Demographic characteristics and needs of families at an urban, low-income, multicultural paediatric clinic.

OBJECTIVES: To describe the demographic characteristics and identify the needs of a population attending an urban, low-income area, multicultural paediatric clinic. METHODS: Surveys were distributed to caregivers of children zero to 16 years of age (n=299). RESULTS: Of the children attending appointments, 55% were female and 51% were five years of age or younger. Of the caregivers, 29.5% were born outside of Canada and 25% reported that their primary spoken language was not English. Sixty-six per cent of families had been living in Edmonton for more than three years, with two-thirds of respondents living in Edmonton's second-lowest average household income region. Seventy-six per cent of respondents lived in households with four or more persons. CONCLUSIONS: Challenges facing individuals attending an urban, low-income area, paediatric clinic include language barriers, lower household income and larger family size. Immigrants living outside of major Canadian cities are under-represented and may have different needs compared with their counterparts in 'gateway' cities. More studies are needed to determine their needs, and will ultimately lead to the provision of culturally competent care.

OBJECTIFS: Décrire les caractéristiques démographiques et déterminer les besoins d'une population fréquentant une clinique pédiatrique multiculturelle dans un milieu urbain à faible revenu. MÉTHODOLOGIE: Les personnes qui s'occupaient d'enfants de 0 à 16 ans ont reçu un sondage (n=299). RÉSULTATS: Parmi les enfants qui se sont rendus à des rendez-vous, 55 % étaient de sexe féminin et 51 % avaient cinq ans ou moins. Parmi les personnes qui s'occupaient d'eux, 29,5 % étaient nées à l'extérieur du Canada et 25 % déclaraient que leur langue parlée principale n'était pas l'anglais. Soixante-six pour cent des familles vivaient à Edmonton depuis plus de trois ans. Les deux tiers des répondants vivaient dans le deuxième quartier au revenu le plus faible par ménage d'Edmonton. Chez 76 % des répondants, au moins quatre personnes formaient la maisonnée. CONCLUSIONS: Les personnes qui fréquentent la clinique pédiatrique d'une région urbaine à faible revenu affrontent les défis suivants : barrière des langues, revenu plus faible que la moyenne et famille plus grosse que la moyenne. Les immigrants qui vivent à l'extérieur des grandes villes canadiennes sont sous-représentés et peuvent avoir des besoins différents de ceux de leurs homologues qui vivent dans des villes « d'entrée ¼. Il faudra mener d'autres études pour évaluer leurs besoins afin de leur offrir des soins adaptés à leur culture.

Impact of social pediatrics rotation on residents' understanding of social determinants of health.

Social Pediatrics is the newest mandatory rotation in the General Pediatrics residency program at the University of Alberta. Evaluation of the residents include a written reflective assignment, asking them to identify assets and disparities that have influenced the health of a child encountered on the rotation. While there are many published papers on reflective writing , few papers are found in the area of how social determinants of health (SDoH) impact an individual's overall health. This study examines the question: how has exploring SDoH during the Social Pediatrics rotation led to changes in residents' awareness of their own practice of pediatrics? Grounded theory was used to analyse 35 reflections from residents who had submitted them as a mandatory assignment at the end of their rotation. In addition, 10 semi-structured telephone interviews were conducted to further understand residents' perceptions. Interviews were transcribed verbatim and analysis of the reflections and interviews was guided by grounded theory using open, axial, and selective coding. Analyses of written reflections revealed the following categories: 1) judgment/bias, 2) systemic challenges, 3) advocacy, and 4) a sense that everyone is doing their best. Interview data reinforced overlapping categories of bias, systemic challenges and advocacy in addition to two new categories: 1) increased exposure and knowledge of specific disadvantaged populations, and 2) understanding impact of SDoH on overall health.Categories that were generated highlight the importance of residents' education regarding the role of SDoH on overall health and management plans. They became aware of structural determinants of health working with health-care professionals who were advocates for the communities they worked with. Analysis of residents' written reflection assignments and follow-up interviews revealed the value of reflective practice in physician development and reinforced the benefit of fostering experiences not typically encountered in traditional clinical learning environments.