Improving Access to Preventive Services for Marginalized Families During Early Childhood: An Integrative Review of Inter-organizational Integration Interventions

Abstract

Marginalized populations exhibit low rates of preventive service use, often avoiding use of non-urgent services. Poor access to preventive and health promoting care serves to maintain inequities in health experienced by many marginalized populations. Of particular concern are marginalized families with young children below the age of school entry, when physical, emotional and psychological foundations for life-long health are being established. Many community based organizations recognize the need to improve families' access and use of preventive services. However, they are faced with a gap in understanding what inter-organizational interventions could be implemented to improve integration of services particularly focused on addressing experiences of marginalized families. Therefore, we used the integrative review method to identify and describe inter-organizational (I-O) interventions in the literature that aim to improve access to preventive services by marginalized families. As per integrative review methods, the literature was searched for research studies using qualitative, quantitative or mixed method designs, and investigating I-O interventions aiming to improve access to preventive services through increased service integration. Three levels of screening and relevance review identified fourteen articles. A conceptual model informed by socio-ecological theory was used to classify interventions as relational or structural. Results show that reports of rigorously conducted studies of I-O interventions are relatively sparse, and emphasize structural factors such as shared leadership, shared review or development of policies/protocols, changes to referral mechanisms and geographical/caseload matching. Inter- organizational interventions that influence relational factors were rare but have included: joint training/education, facilitated communication, addition of an integration role, and strategic partnerships. We suggest that combining both structural- and relational-focused strategies in inter-organizational integration intervention design may have greater impact on improving access to preventive services for marginalized families, with increased use of early childhood preventive services contributing to reducing health disparities.