Devising, Implementing, and Evaluating Interventions to Eliminate Health Care Disparities in Minority Children
Few published studies deal specifically with racial and ethnic health care disparities in children. This study, published in Pediatrics, describes three successful interventions aimed at reducing health disparities in children. The article also describes learnings about devising, implementing and evaluating such interventions, and proposes a research agenda to address pediatric health disparities.
The authors describe three interventions, selected because they were both methodically rigorous and successful. The first was an intervention to increase breastfeeding in a Navajo community. Breastfeeding was increased on a number of metrics, including number of women that breastfed exclusively and percentage of infants fed formula. The second targeted HIV-preventing behaviors in African-American girls. The intervention was evaluated through its ability to reduce behaviors that can transmit HIV. Measures included how consistently girls reported condom use during sexual activity, number of new vaginal sex partners in the past 30 days, rates of chlamydia infection and knowledge about HIV transmission. The intervention was successful on all these fronts, and others. The third intervention evaluated the success of a community care manager in getting uninsured Latino children insurance. Outcome measures were receipt and continuity of coverage, and parental satisfaction with the process. Children in the intervention were more likely to obtain coverage (96% versus 57%), had more continuous coverage, and higher parent satisfaction.
Characteristics of these studies include large sample size, being a randomized clinical trial (2 out of 3), measurable outcomes, were community based and linguistically sensitive, worked with families, and were based on previous qualitative studies performed in that community. Pitfalls that can, to a degree, be planned for ahead of time include lack of follow-on funding and study attrition, which can negatively affect sample size.
Finally, the authors described an agenda that targets some of the most urgent needs in pediatric health disparities research. These include underinsurance in racial minorities, racial disparities in infant and childhood mortality and quality of care issues such as access to transplants and mental health care.