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PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1324-1332

The Effect of a Parenting Education Program on the Use of Preventive Pediatric Health Care Services Among Low-Income, Minority Mothers: A Randomized, Controlled Study

Ayman A. E. El-Mohandes, MD, MPH, Kathy S. Katz, PhD, M. Nabil El-Khorazaty, PhD, Doris McNeely-Johnson, PhD, Phyllis W. Sharps, PhD, RN, Marian H. Jarrett, EdD, Allison Rose, MHS, Davene M. White, RN, NNP, MPH, Michal Young, MD, Larry Grylack, MD, Kennan D. B. Murray, MPH, Pragathi S. Katta, MPH, Melissa Burroughs, MA, Ghassan Atiyeh, MD, Barbara K. Wingrove, MPH and Allen A. Herman, MD, PhD

From the Community of Health and Pediatrics/Obstetrics and Gynecology, George Washington University Medical Center, Washington, District of Columbia

Objective. To determine if a community-based intervention program focusing on parenting education will have an impact on preventive health care utilization behaviors among low-income, minority mothers in Washington, DC.

Design. The experimental design was a randomized, controlled study in which 286 mother-infant dyads were assigned to either the standard social services (control) group or to the intervention group. Women and their newborn infants were recruited during the immediate postpartum period in 4 Washington, DC, hospital sites from April 1995 to April 1997. The year-long multicomponent intervention included home visits and hospital-based group sessions in addition to the standard social services available at the hospital sites. A total of 286 postpartum women with inadequate prenatal care were assigned randomly to the control or the intervention group. Women and their infants were followed for 1 full year. Outcome measures included usage of preventive health care services including well care infant visits and adherence to immunization schedules during the first year of the infant’s life.

Results. Infants in the intervention group initiated well care at an earlier age than controls (by 6 weeks, 62.5% vs 50% had received their first well infant visit). Infants in the intervention group had more frequent well visits (by 12 months of age, 3.5 vs 2.7 visits). Multivariate analyses showed infants in the intervention group to be more likely to complete their scheduled immunizations (by 9 months, odds ratio = 2.2, 95% confidence interval: 1.09–4.53). Those in the intervention group with more frequent contacts (30+ visits) with study personnel were most likely to have followed age-appropriate immunization schedules when compared with controls (at 9 months odds ratio = 3.63, 95% confidence interval: 1.58–8.33).

Conclusions. It is possible to influence health care usage patterns of high-risk minority populations through public health interventions that are global in their perspective. Focusing on parental knowledge and beliefs regarding health-related issues and life skills in a self-efficacy model is associated with improved usage of infant health care resources.

Key Words: intervention program • preventive health care visits • parenting education

Abbreviations: PIP, Pride in Parenting • PSG, parent support group • DPG, developmental play group • HIB, Haemophilus influenzae vaccine • OR, odds ratio • CI, confidence interval • LBW, low birth weight • PNC, prenatal care • DPT, diphtheria, pertussis, tetanus • NIH, National Institutes of Health • NICHD, National Institute of Child Health and Human Development

Received for publication Jul 10, 2002; Accepted Nov 18, 2002.


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