Continuous Support from the Same Public Health Nurse and Parental Perception and Use of Health Care Services: A Retrospective Observational Study.

OBJECTIVE: Continuity is considered essential for high-quality maternal and child health care services, but studies to show this effect on parental well-being are still rare. We studied whether receiving support from the same public health nurse has a beneficial effect on parental perceptions of health care professionals and the use of childcare support services. METHODS: Maternal and child health care services were provided by different nurses in a Japanese municipality until March 2019. From April 2019, all families with infants received continuous support from the same assigned nurse. A questionnaire covering parental perception and the use of services was sent by postal mail to 1,341 families with infants. The data were analyzed using χ2-test, t-test and logistic regression producing odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Parental perceptions of the availability of professionals to discuss children's issues, the degree of understanding about available other childcare support services, the degree of utilizing other services, and satisfaction with health care services were higher in parents who received continuous support from the same assigned nurse compared to those who did not receive continuous support. Continuous support was associated with parental perceptions of the availability of professionals to discuss children's issues (OR = 1.97, 95% CI 1.34-2.91) and the degree of understanding about available other child-care support services (OR = 1.65, 95% CI 1.11-2.44) after adjusting the results for socioeconomic factors. CONCLUSIONS: Continuous support from the same assigned nurse has benefits for parents. This offers a cost-effective way to improve parental well-being.

[Association between financial anxiety and subjective health and physical fatigue perceptions among mothers of 18-month-old infants].

Objective　Poverty is a factor that affects children's health through its role in parental depression and stress. While the association between financial status and depression or quality of life scores of mothers has been previously reported in Japan, no study has focused on mothers' subjective health and physical fatigue perceptions. This study aimed to examine the relationship between mothers' financial anxiety and subjective health and physical fatigue perceptions.Methods　We conducted a survey in parents attending routine health checkups for their 18-month-old infant in a single area of City A between November 2017 and October 2019. After excluding those for whom the required analysis data were missing, we analyzed data from 779 parents who responded to the survey and consented to the use of their children's health checkup data. The response variables were maternal subjective health and physical fatigue perceptions, and the explanatory variables were the presence of financial anxiety in mothers at their child's 3- or 18-month health checkups and financial anxiety situation in both periods. Financial anxiety was classified into four groups according to status at the 3- and 18-month time points. The independence of the qualitative variables among these four groups was verified using Fisher's exact test, and the relationship between financial anxiety and maternal subjective health and physical fatigue perceptions was evaluated using logistic regression analysis.Results　Financial anxiety was present in 54 mothers (6.9%) and 46 mothers (5.9%) at the 3- and 18-month checkup, respectively. Analysis of financial anxiety in both periods showed that 695 mothers (89.2%) had no financial anxiety at either time point, 30 (3.9%) had financial anxiety only at the 18-month checkup, 38 (4.9%) had financial anxiety only at the 3-month checkup, and 16 (2.1%) had financial anxiety at both time points. At the 18-month checkup, the odds ratios of poor subjective health and severe physical fatigue perceptions were 3.85 (95% confidence interval [CI]; 1.34-11.05) and 6.58 (95% CI; 2.18-19.85), respectively, among the mothers who had financial anxiety at both time points compared to those who had no financial anxiety at either time point.Conclusion　Financial anxiety may affect mothers' health. Therefore, mothers should be provided with solution-oriented support geared toward mitigating financial anxiety, in coordination with affiliated organizations, if financial anxiety is detected.

[Associations between mothers' economic insecurity and mood and thoughts on life with children at infants' 3-month check-ups: A cross-sectional study using data from infant health check-ups].

Objectives　We aimed to clarify the relationship between economic insecurity and the psychological profiles of mothers raising infants by analyzing data from three-month health check-ups in relation to the birth population in order to generate basic data that can be used to consider support for families facing economic insecurity.Methods　The study area was a neighborhood in a major Japanese city. The survey focused on 1013 mothers who had received health check-ups for children aged 18 months between November 2017 and October 2019. The data included in the analysis were data from the children's three-month health check-ups and survey data from 908 mothers who responded to the questionnaire and consented to the use of their health check-up data. After excluding data from potential participants who were not mothers or had multiple births, data from 847 participants were analyzed (valid response rate: 93.3%).　The objective variables were mothers' mood and thoughts about life with their children at the time of the three-month check-up as the mothers' psychological profiles. The explanatory variable was the presence or absence of maternal economic insecurity, and logistic regression analysis was conducted, adjusted for the children's sex and birth order, presence or absence of maternal counselors, and the mothers' educational attainment.Results　A total of 60 (7.1%) mothers were economically insecure. Of the mothers' moods, 122 (14.4%) reported feeling anxious, followed by 36 (4.3%) who reported feeling lonely. Of their thoughts on life with their children, 776 (91.6%) mothers reported that they enjoyed it, and 567 (66.9%) reported that they were happy to be parents. On the other hand, 157 (18.5%) reported feeling frustrated, and 75 (8.9%) reported that the lack of time for themselves was painful. Economically insecure mothers had an odds ratio of 5.59 (95% confidence interval, 2.49-12.55) for feeling lonely, 4.77 (2.67-8.54) for feeling anxious, and 2.70 (1.50-4.86) for feeling frustrated, all significantly higher than in mothers not facing economic insecurity.Conclusion　Economic insecurity among mothers at the time of the three-month check-up was associated with the psychological states of loneliness, anxiety, and frustration about living with their children. It was suggested that to solve economically insecure mothers' problems, they need support, including connecting them with social welfare services, so that they will be able to raise their children in a more stable environment.

[Relationship between economic disparity and eating habits of 3-year-old children].

Objectives　This study aimed to clarify the relationship between economic disparity and eating habits of young children to explore the support that should be provided to families with young children.Methods　We conducted an anonymous self-administered questionnaire survey of parents who brought their children to the 3-year-old health checkup in four wards in City A. Questionnaire items examined the children's eating habits and the childrearing environment, such as the parents' socioeconomic status. Of 1,150 parents asked to participate in the survey, 616 responded (response rate: 53.6%). Invalid questionnaires (e.g., with missing answers) were eliminated. The remaining 498 parents (effective response rate: 80.8%) were classified into two groups to examine the association of household financial status with their 3-year-old eating habits: the relative poverty group and the non-relative poverty group. The groups were divided according to the poverty line of the Comprehensive Survey of Living Conditions. Statistical analysis was performed using Fisher's exact test and the Mann-Whitney U test. Eating habits that were identified to be associated with relative poverty were further tested using logistic regression analysis.Results　Analysis of the children's eating habits in the two groups revealed that, compared with the non-relative poverty group, there was a higher proportion of 3-year-olds who ate vegetables less than 6 days a week (P=0.003) and who consumed snacks 6 days or more per week (P=0.034) in the relative poverty group. The associations of relative poverty with vegetable intake less than 6 days a week and snack consumption 6 days or more a week remained significant after adjusting for parents' age, highest educational attainment, and subjective views on the everyday economic situation. Regarding the childrearing environment, the relative poverty group had a higher proportion of parents who were younger than 30 years of age (P<0.001) and in single-parent households (P=0.007). The relative poverty group had a higher proportion of parents whose highest education level was high school (P<0.001). Furthermore, the subjective view of the everyday economic situation was more negative in the relative poverty group (P<0.001).Conclusion　Economic disparity was related to the eating habits of 3-year-old children. The study results indicate that identifying families with financial difficulties during pregnancy and childbirth is necessary to support them early on so that young children can acquire healthy eating habits.