixed methods study
Christine Sugimoto1, Melissa Murphy2,3, Salathiel Kendrick-Allwood4
1Division of Neonatology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA. cssugim@emory.edu.
Insights
High-risk infant follow-up (HRIF) program attendance is influenced by socioeconomic factors and caregiver needs. Interventions should address logistics, social support, and customer service to improve participation for at-risk infants.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- High-risk infant follow-up (HRIF) programs are crucial for monitoring developmental outcomes in vulnerable infants.
- Understanding factors influencing program attendance is essential for optimizing care delivery and improving infant health.
- Identifying barriers and facilitators to participation can inform targeted interventions.
Purpose of the Study:
- To identify demographic and socioeconomic factors associated with non-attendance at a regional HRIF program.
- To explore caregiver-perceived barriers and facilitators impacting HRIF program participation.
- To inform the development of strategies to enhance HRIF program engagement.
Main Methods:
- Retrospective analysis of factors associated with first visit non-attendance in HRIF referrals.
- Mixed-methods needs assessment utilizing surveys and structured interviews with caregivers.
- Inductive qualitative thematic analysis of caregiver perspectives.
Main Results:
- Infants with higher birthweight, public/no insurance, and non-US-born mothers were more likely to miss their initial HRIF visit.
- Key barriers to attendance included logistical challenges, scheduling conflicts, and poor customer service.
- Facilitators included perceived support for parental needs, adequate knowledge, and positive attitudes towards the program.
Conclusions:
- Interventions should proactively engage high-risk families from Neonatal Intensive Care Unit (NICU) discharge onwards.
- Focusing on education, addressing social determinants of health, and improving customer service can enhance HRIF program participation.
- Targeted strategies are needed to overcome identified barriers and leverage facilitators for improved follow-up care.
Objective:
Identify factors that impact attendance at a regional high-risk infant follow-up (HRIF) program and explore caregiver perceived barriers and facilitators to participation.
Study Design:
A retrospective study identified factors associated with first visit non-attendance amongst infants referred to HRIF. Results guided recruitment for a mixed methods needs assessment including surveys and structured interviews to understand caregiver perspectives through inductive qualitative thematic analysis.
Results:
Compared to infants who attended an initial HRIF visit, infants who did not attend had higher mean birthweight, public or no insurance, and maternal nativity outside the US. Qualitative prospective analyses revealed barriers and facilitators to HRIF program attendance were logistics, schedule, customer service, support for parental needs, knowledge, and attitude and motivation.
Conclusion:
Interventions to improve HRIF program participation should engage families at high-risk of non-attendance from the NICU stay onward and should focus on education, social needs, and customer service.