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Impact of a Family-Centered Approach on Attunement of Care and Parents' Disclosure of Concerns: A Quasi-Experimental Study

Hielkema, Margriet MSc*; De Winter, Andrea F. PhD*; Feddema, Ermanda MSc; Stewart, Roy E. PhD*; Reijneveld, Sijmen A. MD, PhD*

Journal of Developmental & Behavioral Pediatrics: May 2014 - Volume 35 - Issue 4 - p 292–300
doi: 10.1097/DBP.0000000000000062
Original Article

Objective: To assess the importance parents place on family-centered care aspects in Preventive Child Healthcare (PCH) and to evaluate whether a family-centered approach influences the attunement of care to these preferences and the willingness of parents to disclose concerns.

Methods: Parents of infants (mean age = 11.4 weeks) attending Dutch PCH participated in the quasi-experimental study. Parents of infants receiving family-centered care (intervention condition) and parents of infants receiving care-as-usual (control condition) filled in a questionnaire regarding the importance of PCH professionals' attitude, parents' empowerment, and monitoring the broad developmental context. They also assessed their experiences regarding these aspects of care. Furthermore, parents rated their willingness to disclose concerns. We compared the 2 conditions, adjusting for background characteristics, and assessed interactions by socioeconomic status (SES) and the child's social-emotional status.

Results: Data were provided by a sample of 2542 parents of infants receiving family-centered care and 2328 parents of infants receiving care-as-usual (return rate of questionnaires 86%). Parents rated the PCH professionals' attitude as most important and monitoring the broad developmental context as least important. Scores were high in both conditions. Compared with care-as-usual, parents receiving family-centered care reported better attunement of care to their preferences (p < .001, effect sizes = 0.10–0.27). Parents' willingness to disclose concerns was similar in both conditions (p = .09). Effects were stable across SES and child's social-emotional status groups.

Conclusions: The family-centered approach improves attunement of care to parents' preferences, but it does not increase their already high willingness to disclose concerns.

*Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands;

Icare Preventive Child Healthcare, Meppel, the Netherlands.

Address for reprints: Margriet Hielkema, MSc, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, Groningen 9713 AV, the Netherlands; e-mail:

This investigation was supported by ZonMw, Netherlands Organisation for Health Research and Development (Grant number: 157002010).

Disclosure: The authors declare no conflict of interest.

Received November , 2013

Accepted March , 2014

© 2014 by Lippincott Williams & Wilkins