Research Article| Volume 18, ISSUE 5, P516-524, July 2018

Qualitative Evaluation of Individual and Group Well-Child Care

Published:January 19, 2018DOI:



      Individual well care (IWC) is the standard delivery model for well-child care in the United States. Alternative models, such as group well care (GWC), may create opportunities to enhance care for babies. The purpose of this study was to evaluate parents' perceptions of social/wellness benefits and system challenges of IWC and GWC.


      Since 2014, we have provided both IWC and GWC at an urban academic practice serving a low-income minority community. We conducted a mixed method study involving surveys and 18 focus groups (11 IWC groups, n = 32 parents; 7 GWC groups, n = 33 parents). Parents completed surveys before convening focus group discussions. Survey results were analyzed using independent t tests; focus groups were digitally recorded, transcribed, and analyzed to identify themes.


      Both groups had similar demographics: parents were mostly female (91%) and black (>80%); about half had incomes < $20,000. Parents' mean age was 27 years; children's mean age was 11 months. There were no significant differences in overall scores measuring trust in physicians, parent empowerment, or stress. IWC parents' themes highlighted ways to improve care delivery, while GWC parents highlighted both satisfaction with care delivery and social/wellness benefits. GWC parents strongly endorsed this model and reported unique benefits, such as garnering social support and learning from other parents.


      Parents receiving both models of care identified ways to improve primary care delivery. Given some of the benefits reported by GWC parents, this model may provide the means to enhance resilience in parents and children in low-income communities.


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        • Halfon N.
        • DuPlessis H.
        • Inkelas M.
        Transforming the US child health system.
        Health Aff. 2007; 26: 2315-2330
        • Halfon N.
        • Stevens G.D.
        • Larson K.
        • et al.
        Duration of a well-child visit: association with content, family-centeredness, and satisfaction.
        Pediatrics. 2011; 128: 657-664
        • Coker T.R.
        • Thomas T.
        • Chung P.J.
        Does well-child care have a future in pediatrics?.
        Pediatrics. 2013; 131: 149-159
        • Lantos J.D.
        • Ward N.A.
        A new pediatrics for a new century.
        Pediatrics. 2013; 131: 121-126
        • Zuckerman B.
        Two-generation pediatric care: a modest proposal.
        Pediatrics. 2015; 137: e20153447
        • Needlman R.
        Thoughts on health supervision: learning-focused primary care.
        Pediatrics. 2006; 117: e1233-e1236
        • Fierman A.H.
        • et al.
        Redesigning health care practices to address childhood poverty.
        Acad Pediatr. 2016; 16: S136-S146
        • Schuster M.
        • Duan N.
        • Regalado M.
        • et al.
        Anticipatory guidance: what information do parents receive? What information do they want?.
        Arch Pediatr Adolesc Med. 2000; 154: 1191-1198
        • Triggs E.G.
        • Perrin E.C.
        Listening carefully. Improving communication about behavior and development.
        Clin Pediatr. 1989; 28: 185-192
        • Bethell C.
        • Reuland C.H.
        • Halfon N.
        • et al.
        Measuring the quality of preventive and developmental services for young children: national estimates and patterns of clinicians' performance.
        Pediatrics. 2004; 113: 1973-1983
        • Halfon N.
        • Regalado M.
        • Sareen H.
        • et al.
        Assessing development in the pediatric office.
        Pediatrics. 2004; 113: 1926-1933
        • Freed G.L.
        • Clark S.J.
        • Pathman D.E.
        • et al.
        Influences on the receipt of well-child visits in the first two years of life.
        Pediatrics. 1999; 103: 864-869
        • Chung P.J.
        • Lee T.
        • Morrison J.
        • et al.
        Preventive care for children in the United States: quality and barriers.
        Annu Rev Public Health. 2006; 27: 491-515
        • Olson L.M.
        • Inkelas M.
        • Halfon N.
        • et al.
        Overview of the content of health supervision for young children: reports from parents and pediatricians.
        Pediatrics. 2004; 113: 1907-1916
        • Traub F.
        • Boynton-Jarrett R.
        Modifiable resilience factors to childhood adversity for clinical pediatric practice.
        Pediatrics. 2017; 139: e20162569
        • Coker T.
        • Chung P.J.
        • Cowgill B.
        • et al.
        Low-income parents' views on the redesign of well-child care.
        Pediatrics. 2008; 24: 194-204
        • Coker T.R.
        • Windon A.
        • Moreno C.
        • et al.
        Well-child care clinical practice redesign for young children: a systematic review of strategies and tools.
        Pediatrics. 2013; 131: 5-25
        • Coker T.R.
        • DuPlessis H.M.
        • Davoudpour R.
        • et al.
        Well-child care practice redesign for low-income children: the perspectives of health plans, medical groups, and state agencies.
        Acad Pediatr. 2012; 12: 43-52
        • Coker T.R.
        • Moreno C.
        • Shekelle P.G.
        • et al.
        Well-child care clinical practice redesign for serving low-income children.
        Pediatrics. 2014; 134: e229-e239
        • Stein M.T.
        The providing of well-baby care within parent–infant groups.
        Clin Pediatr. 1977; 17: 825-828
        • Osborn L.M.
        • Woolley F.R.
        Use of groups in well child care.
        Pediatrics. 1981; 67: 701-706
        • Page C.
        • Reid A.
        • Hoagland E.
        • et al.
        WellBabies: mothers' perspectives on an innovative model of group well child-care.
        Fam Med. 2010; 42: 202-207
        • Taylor J.A.
        • Davis R.L.
        • Kemper K.J.
        Health care utilization and health status in high-risk children randomized to receive group or individual well child care.
        Pediatrics. 1997; 100: e1-e4
        • Yoshida H.
        • Fenick A.M.
        • Rosenthal M.S.
        Group well-child care: an analysis of cost.
        Clin Pediatr. 2014; 53: 387-394
      1. Hagan J.F. Shaw J.S. Duncan P.M. Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. American Academy of Pediatrics, Elk Grove Village, Ill2017
        • Cox J.L.
        • Holden J.M.
        • Sagovsky R.
        Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale.
        Br J Psychiatry. 1987; 150: 782-786
        • Dubowitz H.
        • Lane W.G.
        • Semiatin J.N.
        • et al.
        The Safe Environment for Every Kid model: impact on pediatric primary care professionals.
        Pediatrics. 2011; 127: e962-e970
        • Needlman R.
        • Fried L.E.
        • Morley D.S.
        • et al.
        Clinic-based intervention to promote literacy: a pilot study.
        Am J Dis Child. 1991; 145: 881-884
        • Centering Healthcare Institute
        CenteringParenting Facilitator's Guide.
        Centering Healthcare Institute, Boston, Mass2016
        • Hall M.A.
        • Zheng B.
        • Dugan E.
        • et al.
        Measuring patients' trust in their primary care physicians.
        Med Care Res Rev. 2002; 59: 293-318
        • Koren P.E.
        • DeChillo N.
        • Friesen B.J.
        Measuring empowerment in families whose children have emotional disabilities: a brief questionnaire.
        Rehabil Psychol. 1992; 37: 305-321
        • Abidin R.R.
        Parenting Stress Index: Professional Manual.
        3rd ed. Psychological Assessment Resources, Lutz, Fla1995
        • Radecki L.
        • Olson L.M.
        • Frintner M.P.
        • et al.
        What do families want from well-child care? Including parents in the rethinking discussion.
        Pediatrics. 2009; 124: 858-865
        • Miles M.B.
        • Huberman A.M.
        Qualitative Data Analysis: An Expanded Sourcebook.
        Sage, Thousand Oaks, Calif1994
        • Strauss A.
        • Corbin J.
        Grounded Theory in Practice.
        Sage, Thousand Oaks, Calif1997
        • IBM Corp
        IBM SPSS Statistics for Windows, Version 21.0.
        IBM Corp, Armonk, NY2012
        • American Academy of Pediatrics
        The Resilience Project.
        (Available at:)
        • Research and Evaluation Group at Philadelphia Health Management Corporation
        Findings from the Philadelphia Urban ACE survey.
        (Institute for Safe Families; Available at:)