Project Healthy Juneau Kids: Community-focused and theory driven interventions to increase access to and the utilization of preventive care among underserved children

Background: Well child care fulfills a critical role both in health promotion and preventing childhood mortality and morbidity. Factors such as a lack of health insurance and lack of awareness or understanding of the importance of care may prevent access to and the utilization of these preventative services. Before this study, little was known about access to and the utilization of well child care or the needs of uninsured and underinsured (underserved) children in Juneau, Alaska. Project Healthy Juneau Kids sought 1) to assess the level of utilization and the needs of underserved children and 2) to develop community-focused and theory driven interventions to improve access to and the utilization of well child care among underserved children. Methods: Following a literature review, the researchers used the behavioral utilization theory to design a set of initial interventions. These interventions included 1) free well child care for underserved children, 2) more collaboration with local clinics and agencies, 3) enhanced community outreach, and 4) advocacy for a more accessible health care system. The researchers then sought community input in the form of a community needs assessment. This assessment included 1) a local health provider survey to examine the availability and accessibility of well child care and 2) focus group discussions to explore individual perceptions of well child care. Results: Findings from the needs assessment indicated a need for both expanding awareness for the importance of well child care and improving attitudes toward the benefits of preventive care. A universal postpartum home visiting service was also identified as a means of outreach to vulnerable families as to the importance of regular well child care. This outreach would also promote the concept of a medical home and connect them with available community resources. Conclusions: This project was our public health center's first attempt in designing public health nursing interventions through theory and community participation. This project addressed multiple factors including social determinants affecting access to and the utilization of well child care among underserved children. By seeking community participation, we developed relevant interventions to help vulnerable families in the community.