412 - Barriers and Facilitators of Family Engagement in NICU Care for Low-Income Parents in California

Publication Number: 412.3597

Mary K. Quinn, Stanford University School of Medicine, Palo Alto, CA, United States; Clarissa E. Jaime-Gonzalez, University of Colorado Anschutz Medical Campus, Denver, CO, United States; Marina Magalhães, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States; Jochen Profit, Stanford University School of Medicine, Palo Alto, CA, United States; Henry C. Lee, University of California, San Diego School of Medicine, La Jolla, CA, United States

Background: Family presence in the NICU during the hospitalization of a preterm baby enables holding and skin-to-skin care which improves outcomes, including stabilization of vital signs patterns, breastfeeding success, improved long-term neurodevelopment, and improved parental mental health. Greater family presence has been reported among high-income compared with low-income parents. Few studies have investigated the unique barriers and facilitators that low-income families experience when engaging in their child's NICU care.

Objective: To assess the barriers and facilitators of parental engagement in care for low-income parents in a California NICU

Design/Methods: We used qualitative methods including semi-structured individual phone interviews to investigate facilitators and barriers to parental engagement. The analysis involved 3 reviewers using a constructivist grounded theory approach. Themes were developed through iterative coding and discussion. Parents were recruited in the hospital using purposeful sampling until data saturation. Eligible parents had infants born under 37 weeks gestational, had spent at least 3 weeks in the NICU, and had an income eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Results: The study included 20 parents, (ages 22-41, 95% female), with 11 interviews in Spanish and 9 in English. The study included 17 Latino, 1 Black, 1 Asian, and 1 White parents. The primary themes involved barriers to engagement that prevented parents from spending time at the bedside including high costs of transportation; housing instability; food insecurity; difficulty accessing or ineligibility for disability leave or paid family leave; mental health and emotional well-being of parents and siblings; and fragmented maternal and sibling health care. The primary facilitators of spending time at the bedside were overnight accommodation at the hospital; financial, emotional, and instrumental support from family; and gas and food vouchers distributed by social workers from the hospital. Within the NICU, open-ended communication with health care workers, availability of interpreter services, and a welcoming environment supported parental involvement.

Conclusion(s): Structural barriers outside the hospital posed the greatest challenge to engagement in care. Parents emphasized the value of hospital programs like food, housing, and gas vouchers. Investment in programs that directly address social determinants of health during the NICU stay may result in improved family engagement in care.

Table of Themes for Facilitators and Barriers to Engagement in Care
Table of Themes_FamEngagement.pdf

Table of Themes for Facilitators and Barriers to Engagement in Care
Table of Themes_FamEngagement.pdf