Young parents from low-literacy and low-income backgrounds are an under-resourced population, which makes them highly vulnerable to inequities in healthcare access. Here, we explore what systemic challenges stand in the way of providing quality care to this community, and steps we can take to bridge the gaps.
In our previous post, we discussed the expansion of health education onto online platforms and high-level issues surrounding equity and accessibility of digital health information among under-resourced populations. Literature has shown that a variety of systemic determinants exist that can create digital divides in how people learn, use, interact with, and interpret information online, including age, income, and education.
Social Cascade’s mission is to identify ways to deliver health information across social media through AI technology, particularly for parents and caregivers, a population that frequently uses the Internet to seek health information. Here, we will be focusing specifically on young parent populations from low-literacy and low-income backgrounds and examining what we know about their information-seeking behaviors and experiences with barriers to accessing quality and safe healthcare.
Primary care disparities among young parents
Accessing healthcare is one of the most prevalent challenges for low-income families, and low-education, complexities with health insurance, and distrust of healthcare providers were stated as common obstacles that perpetuate those challenges. An assessment of parent experiences with primary care revealed that minority families have poorer experiences than White families when it comes to accessibility, services offered, and interpersonal relationships with their health providers. Moreover, a 2015 article reports that “more than 1 in 3 adults in the U.S. have low health literacy”; this has further negative impacts on the quality and cost of healthcare received by parents from historically marginalized backgrounds, specifically when it comes to managing symptoms and medication.
Across the literature on health disparities among young parents and families, one key equity issue that comes up consistently is language barriers. Establishing and maintaining an open dialogue between patients and providers is one of the most important elements of providing quality healthcare services, but what happens when there is a breakdown in effective communication? A 2017 study conducted with a sample of Spanish-speaking and English-speaking parents found that in-person interactions with a healthcare provider when language barriers were present proved to be inefficient in providing care and the use of an interpreter did not make a difference in understanding.
Furthermore, when we think about young parents from underserved backgrounds, we are looking at the intersection of linguistic and ethnic differences with low-income and low education, which creates a multitude of complex limitations when accessing care. Similar to the finding above, a study with teenage parents also revealed that in-person services may not be the most effective source of care for marginalized populations, as there continues to be an association between stigma and systemic biases and negative maternal health outcomes.
Advantages of digital and social media-based health information for young parent populations
Studies have shown that almost all parents use digital media to seek information about their child's health due to its 24/7 availability and convenience. That being said, parents tend to use digital health as a supplement to in-person care from a provider since there is still a lot of skepticism around the accuracy and interpretation of online health information.
Additionally, in a qualitative focus group conducted with postpartum mothers, who tend to encounter a high need for information as their responsibilities as new parents rapidly evolve, there seemed to be a preference for experiential information received from peers or family members due to information overload online and the fear of being judged for any online health-seeking behaviors. To build on this idea, feelings around seeking information online and the actual experiences of doing so can differ across mothers from various educational backgrounds, but younger and less educated mothers tend to be hesitant to participate in focus group studies.
One study that attempted to fill this inclusion gap found that how low-income mothers perceived their postpartum needs informed their information-seeking behaviors. Mobile apps were used heavily during pregnancy but became less helpful after birth, while mobile phones with access to pregnancy-related websites were consistently relied on. Moreover, parental health literacy has been foundationally associated with online information-seeking, such that less educated parents are less likely to be online health seekers to begin with, widening the digital divide. In such cases, adolescent children have been found to seek information online on behalf of their parents and serve as advocates in healthcare spaces. This also begs the question of how we are reaching audiences across different age groups and generations.
Keeping in mind all potential audiences of social media and the Internet, how coherent, clear, and literacy-level-appropriate is the health advice shared online? Continued research with low-income and low-literacy mothers will reveal the best strategies for engaging this historically marginalized parent population, their children and extended families. While in-person healthcare services may always be the preferred method of care, in circumstances where that is not accessible or cost-effective to a family, one of their fallbacks would be information communicated digitally, which is why it is crucial for
Embracing the integration of technology in healthcare and finding strategies to improve its validity and utility
A recent study focusing on communication within the patient-provider relationship reported that physicians are relying more and more on technology to gather and store patient data and make medical decisions, rather than in-person appointments as is traditional, due to high demands on their time and on healthcare facility resources. While at first this might be seen as unideal circumstances, we also must embrace that integrating technology into health services will likely continue to see sharp inclines as digital device and machine learning industries expand. Therefore, it is imperative, now more than ever, to ensure that health information communicated online is backed up by research and endorsed by medical providers. Social Cascade is already working towards closing this gap through innovative patient education strategies utilizing AI technologies.
Where do we start? To begin, there are several common motivators of parents who engage with social media content around health advice: curiosity about their symptoms prior to a diagnosis, desire to learn more about their health status following a diagnosis, and interest in social support and the lived experiences of other parents in their communities. These findings go hand in hand with frequent challenges encountered by parents, which include social isolation and frustrations with healthcare systems. Parents reported that resources that help them to feel prepared for managing their or their child's health condition, connect with peers in similar circumstances, and develop partnerships with support and advocacy groups were helpful strategies in bridging gaps in their care.
Forwarding this work
Social Cascade is looking forward to a unique partnership with the Pediatrics Supporting Parents (PSP) initiative through the Center for the Study of Social Policy (CSSP) to collaborate on innovative solutions to address some of the challenges considered in this article. The CSSP shares Social Cascade’s aim to create equitable health outcomes for families and children, and are currently working together to identify the barriers to accessing safe and high-quality pediatric primary care and exploring the most effective ways to communicate credible health advice to parents across the United States.
References
Chang, F.-C., Chiu, C.-H., Chen, P.-H., Miao, N.-F., Lee, C.-M., Chiang, J.-T., & Pan, Y.-C. (2015). Relationship Between Parental and Adolescent eHealth Literacy and Online Health Information Seeking in Taiwan. Cyberpsychology, Behavior, and Social Networking, 18(10), 618–624. https://doi.org/10.1089/cyber.2015.0110
Cotten, S. R., & Gupta, S. S. (2004). Characteristics of online and offline health information seekers and factors that discriminate between them. Social Science & Medicine, 59(9), 1795–1806. https://doi.org/10.1016/j.socscimed.2004.02.020
Drossman, D. A., Chang, L., Deutsch, J. K., Ford, A. C., Halpert, A., Kroenke, K., Nurko, S., Ruddy, J., Snyder, J., & Sperber, A. (2021). A Review of the Evidence and Recommendations on Communication Skills and the Patient–Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology, 161(5), 1670-1688.e7. https://doi.org/10.1053/j.gastro.2021.07.037
Flower, K. B., Skinner, A. C., Yin, H. S., Rothman, R. L., Sanders, L. M., Delamater, A., & Perrin, E. M. (2017). Satisfaction With Communication in Primary Care for Spanish-Speaking and English-Speaking Parents. Academic Pediatrics, 17(4), 416–423. https://doi.org/10.1016/j.acap.2017.01.005
Frey, E. F. J., Bonfiglioli, C., Brunner, M., & Frawley, J. (2021). Parents’ use of social media as a health information source for their children: A scoping review. Academic Pediatrics, 22(4). https://doi.org/10.1016/j.acap.2021.12.006
Guerra-Reyes, L., Christie, V. M., Prabhakar, A., Harris, A. L., & Siek, K. A. (2016). Postpartum Health Information Seeking Using Mobile Phones: Experiences of Low-Income Mothers. Maternal and Child Health Journal, 20(S1), 13–21. https://doi.org/10.1007/s10995-016-2185-8
Jaks, R., Baumann, I., Juvalta, S., & Dratva, J. (2019). Parental digital health information seeking behavior in Switzerland: a cross-sectional study. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-6524-8
Kountz, D. S. (2009). Strategies for Improving Low Health Literacy. Postgraduate Medicine, 121(5), 171–177. https://doi.org/10.3810/pgm.2009.09.2065
Kratz, L., Uding, N., Trahms, C. M., Villareale, N., & Kieckhefer, G. M. (2009). Managing childhood chronic illness: Parent perspectives and implications for parent-provider relationships. Families, Systems, & Health, 27(4), 303–313. https://doi.org/10.1037/a0018114
Lazar, M., & Davenport, L. (2018). Barriers to Health Care Access for Low Income Families: A Review of Literature. Journal of Community Health Nursing, 35(1), 28–37. https://doi.org/10.1080/07370016.2018.1404832
Loudon, K., Buchanan, S., & Ruthven, I. (2016). The everyday life information seeking behaviours of first-time mothers. Journal of Documentation, 72(1), 24–46. https://doi.org/10.1108/jd-06-2014-0080
SmithBattle, L., Loman, D. G., & Cibulka, N. J. (2019). Family-Centered Primary Care for Teen Parents and Their Children. Journal of Pediatric Health Care, 34(3). https://doi.org/10.1016/j.pedhc.2019.09.010
Stevens, G. D. (2003). Patient-Provider Racial and Ethnic Concordance and Parent Reports of the Primary Care Experiences of Children. The Annals of Family Medicine, 1(2), 105–112. https://doi.org/10.1370/afm.27
Zhao, S. (2009). Parental education and children’s online health information seeking: Beyond the digital divide debate. Social Science & Medicine, 69(10), 1501–1505. https://doi.org/10.1016/j.socscimed.2009.08.039
