When Parents Bring Children to Appointments, Does Treatment Suffer?

Designing healthcare facilities that meet the needs of all visitors

By Megan Headley

Imagine going to a routine gynecology exam that, if proactively done, could identify major health risks early on. Now imagine going to that same exam with a 5-year-old child in tow. Or discussing your cancer treatment options before a closely listening 7-year-old. Or trying to remember the symptoms you wanted to discuss with your primary care physician while your 3-year-old dumps out the contents of your diaper bag.

It’s easy to imagine how these ordinary distractions could prevent adherence to a treatment plan or cause harried parents to ignore potentially critical visits altogether rather than drag children along. This aspect of population health is what Jingfen Guo, assistant professor in the Interior Design Department at the University of Central Oklahoma and currently in the Long Range Planning Department at Oklahoma State University, and Douglas King, principal with Stantec, seek to address.

As Guo puts it, population health is about understanding the needs of users, and a huge need for many individuals is managing multiple pulls—from often inflexible work schedules to the need to provide full-time childcare. So, Guo and King have proposed developing more child-friendly healthcare design in non-pediatric facilities as a relatively simple strategy to improve well-visit attendance for adults.

The pair have completed a pilot study and are wrapping up the first phase of their field research, funded under Stantec’s Greenlight Creativity & Innovation Program. Their research has been conducted at the clinics of Heartland Health Centers, a Federally Qualified Healthcare Center. As King explains, more than 90% of the 30,000 patients seen annually by Heartland are immigrants or refugees.

“What we’re dealing with here are people who are very poor, highly undereducated, and in some cases removed from a country that might have experienced warfare,” he says. “They’re dealing with significant challenges and coming to a clinic for everything from flu shots to serious medical treatment.” Strategies to improve wellness are critically needed in these communities.

In the pilot study, the researchers gathered online responses to questions from parents, patients, and providers. They also formulated a mixed-method approach for their next phase of research, in which Guo and King observed patients and their children in waiting rooms and exam rooms at the clinics, followed by an online survey of the providers. They found that for 70% of doctor’s visits, patients came with their kids. This occurred far more frequently for scheduled appointments than emergency visits. And there were major effects of having kids in tow. For starters, they proved a distraction. Parents quickly lost their focus on the primary task, while caregivers became distracted by repeated interruptions. It’s a recipe for forgetting critical instructions or misremembering information discussed, which can lead to lower rates of medication compliance and follow-up appointments, or other problems down the road.

The savviest parents packed coloring books or other distractions when taking kids to their appointments, but Guo noticed that children typically lost interest in these activities before long. It’s not surprising, Guo notes, given research indicating that kids are most interested in engaging with their environment and the people around them. And therein lies the problem for parents and providers.

The good news, Guo points out, is that there’s already extensive research on how to make healthcare facilities child-friendly. Pediatric hospitals hold many potential keys here. Guo suggests including some kid-friendly furnishings in the exam room as one way to solve this challenge. That doesn’t mean childish décor—a room might contain a low-hung whiteboard on which bored kids can doodle, for example. A comfortable, home-like feel and upbeat color scheme may be enough to put both kids and parents at ease.

Another potential solution: including playrooms or play areas where children can be attended, perhaps with a dedicated sitter like many fitness centers offer.

As King puts it, “We’re trying to figure out at what point does it make sense to provide childcare in the healthcare setting as a service to allow the sanctity of the medical visit to occur.” He points out that many gyms offer childcare to help customers stick to a regular exercise routine; it’s a wellness strategy that many healthcare facilities might do well to mimic.

Guo and King collected numerous anecdotes from staff on experiences with interviewing patients or conducting sensitive tests while simultaneously balancing the care of several children also present in the exam room. One provider shared that she has perfected a technique of holding onto kids while conducting tests on the parent.

King says the next step, phase three of the study, is to conduct a replication study at a more affluent clinic to test how adults manage their kids when they have greater financial resources and stability. From there, the pair hopes to gather insight for achievable solutions and explore technology, policy, or other solutions, including childcare. The expectation, of course, is that designing for the full population—including those not being treated—will make a population’s wellness more achievable.

Megan Headley is a freelance writer and owner of ClearStory Publications. She has covered healthcare safety and operations for numerous publications. Headley can be reached at megan@clearstorypublications.com.