Barriers to Infant Preventative Care During the COVID-19 Pandemic

Background: Preventative care visits, declared essential by government entities, hospitals, and professional organizations, decreased during the COVID-19 pandemic putting infants at risk of poor health outcomes. Parental reasons for visit decline have not been formally studied, especially among those with disproportionate COVID-19 disease burden. Objective is to describe perceived barriers by parents to accessing infant preventative care during the COVID-19 pandemic.

Methods: Retrospective EMR chart review of 3 academic outpatient centers identified patients who missed a 2, 4, 6, or 12-month preventative visit by at least 1 month from March 16 – September 30 2020 with a guardian aged 18 years or older. The study team telephoned all eligible participants. Respondents, verbally consented in English or Spanish, completed a telephone survey with 9 closed-ended questions (yes or no) and one open-ended question. The EMR provided demographic information. No financial incentives were provided. Data variables were compared by chi-square test or Fisher’s exact test. Qualitative responses were reviewed by authors and analyzed for themes. The study was IRB exempt.

Results: Of 344 patients who met inclusion criteria, 66 participated in the survey; 175 were eligible but not reached and 103 were eligible but declined participation. Use of the American Association for Public Opinion Research calculator showed 0.19 response rate, 0.39 cooperate rate, 0.30 refusal rate, and 0.49 contact rate. Respondents and non-respondents did not differ by insurance type, race/ethnicity, or type of visit missed. Consistent with predominant clinic demographics, respondents primarily represented Black/African American parents with public insurance and medical homes in under-resourced neighborhoods. The most common responses were concern about exposure to COVID-19 during the clinic visit and belief that preventative visits were not essential. Concern for exposure during travel to visit and lack of childcare for other children were cited. Insurance lapse or switching providers were not frequent responses. Responses were not statistically different among age of visit missed. Reponses to the open-ended question echoed the survey responses.

Conclusion: Results, although limited by small sample size, volunteer bias, and recall bias, show that addressing real and perceived threats of COVID-19 infection during preventative care visits and clarifying recommendations from trusted institutions are necessary to avoid future gaps in care; this is especially critically among communities with long-standing inequities resulting in disproportionate disease burden.