Predictors of Adherence and Continuity for Parents of Newborns

描述(申请人提供)：婴儿猝死综合症(SID)和儿童早期龋齿对非裔美国儿童的影响不成比例。由于当父母按照正常儿童例行就诊时医生的建议进行睡眠姿势和夜间喂养时，这两种情况都会显著减少，因此了解坚持和持续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，医患关系的质量与坚持性和连续性密切相关。少数族裔对他们的服务提供者关系的评分比非西班牙裔白人更差。关于这种关联是否与父母与孩子的医生之间的关系存在关联的信息很少。这项研究的目的是确定：1)影响父母-医生关系质量的可修改因素，这些因素强烈预测父母遵守仰卧睡眠和夜间喂养预期指导建议；2)影响父母-儿科关系质量的可修改因素，预测生命第一年的连续性；3)非裔美国人和非西班牙裔白人父母在这些因素方面的相似和不同；以及4)根据结果制定干预措施，以提高父母对这些建议的遵守。这些目标将通过对新生儿的非洲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。职业发展的目标是：1)发展定量和定性研究的技能，以成功完成拟议的项目；2)了解父母与医生的关系如何影响新生儿父母的忠诚度和连续性；3)发展未来的项目，作为一名独立调查者，专注于加强父母与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、完成公共卫生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。密歇根大学的普通儿科1儿童健康评估和研究单位(CHEAR)、生物伦理学项目和公共卫生学院提供了临床和研究环境。在该拟议项目结束时，候选人将以独立调查员的身份提交一份RO1提案，以进一步调查该拟议项目发现的问题。

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.