Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Michael Broda


Study 1

OBJECTIVES: The research aim of this study was to identify predictors associated with the receipt of PFCC among U.S. children/families

METHODS: Caregivers of 38,803 non-institutionalized children, aged 0 to 17 years, were surveyed by the National Survey of Children’s Health (NSCH) 2018–20019. Patient/family-centered care (PFCC) was measured using five components of health care delivery that were answered on a 4-point Likert scale. Logistic regression models were analyzed for the overall receipt of PFCC and each component of PFCC, with survey weighting added to adjust for complex sampling design.

RESULTS: Many predictors were associated with the receipt of PFCC. Those with lower odds of receiving higher levels of PFCC included children with special health care needs (CSHCN) or children with less than excellent health (CLEH), the uninsured, those whose usual place of sick care was the hospital outpatient department, clinic or health center, or retail store clinic or minute clinic, those without a personal doctor or nurse, those in households whose primary language in the home is non-English, those who do not agree that they live in safe neighborhoods or attend safe schools, those below the 400% FPL, those with mother’s who have a physical or mental health concern, and those with parents who were born outside of the country. The five states with the lowest receipt of higher levels of PFCC were Wyoming, Alabama, Oklahoma, Mississippi, and Virginia. Conversely, the five states with the highest levels of PFCC were Minnesota, Connecticut, New York, Ohio, and Colorado. Results by component were mostly consistent with the "final overall" model but somewhat varied.

CONCLUSION: Many predictors were significantly associated with PFCC and require further exploration. Future research should utilize a mixed-methods design to better understand the quantitative results of the NSCH as well as the barriers and mechanisms for disparities that are present at the provider and systems level to deliver PFCC.

Study 2

OBJECTIVES: The aims of this study were to determine the extent to which variability in PFCC exists within states vs. between states, identify the highest and lowest performing states, and understand PFCC’s relationship to child health utilizing the National Survey of Children’s Health (NSCH).

METHODS: Caregivers of 38,803 non-institutionalized children, aged 0 to 17 years, were surveyed by the NSCH 2018–2019. A continuous composite variable for PFCC was defined by five questions that were answered on a Likert scale from always to never. Questions included if the provider spent enough time with the family, showed cultural sensitivity, provided specific information, made the family feel like a partner in their child’s care, and listened carefully to the family. Multilevel modeling and linear regressions were analyzed and results were mapped.

RESULTS: Ninety-one percent of the sample population received PFCC. Children with special health care needs (CSHCN), children with less than excellent health (CLEH), the uninsured, those who received sick care from somewhere other than a doctor’s office, were from households with less than 400% FPLs, were from unsafe neighborhoods or unsafe schools, or had mothers with health concerns had significantly lower amounts PFCC. PFCC varied by state but receipt of PFCC was mostly explained by within-state differences. In an unadjusted MLM, those who identified as Hispanic, Black, American Native/ Pacific Islander, or Multiracial had significantly lower amounts of PFCC; however, after adjustments, no race/ethnicity had significant results. Additionally, many states, particularly in the southeastern region, showed disparities for receiving PFCC. The lowest-performing states were Wyoming, Alabama, Mississippi, Virginia, and Nevada. In contrast, New York, Ohio, Colorado, Minnesota, and Hawaii were the highest-performing states.

CONCLUSION: The final PFCC model was only able to explain 6% of the variability in receipt of PFCC for the full sample population. Further exploration by geography and for specific populations is needed. Future research should consider smaller geographic regions, health systems, state policies and programs, and include the patient, provider, and health system voice via a mixed-methods design.


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