Abstract：
OBJECTIVE: Missed infant well-child visits (WCV) result in lost opportunities for critical preventive care. Black infants consistently receive less WCV care than other racial groups. We sought to understand barriers and facilitators to timely infant WCV for Black families in the context of COVID-19.
METHODS: We conducted 21 semi-structured interviews with caregivers of Medicaid-insured Black children aged 15- to 24-months who attended six or fewer of eight recommended well-child visits within the first 15 months of life. Interviews focused on WCV value, barriers, and facilitators. After developing our initial coding structure through rapid qualitative analysis, we inductively derived the final codebook and themes through line-by-line content analysis.
RESULTS: Caregivers attended a mean of 3.53 of eight infant visits. Structural (e.g., transportation) and psychological (e.g., maternal depression) barriers delayed Black infant WCV. Families most frequently valued monitoring development and addressing concerns. Caregivers perceived visits as less urgent when infants seemed healthy or more recently avoided visits due to fears around COVID-19. Long waits and feeling rushed/dismissed were linked to WCV delays; positive provider relationships encouraged WCV attendance. Most caregivers reported reluctance to vaccinate. Vaccine hesitancy contributed to delayed infant WCV.
CONCLUSIONS: Caregivers described several factors that impacted WCV attendance for Black infants. Persistent structural and psychological barriers are compounded by perceptions that caregiver time is not respected and by notable vaccine hesitancy. To address these barriers, well-care can meet Black families in their communities, better address caregiver wellbeing, more efficiently use caregiver and provider time, and cultivate partnerships with Black caregivers.
METHODS: We conducted 21 semi-structured interviews with caregivers of Medicaid-insured Black children aged 15- to 24-months who attended six or fewer of eight recommended well-child visits within the first 15 months of life. Interviews focused on WCV value, barriers, and facilitators. After developing our initial coding structure through rapid qualitative analysis, we inductively derived the final codebook and themes through line-by-line content analysis.
RESULTS: Caregivers attended a mean of 3.53 of eight infant visits. Structural (e.g., transportation) and psychological (e.g., maternal depression) barriers delayed Black infant WCV. Families most frequently valued monitoring development and addressing concerns. Caregivers perceived visits as less urgent when infants seemed healthy or more recently avoided visits due to fears around COVID-19. Long waits and feeling rushed/dismissed were linked to WCV delays; positive provider relationships encouraged WCV attendance. Most caregivers reported reluctance to vaccinate. Vaccine hesitancy contributed to delayed infant WCV.
CONCLUSIONS: Caregivers described several factors that impacted WCV attendance for Black infants. Persistent structural and psychological barriers are compounded by perceptions that caregiver time is not respected and by notable vaccine hesitancy. To address these barriers, well-care can meet Black families in their communities, better address caregiver wellbeing, more efficiently use caregiver and provider time, and cultivate partnerships with Black caregivers.
摘要：
目标：错过的婴儿健康访视（WCV）导致失去了关键预防性护理的机会。与其他种族相比，黑人婴儿得到的WCV护理始终较少。我们试图在COVID-19的背景下了解黑人家庭及时婴儿WCV的障碍和促进者。
方法：我们对15至24个月的有医疗补助保险的黑人儿童的看护人进行了21次半结构化访谈，他们在生命的前15个月内参加了8次推荐的健康儿童访视中的6次或更少。面试重点关注WCV的价值，障碍,和促进者。在通过快速定性分析开发我们的初始编码结构之后，我们通过逐行内容分析归纳得出最终的码本和主题。
结果：照顾者平均参加了8次婴儿访视中的3.53次。结构(例如，交通)和心理(例如，母亲抑郁症)障碍延迟黑人婴儿WCV。家庭最经常重视监测发展和解决关切。当婴儿看起来健康或最近由于担心COVID-19而避免探视时，护理人员认为探视不那么紧迫。长时间的等待和匆忙/被解雇的感觉与WCV的延迟有关；积极的提供者关系鼓励WCV出勤。大多数护理人员报告不愿接种疫苗。疫苗犹豫导致婴儿WCV延迟。
结论：照顾者描述了影响黑人婴儿WCV出勤的几个因素。持续的结构和心理障碍因照顾者时间不受尊重以及明显的疫苗犹豫而加剧。为了解决这些障碍，良好的照顾可以满足黑人家庭在他们的社区，更好地解决护理人员的健康问题，更有效地利用护理人员和提供者的时间，并与黑人看护者建立伙伴关系。
方法：我们对15至24个月的有医疗补助保险的黑人儿童的看护人进行了21次半结构化访谈，他们在生命的前15个月内参加了8次推荐的健康儿童访视中的6次或更少。面试重点关注WCV的价值，障碍,和促进者。在通过快速定性分析开发我们的初始编码结构之后，我们通过逐行内容分析归纳得出最终的码本和主题。
结果：照顾者平均参加了8次婴儿访视中的3.53次。结构(例如，交通)和心理(例如，母亲抑郁症)障碍延迟黑人婴儿WCV。家庭最经常重视监测发展和解决关切。当婴儿看起来健康或最近由于担心COVID-19而避免探视时，护理人员认为探视不那么紧迫。长时间的等待和匆忙/被解雇的感觉与WCV的延迟有关；积极的提供者关系鼓励WCV出勤。大多数护理人员报告不愿接种疫苗。疫苗犹豫导致婴儿WCV延迟。
结论：照顾者描述了影响黑人婴儿WCV出勤的几个因素。持续的结构和心理障碍因照顾者时间不受尊重以及明显的疫苗犹豫而加剧。为了解决这些障碍，良好的照顾可以满足黑人家庭在他们的社区，更好地解决护理人员的健康问题，更有效地利用护理人员和提供者的时间，并与黑人看护者建立伙伴关系。
