How COVID-19 impacted child and family health and healthcare: a mixed-methods study incorporating family voices

Abstract

To describe how social disruptions caused by the COVID-19 pandemic impacted child access to healthcare and child health behaviors in 2020. We used mixed-methods to conduct surveys and in-depth interviews with English- and Spanish-speaking parents of young children from five geographic regions in the USA. Participants completed the COVID-19 Exposure and Family Impact Survey (CEFIS). Semistructured telephone interviews were conducted between August and October 2020. Of the 72 parents interviewed, 45.8% of participants were Hispanic, 20.8% Black (non-Hispanic), and 19.4% White (non-Hispanic). On the CEFIS, the average (SD) number of social/family disruptions reported was 10.5 (3.8) out of 25. Qualitative analysis revealed multiple levels of themes that influenced accessing healthcare during the pandemic, including two broad contextual themes: (a) lack of trustworthiness of medical system/governmental organizations, and (b) uncertainty due to lack of consistency across multiple sources of information. This context influenced two themes that shaped the social and emotional environments in which participants accessed healthcare: (a) fear and anxiety and (b) social isolation. However, the pandemic also had some positive impacts on families: over 80% indicated that the pandemic made it "a lot" or "a little" better to care for their new infants. Social and family disruptions due to COVID-19 were common. These disruptions contributed to social isolation and fear, and adversely impacted multiple aspects of child and family health and access to healthcare. Some parents of infants reported improvements in specific health domains such as parenting, possibly due to spending more time together.

Keywords: COVID-19; Healthcare access; Mixed-methods research; Underserved populations.

Fig 1

Pictorial representation of the potential relationships between themes identified in the qualitative analysis. Based on the social–ecological framework.

Fig 2

Participant responses to the COVID-19 Exposure and Family Impact Survey. This figure displays the responses to 12 items that measure the impact of COVID-19 on participants’ and families’ lives. They are scored on a four-point Likert scale with the following response options: 1—Made it a lot better, 2—Made it a little better, 3—Made it a little worse, and 4—Made it a lot worse.