Abstract
BackgroundAdvocacy regarding child health policy is a core tenet of pediatrics. Previous research has demonstrated that most pediatric providers believe collective advocacy and political involvement are essential aspects of their profession, but less is known about how pediatric providers engage with families about policy issues that impact child health. The objectives of this study were to examine providers’ perceptions and practices with regards to discussing health policy issues with families and to identify provider characteristics associated with having these discussions.MethodsIn this cross-sectional mixed methods study, pediatric resident physicians, attending physcians, and nurse practitioners at primary care clinics within a large academic health system were surveyed to assess (1) perceived importance of, (2) frequency of, and (3) barriers to and facilitators of health policy discussions with families. Multivariable ordinal regression was used to determine provider characteristics (including demographics, practice location, and extent of civic engagement) associated with frequency of these discussions. A subset of providers participated in subsequent focus groups designed to help interpret quantitative findings.ResultsThe overall survey response rate was 155/394 (39%). The majority of respondents (76%) felt pediatricians should talk to families about health policy issues affecting children, but most providers (69%) reported never or rarely having these discussions. Factors associated with discussing policy issues included being an attending physician/nurse practitioner (OR 8.22, 95% CI 2.04–33.1) and urban practice setting (OR 3.85, 95% CI 1.03–14.3). Barriers included feeling uninformed about relevant issues and time constraints. In provider focus groups, four key themes emerged: (1) providers felt discussing policy issues would help inform and empower families; (2) providers frequently discussed social service programs, but rarely discussed policies governing these programs; (3) time constraints and concerns about partisan bias were a barrier to conversations; and (4) use of support staff and handouts with information about policy changes could help facilitate more frequent conversations.ConclusionsPediatric providers felt it was important to talk to families about child health policy issues, but few providers reported having such conversations in practice. Primary care practices should consider incorporating workflow changes that promote family engagement in relevant health policy discussions.
Highlights
Pediatricians have served as child health advocates since the field’s inception
Pediatric providers felt it was important to talk to families about child health policy issues, but few providers reported having such conversations in practice
[1] This responsibility has been formalized by the American Academy of Pediatrics (AAP) in their policy statement on Poverty and Child Health, which recommends that pediatricians “advocate for public policies that support all children and mitigate the effects of poverty on child health,“ [2] and by the Accreditation Council for Graduate Medical Education (ACGME), which mandates that all pediatric residency programs provide residents with advocacy training [3]
Summary
Pediatricians have served as child health advocates since the field’s inception. Abraham Jacobi, one of the founders of pediatric medicine, famously stated, “every physician is by destiny a political being.” [1] This responsibility has been formalized by the American Academy of Pediatrics (AAP) in their policy statement on Poverty and Child Health, which recommends that pediatricians “advocate for public policies that support all children and mitigate the effects of poverty on child health,“ [2] and by the Accreditation Council for Graduate Medical Education (ACGME), which mandates that all pediatric residency programs provide residents with advocacy training [3].Previous research has demonstrated that a majority of physicians believe collective advocacy and political involvement are important aspects of the medical profession and that most physicians, including pediatricians, have participated in these activities [4]. In a recent survey of pediatricians in the United States, the majority of respondents felt that their professional organization, the AAP, should engage in advocacy around government policies impacting child health, including policies related to income support, housing, education, and access to health care [5]. These studies show that pediatricians are motivated to engage in and support advocacy on behalf of their patients. Previous research has demonstrated that most pediatric providers believe collective advocacy and political involvement are essential aspects of their profession, but less is known about how pediatric providers engage with families about policy issues that impact child health. The objectives of this study were to examine providers’ perceptions and practices with regards to discussing health policy issues with families and to identify provider characteristics associated with having these discussions
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