Predictors of Adherence and Continuity for Parents of Newborns

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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.