Multilevel Factors Associated with Participation in Group Well-Child Care.

Abstract

To identify factors associated with participation in group well-child care (GWCC), wherein families share preventive health care visits. We extracted electronic health record data of mother-infant dyads with infants born 2013-2018 at Yale New Haven Hospital and followed at the primary care center. Using chi-square analysis and multivariate logistic regression, we examined the extent to which (1) maternal/infant characteristics and recruitment timing were associated with GWCC initiation and continued engagement and (2) initiation was associated with primary care visits. Of 2,046 eligible mother-infant dyads, 11.6% initiated GWCC. The odds of initiation were higher among mothers with Spanish versus English primary language (OR:2.36 [95% CI:1.52-3.66]), with 1 child versus >3 children (1.58 [1.13-2.22]), and of non-Hispanic Black versus non-Hispanic White infants (2.72 [1.39-5.32]). Initiation was lower among infants born in 2016 (0.53 [0.32-0.88]) and 2018 (0.29 [0.17-0.52]) versus 2013. Among GWCC initiators with follow-up data (n=217), continued engagement (n=132, 60.8%) was positively associated with maternal age of 20-29 years (2.85 [1.10-7.34]) and >30 years (3.46 [1.15-10.43]) compared with <20 years, and mothers with 1 child versus ≥3 (2.28 [1.04-4.98]). GWCC initiators, versus non-initiators, had 5.06 times higher adjusted odds of attending >9 primary care appointments in the first 18 months (95% CI:3.74-6.85). As evidence builds on health and social benefits of GWCC, recruitment efforts may gain from considering multi-level socio-economic, demographic, and cultural factors associated with GWCC participation. Higher participation among systemically marginalized groups may present unique opportunities for family-based health promotion to mitigate health inequities.