Parents’ Adherence to Childhood Screening Tests and Referrals: A Retrospective Cohort Study with Randomized Sampling
Abstract
:1. Introduction
Preventative Health Services in Israel
- (a)
- To explore the potential factors associated with parents’ nonadherence with routine screening tests performed by physicians and nurses at MCHCs.
- (b)
- To explore parents’ response to referrals for further diagnostic evaluation and health outcomes of diagnostic tests.
2. Materials and Methods
2.1. Data Source
2.2. Measures of Variables
- Child information, including gender, number of children in the pregnancy, weeks of pregnancy (weeks and days), delivery process (vaginal, caesarian section, or complex).
- Mother’s information, including mother’s age, mother’s citizenship (Israeli citizen/foreign worker or asylum seeker), education level (academic/not academic), religion (Jewish/Arab), marital status (married/not married), number of children in the family.
- Physician and nurse examination, including date of two-month and nine-month ST, outcome of ST (no finding/suspicion of unusual finding), whether the outcome was the first observation (yes, it is the initial finding/no, the child was diagnosed previously. This measure was relevant only for physicians), referral for further diagnosis (yes/no), parents acted on the referral (yes/no), outcome of further diagnosis (no finding/pathological finding).
2.3. Data Analyses
3. Results
3.1. Screening Test Outcomes
3.2. Parents’ Response to Referrals
4. Discussion
- (a)
- The national health insurance law applies to all children in Israel who are citizens, including minority citizens, with the exception of foreign workers’ children. This means that all citizen children necessarily receive health care.
- (b)
- Children of foreign workers/asylum seekers, of whom only some had health insurance, were significantly more likely to undergo physician and nurse examinations than Israeli citizen children.
- (c)
- No differences were found between children whose parents did or did not comply with physician/nurse referrals by their health insurance (citizen children compared to foreign children).
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Variable | N (%) | M (SD) | Median |
---|---|---|---|
Child’s information | |||
Gender | |||
Female | 420 (49.8) | ||
Male | 424 (50.2) | ||
Number of children in pregnancy | |||
1 | 800 (94.9) | ||
2 | 42 (5.0) | ||
3 | 1 (0.1) | ||
Delivery process * | |||
Vaginal | 574 (68.0) | ||
Caesarian/complex | 268 (31.8) | ||
Infant medical problems at delivery | |||
No finding | 584 (69.6) | ||
Abnormal findings ** | 255 (30.4) | ||
Birth age (weeks) | 39.2 (2.03) | 39.7 | |
Mother’s information | |||
Age | 33.8 (5.52) | 34.0 | |
Number of children in the family | 1.96 (1.27) | 2.0 | |
Marital status | |||
Married | 740 (88.0) | ||
Not married | 101 (12.0) | ||
Citizenship | |||
Israeli citizen | 707 (84.0) | ||
Foreign worker/asylum seeker | 135 (16.0) | ||
Education level | |||
Not academic | 345 (41.5) | ||
Academic | 487 (58.5) | ||
Religion | |||
Jewish | 638 (75.6) | ||
Muslim | 61 (7.2) | ||
Christian | 139 (16.5) | ||
Other | 6 (0.7) |
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2016 Cohort (n = 397) | 2017 Cohort (n = 447) | χ2 | p Value | |
---|---|---|---|---|
Physician’s screening test | N (%) | N (%) | ||
Underwent physician’s screening test | 9.98 | 0.002 | ||
Yes | 289 (72.8) | 366 (81.9) | ||
No | 108 (27.2) | 81 (18.1) | ||
Nurse’s screening test | N (%) | N (%) | ||
Underwent nurse’s screening test | 33.02 | 0.001 | ||
Yes | 348 (87.7) | 437 (97.8) | ||
No | 49 (12.3) | 10 (2.2) |
Physician’s Screening Test N (%) | Nurse’s Screening Test N (%) | χ2 | p< | |
---|---|---|---|---|
Performed | 134.3 | 0.0001 | ||
Yes | 655 (77.6) | 785 (93.0) | ||
No | 189 (22.4) | 59 (7.0) | ||
Outcome | 3.29 | 0.07 | ||
No finding | 393 (60.0) | 692 (88.4) | ||
Suspicious finding | 262 (40.0) | 91 (11.6) | ||
Types of findings: | ||||
General condition | 46 (17.4) | |||
Skin system | 62 (23.5) | |||
Head, face, neck | 63 (23.9) | |||
Chest | 14 (5.3) | |||
Cardiovascular system | 15 (5.6) | |||
Stomach | 19 (7.2) | |||
Genital system | 18 (6.8) | |||
Bones | 21 (8.0) | |||
Neurological system | 6 (2.2) | |||
Growth problem | - | 73 (80.2) | ||
Developmental problem | - | 18 (19.8) | ||
Initial finding | ||||
Yes | 137 (52.3) | - | ||
No | 84 (32.1) | |||
Unknown | 41 (15.6) | |||
Referral a | 54.63 | 0.0001 | ||
Yes | 94 (35.9) | 79 (86.8) | ||
No | 168 (64.1) | 12 (13.2) | ||
Parents acted on the referral | 14.43 | 0.0001 | ||
Yes | 61 (64.9) | 70 (88.6) | ||
No | 33 (35.1) | 9 (11.4) | ||
Referral Outcome b | 0.00 | 0.98 | ||
No finding | 29 (47.5) | 34 (48.6) | ||
Pathological finding | 32 (52.5) | 36 (51.4) |
Physician’s Screening Test | Nurse’s Screening Test | |||
---|---|---|---|---|
Underwent N (%) | Did Not Undergo N (%) | Underwent N (%) | Did Not Undergo N (%) | |
Gender a | ||||
Female | 316 (75.2) | 104 (24.8) | 384 (91.4) | 36 (8.6) |
Male | 339 (80.0) | 85 (20.0) | 401 (94.6) | 23 (5.4) |
Number of children in pregnancy a | ||||
1 | 626 (78.3) | 28 (65.1) | 743 (92.9) | 57 (7.1) |
2 or more | 174 (21.8) | 15 (34.9) * | 41 (95.3) | 2 (4.7) |
Delivery process a | ||||
Vaginal | 432 (75.3) | 142 (24.7) | 531 (92.5) | 43 (7.5) |
Caesarian/complex | 221 (82.5) | 47 (17.5) * | 252 (94.0) | 16 (6.0) |
Infant medical problem at delivery a | ||||
No finding | 455 (77.9) | 129 (22.1) | 537 (92.0) | 47 (8.0) |
Pathological findings | 196 (76.9) | 59 (23.1) | 243 (95.3) | 12 (4.7) |
Mother’s age, M(SD) b | 33.4 (5.53) | 35.1 (5.32) *** | 33.6 (5.50) | 36.2 (5.28) *** |
Number of children in the family, M (SD) b | 1.9 (1.25) | 2.3 (1.29) *** | 1.9 (1.28) | 2.2 (1.19) |
Marital status a | ||||
Married | 570 (77.0) | 170 (23.0) | 685 (92.6) | 55 (7.4) |
Not married | 83 (82.2) | 18 (17.8) | 97 (96.0) | 4 (4.0) |
Citizenship a | ||||
Israeli citizen | 529 (74.8) | 178 (25.2) | 649 (91.8) | 58 (8.2) |
Foreign worker/asylum seeker | 124 (91.9) | 11 (8.1) *** | 134 (99.3) | 1 (7.0) ** |
Education level a | ||||
Not academic | 238 (82.0) | 62 (18.0) | 327 (94.8) | 18 (5.2) |
Academic | 361 (74.1) | 126 (25.9) ** | 447 (91.8) | 40 (8.2) |
Religion a | ||||
Jewish | 480 (75.2) | 158 (24.8) | 585 (91.7) | 53 (8.3) |
Arab | 175 (85.0) | 31 (15.0) ** | 200 (97.1) | 6 (2.9) ** |
Predictor: Physician’s Screening Test | Predictor: Nurse’s Screening Test | |||
---|---|---|---|---|
Adjusted OR | 95% CI | Adjusted OR | 95% CI | |
Number of children in pregnancy | - | - | ||
One child—ref | 1 | |||
Two or more | 0.05 | 0.25–1.02 | ||
Mother’s age | 0.96 | 0.93–0.99 * | 0.93 | 0.88–0.98 ** |
Delivery process | 1 | - | - | |
Vaginal—ref | ||||
Caesarian/complex | 1.70 | 1.14–2.54 ** | ||
Number of children in the family | 0.84 | 0.72–0.97 * | - | - |
Citizenship | ||||
Israeli citizen—ref | 1 | 1 | ||
Foreign worker/asylum seeker | 3.95 | 1.73–9.04 *** | 10.33 | 1.18–0.98 * |
Education level | - | - | ||
Not academic—ref | 1 | |||
Academic | 0.84 | 0.55–1.28 | ||
Religion | ||||
Jewish—ref | 1 | 1 | ||
Arab | 1.51 | 0.83–2.75 | 1.16 | 0.43–3.13 |
Physician’s Referral (n = 94) | Nurse’s Referral (n = 79) | |||
---|---|---|---|---|
Took Action N (%) | Did Not Take Action N (%) | Took Action N (%) | Did Not Take Action N (%) | |
Gender | ||||
Female | 24 (58.8) | 17 (41.5) | 36 (87.8) | 5 (12.2) |
Male | 37 (69.8) | 16 (30.2) | 34 (89.5) | 4 (10.5) |
Delivery process | ||||
Vaginal | 31 (62.0) | 19 (38.0) | 45 (86.5) | 7 (13.5) |
Caesarian/complex | 30 (68.2) | 14 (31.8) | 25 (96.2) | 1 (3.8) |
Infant medical problem at delivery | ||||
No finding | 39 (62.9) | 23 (37.1) | 46 (86.6) | 7 (13.2) |
Pathological findings | 22 (71.0) | 9 (29.0) | 24 (92.3) | 2 (7.7) |
Mother’s age, M (SD) | 33.1 (6.62) | 33.7 (5.32) | 33.9 (4.95) | 33.3 (4.58) |
Number of children in the family, M (SD) | 1.6 (0.73) | 2.06 (0.99) * | 1.8 (0.86) | 1.6 (0.52) |
Origin | ||||
Israeli citizen | 42 (60.9) | 27 (39.1) | 54 (88.5) | 7 (11.5) |
Foreign worker/asylum seeker | 19 (76.0) | 6 (24.0) | 16 (88.9) | 2 (11.1) |
Education level | ||||
Not academic | 33 (63.5) | 19 (36.5) | 35 (94.6) | 2 (5.4) |
Academic | 27 (67.5) | 13 (32.5) | 35 (83.3) | 7 (16.7) |
Religion | ||||
Jewish | 37 (63.8) | 21 (36.2) | 51 (87.9) | 7 (12.1) |
Arab | 24 (66.7) | 12 (33.3) | 19 (90.5) | 2 (9.5) |
Initial finding | ||||
Yes | 53 (70.7) | 22 (29.3) | ||
No | 8 (42.1) | 11 (57.9) * | - | - |
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Amit Aharon, A. Parents’ Adherence to Childhood Screening Tests and Referrals: A Retrospective Cohort Study with Randomized Sampling. Int. J. Environ. Res. Public Health 2022, 19, 6143. https://doi.org/10.3390/ijerph19106143
Amit Aharon A. Parents’ Adherence to Childhood Screening Tests and Referrals: A Retrospective Cohort Study with Randomized Sampling. International Journal of Environmental Research and Public Health. 2022; 19(10):6143. https://doi.org/10.3390/ijerph19106143
Chicago/Turabian StyleAmit Aharon, Anat. 2022. "Parents’ Adherence to Childhood Screening Tests and Referrals: A Retrospective Cohort Study with Randomized Sampling" International Journal of Environmental Research and Public Health 19, no. 10: 6143. https://doi.org/10.3390/ijerph19106143