Health Services Research
HSR 4: National or Novel
Kristine H. Schmitz, MD (she/her/hers)
Rutgers, Robert Wood Johnson Medical School
New Brunswick, New Jersey, United States
We aimed to develop a framework for pediatric clinical measurement that captures the complexity of contextual factors, life course, and interacting predictors of health/wellness. To illustrate the application of the model, we applied it to Intimate Partner Violence (IPV) exposure which has serious implications for children's health.
Design/Methods: A team of academic researchers, family representatives, and clinicians, funded by HRSA, utilized the validated Haddon Matrix, theories of co-design, and CFIR to develop an improved framework to measure clinical interventions and pediatric outcomes.
We present a novel, 3-dimensional depiction of complex pediatric health interactions derived from the Haddon Matrix, a public health framework for identifying countermeasures, complemented by principles from CFIR and co-design theory, that includes complex, interrelated components with an explicit consideration for the context and life course of children (Figure 1).
The x-axis depicts the child’s life course. The y-axis outlines aspects of health within the child’s life course and reminds researchers to consider aspects of wellbeing. The z-axis shows the specific interacting contextual and systemic factors. The x and y axes remain static for all clinical measures, but the z-axis is adapted to the characteristic to be measured. These decision criteria change based on the topic and are interactive with one another. In this example, the z-axis describes contextual and systemic factors that interact with causes and potential countermeasures of intimate partner violence.
Figure 2 offers guidance when developing a child health evaluation model. Figure 3 offers an example of the application to IPV.
Conclusion(s): This novel, 3-dimensional, multistep approach offers a pediatric-specific framework for facilitating decision-making by assisting child health and public health researchers to integrate: 1) health along the life course, 2) health and well-being, and 3) contextual and systemic factors.