P0046 - Evaluating Perception of Child Health and Safety Needs in a Community Through the Perspective of Caregivers and Physicians

Background: There is a paucity of studies comparing the alignment of community health and safety concerns from a physicians’ and caregivers’ perspective. Discrepancies could impact the quality of health and safety programming delivered to these communities. Our objective was to identify and compare child health and safety concerns in the community from the perspective of physicians and caregivers in Louisville.

Methods: We administered surveys from 2017 to 2018 to caregivers with children who attended community events in Park Duvalle, a low-income neighborhood with greater health disparities including higher infant mortality. We simultaneously administered surveys to physicians at the University of Louisville/Norton Healthcare system. Participants were asked to list, via open-ended questions, the top three health or safety concerns they had for children they cared for in three separate age groups (≤ 3, 4-11, and ≥12 years old). Four reviewers assigned responses to a pre-specified category/subcategory through a schematic designed by the study team and a fifth reviewer addressed any discrepancies and
assigned final categories. Agreement in assigning overall categories was measured using Fleiss Kappa and descriptive statistics were used to characterize the responses.

Results: A total of 41 caregivers and 43 physicians were surveyed in this study. Overall categorical agreement between reviewers was k= 0.839, indicating good agreement on assignment. Table 1 outlines the top three health and safety concerns of caregivers and physicians as a percentage of all concerns for each age group. Notably, injury/violence was identified by both caregivers and physicians as the top concern for children across all age groups. Wide variation was found when analyzing specific injury/violence subcategories, with caregivers more worried about household safety (17-40%) and gangs/unsafe neighborhoods (10-50%) while physicians were more concerned about sleep safety (36%), domestic violence (8-27%), and unintentional injury (10-20%).

Conclusions: Survey administration was a feasible method of comparing health and safety concerns among caregivers and physicians. We identified injury/violence as the top health and safety concern across all age groups in our community but noted variation on the specific type of injury/violence. Replication of our study methodology in other neighborhoods may allow for improved comparison of caregiver and physician concerns.