study descriptionQualitative: discourse analysis and phenomenological study.
core topic(s)Early Relational Health
Population CharacteristicsRace, Ethnicity, and Culture
Exposures, Outcomes, OtherClinic-Based Programs and Interventions , Disparity/Adversity , Early Relational Health Screen , Parent Knowledge, Attitudes, and Beliefs , Screening and Tools , Validity, Reliability, Feasibility, and Acceptability
metric(s)Early Relational Health Screen (ERHS)
objectivesThis is the first investigation of experiences and perspectives of African American families and Healthy Steps Specialists (HSS) of color with the Early Relational Health Screen (ERHS) in a pediatric primary care setting.
exposureEarly Relational Health Screen (ERHS).
outcomes evaluatedERHS relevance, acceptance, and utility.
settingTwo pediatric primary care settings in Washington, D.C. where families have the option of enrolling in Healthy Steps (HS-DC).
methodsAuthors present findings of a discourse analysis and phenomenological study of experiences of African American families’ and Healthy Steps Specialists’ (HSS) of color with screening ERH in Washington, D.C., USA.
sample sizen=13 (participants)
Discourse Analysis: examined ways in which people who were involved in ERH interacted with each other, how they understood implications of their words, decisions, and actions to determine how thinking among members of dominant groups affects members of minority groups. Analysis of discourses that are operative in particular situations, for example, screening ERH in pediatric primary care, is also a way to detect thinking, language, and practices that enable systemic racism.
Phenomenology: understanding the subjective nature of lived experience to identify unanticipated phenomena and influences, generate new theories, and develop causal explanations. To mitigate the influence of presuppositions on participant observation, data analysis and interpretation, researchers begin by studying phenomena, and engage in self-critique during content analysis. The last step in analysis is relating findings to relevant literature.
resultsFindings indicate relevance, acceptance and utility may be influenced by positionality, cultural context, issues of equity, and engagement in mutual reflection. A family-centered approach that opened space for non-dominant knowledge about ERH made positive differences in engagement and utility for families and practitioners alike. Health and vulnerability were detected reliably using this approach.
conclusionsOutcomes include new theories about ERH-focused visits with African American families and infants, and a new model for centering ERH in pediatric practice, entitled Early Relational Health Conversations. ERH-C is a family reflection model, not necessarily dyadic. It may have value for other populations. Future directions in ERH-C research are suggested.
limitationsJust two fathers participated. Clinic nurses, nurse practitioners and pediatricians were not participants in the study or in RSC. HSS would have preferred families be engaged as true co-investigators, developing research questions, analyzing and interpreting data, and disseminating lessons learned (Foster-Fishman & Watson, 2011), but it was not possible at the time this quality improvement initiative was undertaken.