Intervention to Reduce Diaper Need and Increase Use of Pediatric Preventive Care
| Status: | Recruiting |
|---|---|
| Conditions: | Depression, Other Indications, Infectious Disease, Dermatology, Urology, Urinary Tract Infections |
| Therapuetic Areas: | Dermatology / Plastic Surgery, Immunology / Infectious Diseases, Nephrology / Urology, Psychiatry / Psychology, Other |
| Healthy: | No |
| Age Range: | 25 - 35 |
| Updated: | 4/5/2019 |
| Start Date: | April 1, 2019 |
| End Date: | May 2020 |
| Contact: | Megan R Smith, Dr.PH |
| Email: | megan.smith@yale.edu |
| Phone: | 203-764-8655 |
Examining the Impact of an Intervention to Reduce Diaper Need and Increase Use of Pediatric Preventive Care
Well-child care is the primary source of preventative health care for children. These visits
provide an opportunity for physicians to assess an infant's biomedical health, development,
and behavior, as well as help ensure timely immunizations, reduce the use of acute care
services, and assess and family functioning. Yet, disparities in the utilization of pediatric
care exist by race, ethnicity and income in the U.S., even despite high rates of overall
access to primary care. Incentives have been proposed as one way to increase utilization of
preventative care for mothers and children.
Diapering is another important form of preventative health care that can be particularly
difficult for low-income parents due the cost of diapers, which is $70-80 per child per
month, or approximately $960 per year, on average. And government programs, such as Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC), Supplemental Nutrition
Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF), either cannot
be used to purchase diapers, or do not provide enough assistance to cover the cost of diapers
and other basic needs. A family's inability to provide an adequate supply of diapers for
their child is called diaper need. Nationwide, one in three families with young children
report experiencing diaper need, which was found to be significantly associated with maternal
stress and depression, which in turn, can have a detrimental impact on a family's health and
economic success.
The primary goal of this study is to conduct a randomized controlled trial of a diaper
provision intervention designed to increase utilization of, and adherence to, well-child
visits and reduce diaper need among low-resourced families in New Haven, CT.
provide an opportunity for physicians to assess an infant's biomedical health, development,
and behavior, as well as help ensure timely immunizations, reduce the use of acute care
services, and assess and family functioning. Yet, disparities in the utilization of pediatric
care exist by race, ethnicity and income in the U.S., even despite high rates of overall
access to primary care. Incentives have been proposed as one way to increase utilization of
preventative care for mothers and children.
Diapering is another important form of preventative health care that can be particularly
difficult for low-income parents due the cost of diapers, which is $70-80 per child per
month, or approximately $960 per year, on average. And government programs, such as Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC), Supplemental Nutrition
Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF), either cannot
be used to purchase diapers, or do not provide enough assistance to cover the cost of diapers
and other basic needs. A family's inability to provide an adequate supply of diapers for
their child is called diaper need. Nationwide, one in three families with young children
report experiencing diaper need, which was found to be significantly associated with maternal
stress and depression, which in turn, can have a detrimental impact on a family's health and
economic success.
The primary goal of this study is to conduct a randomized controlled trial of a diaper
provision intervention designed to increase utilization of, and adherence to, well-child
visits and reduce diaper need among low-resourced families in New Haven, CT.
The investigators will conduct a randomized controlled trial of a diaper incentive
intervention whereby diapers will be used to achieve two separate but related aims.
First, diapers will be used as an incentive to increase utilization of, and adherence to,
well-child visits, during the first year of a newborn's life. More specifically, postpartum
women who receive care in the Yale New Haven Health System will be randomly assigned to
receive a diaper incentive in conjunction with their attendance at regularly scheduled
well-child visits, according to the American Academy of Pediatrics (AAP) recommended schedule
during the first year of a child's life. Diapers will be provided at the completion of the 2-
week, 2-month, 4- month and 6-month visits. A follow-up phone call assessment will also occur
approximately 3 months after the family receives their final distribution of diapers or
conditional cash transfer. Postpartum women randomly assigned to the control condition will
receive the cash equivalent value of the diaper incentive for their participation at these
same time points.
Second, diapers will be used to reduce the level of diaper need. This will be evaluated using
a self-report diaper need survey that will be administered along with other surveys to women
in the intervention and control conditions in accordance with the AAP well-child visit
schedule. In addition to diaper need, the following domains will be assessed:
Depressive symptoms, perceived stress, maternal-child attachment, ability to meet basic
needs, and demographic information including but not limited to race-ethnicity, mother's age,
parity, marital status, education level, income, employment status, child(ren)'s sex,
child(ren)'s age, health status, healthcare access, and use.
The investigators anticipate that this study will result in greater use of, and adherence to,
the recommended schedule of pediatric well-child visits, as well as a greater reduction of
diaper need among families in the intervention group. The investigators also anticipate that
the reduction of diaper need will be associated with decreased parenting stress and improved
diaper-related health among women and children, respectively, in the intervention group.
intervention whereby diapers will be used to achieve two separate but related aims.
First, diapers will be used as an incentive to increase utilization of, and adherence to,
well-child visits, during the first year of a newborn's life. More specifically, postpartum
women who receive care in the Yale New Haven Health System will be randomly assigned to
receive a diaper incentive in conjunction with their attendance at regularly scheduled
well-child visits, according to the American Academy of Pediatrics (AAP) recommended schedule
during the first year of a child's life. Diapers will be provided at the completion of the 2-
week, 2-month, 4- month and 6-month visits. A follow-up phone call assessment will also occur
approximately 3 months after the family receives their final distribution of diapers or
conditional cash transfer. Postpartum women randomly assigned to the control condition will
receive the cash equivalent value of the diaper incentive for their participation at these
same time points.
Second, diapers will be used to reduce the level of diaper need. This will be evaluated using
a self-report diaper need survey that will be administered along with other surveys to women
in the intervention and control conditions in accordance with the AAP well-child visit
schedule. In addition to diaper need, the following domains will be assessed:
Depressive symptoms, perceived stress, maternal-child attachment, ability to meet basic
needs, and demographic information including but not limited to race-ethnicity, mother's age,
parity, marital status, education level, income, employment status, child(ren)'s sex,
child(ren)'s age, health status, healthcare access, and use.
The investigators anticipate that this study will result in greater use of, and adherence to,
the recommended schedule of pediatric well-child visits, as well as a greater reduction of
diaper need among families in the intervention group. The investigators also anticipate that
the reduction of diaper need will be associated with decreased parenting stress and improved
diaper-related health among women and children, respectively, in the intervention group.
Inclusion Criteria:
- Postpartum women who receive care at Yale New Haven Health
- Are about to give birth or recently gave birth to a singleton infant who is 0 to
1-week old (index child)
- Have not received a distribution of diapers for the index child
- English- speaking
Exclusion Criteria:
- Infant admitted to the NICU during the baseline assessment time period
- Infant admitted to the hospital at assessment visits 1-4
- Infant is born with or develops a gastrointestinal condition or illness that will
impact the health outcomes of the study
We found this trial at
2
sites
New Haven, Connecticut 06510
Principal Investigator: Megan V Smith, DrPH
Phone: 203-764-7621
Click here to add this to my saved trials
New Haven, Connecticut 06520
Principal Investigator: Megan V Smith, MPH, DrPH
Phone: 203-764-7621
Click here to add this to my saved trials