Predictors of Adherence and Continuity for Parents of Newborns

描述（由申请人提供）：婴儿猝死综合症（SIDS）和幼儿龋齿对非裔美国儿童的影响尤为严重。由于当父母遵循医生在儿童常规就诊时给出的睡眠姿势和夜间喂养的建议时，这两种情况都会大大减少，因此了解依从性和连续性护理的预测因素对于消除这种差异至关重要。对于成年患者，研究表明，医患关系的质量与依从性和连续性密切相关。与非西班牙裔白人相比，少数族裔对医疗服务提供者关系的评价更差。关于这种关联是否存在于父母与孩子的医生之间的信息很少。研究目的是确定：1)影响父母-医生关系质量的可修改因素，这些因素可以强烈预测父母是否坚持仰卧睡眠和夜间喂养预期指导建议；2)影响父母-儿科医生关系质量的可修改因素，可以预测第一年的护理连续性；3)非裔美国人和非西班牙裔白人父母在这些因素上的异同。4)根据结果制定干预措施，以提高家长对这些建议的依从性。这些目标将通过对新生儿的非裔美国人和非西班牙裔白人父母进行为期12个月的纵向研究来实现。职业发展目标是：1)发展定量和定性研究的技能，以成功完成拟议的项目；2)了解父母-医生关系如何影响新生儿父母的依从性和连续性；3)作为一名独立研究者，发展未来的项目，专注于增强父母-医生关系中与父母决策密切相关的因素。这些目标将通过密集的指导，完成硕士学位和拟议的研究来实现。三名导师和一名生物统计学家顾问将指导拟议的多学科研究。密歇根大学普通小儿科1儿童健康评估和研究部门（CHEAR）、生物伦理计划和公共卫生学院提供临床和研究环境。在本项目结束时，候选人将作为独立调查员提交RO1提案，以进一步调查本项目发现的问题。

DESCRIPTION (provided by applicant): Sudden Infant Death Syndrome (SIDS) and early childhood caries disproportionately affect African American children. Since both are substantially reduced when parents follow physician recommendations given at routine well-child visits for sleep position and night-time feeding, understanding predictors of adherence and continuity of care is vital to eliminating this disparity. For adult patients, research has demonstrated that the quality of the patient-physician relationship is strongly associated with adherence and continuity. Minorities' ratings of their provider relationships are worse than non-Hispanic Whites. There is little information as to whether this association exists with parents' relationship with their child's doctor. The Research Aims are to identify: 1) modifiable factors affecting the quality of the parent-physician relationship that are strongly predictive of parental adherence to supine sleep and night feeding anticipatory guidance recommendations, 2) modifiable factors affecting the quality of the parent-pediatrician relationship that are predictive of continuity of care in the 1st year of life, 3) similarities and differences between African American and non- Hispanic White parents in these factors, and 4) to develop an intervention based on the results to improve parental adherence to these recommendations. These aims will be achieved through a 12-month longitudinal study of African American and non-Hispanic White parents of newborns. The Career Development Aims are to: 1) develop skills in quantitative and qualitative research to successfully complete the proposed project, 2) understand how the parent-physician relationship affects adherence and continuity for parents of newborns, and 3) develop future projects as an independent investigator focused on enhancing factors within the parent-physician relationship strongly associated with parental decision-making. These aims will be achieved through intensive mentoring, completing an MPH degree and the proposed research. Three mentors and one biostatistician consultant will guide the multi-disciplinary proposed research. The University of Michigan's Department of General Pediatrics1 Child Health Evaluation and Research Unit (CHEAR), Bioethics Program, and School of Public Health provide the clinical and research environment. By the end of this proposed project, the candidate will submit an RO1 proposal as an independent investigator to further investigate issues discovered by this proposed project.