Unmet needs and barriers to navigating care services in the low- and middle-income families with young children in Singapore: a qualitative study.

Abstract

Introduction: Children's health and health behaviours primarily depend on their parental socioeconomic status backgrounds. There is limited research seeking to understand in depth the health needs and challenges of low- to middle-income families in Singapore. Understanding this can help the healthcare professional identify vulnerable families at an early stage, allowing for targeted interventions and preventive measures to address socioeconomic comorbidities and their consequences during childhood.

Objectives: To explore the health needs of the low- and middle-income families with children aged 2 months to 6 years in Singapore, and their facilitators and barriers to engagement in existing health, social and education services.

Methods: An interpretive qualitative approach was adopted in this study. We conducted 34 semi-structured one-to-one interviews with purposively sampled low- and middle-income families with children aged 2 months to 6 years. In addition, four focus group discussions comprising 19 service providers were conducted to complement the findings. All interviews were transcribed verbatim. Thematic analysis was conducted to identify key themes and subthemes.

Results: The bottom two tiers of Maslow's Hierarchy of Needs (physical, safety and security needs) constituted the larger proportion of unmet needs expressed by families. Physical needs encompassed food, exercise, sleep, screen time as well as needs related to smoking and alcohol consumption, while safety and security needs included social security needs, educational needs and physical health. Themes identified as enablers of service engagement included accessibility and convenience, financial and policy support, health awareness and engagement, trust and relationship-based engagement, interagency and technological support, and holistic family and workforce support. Conversely, themes identified as barriers to service engagement consisted of access and utilisation barriers, financial and policy inequities, challenges in information management and service coordination, and service delivery and support gaps.

Conclusions: Our analysis assembled an objective picture of challenges and strengths in relation to the health status of caregivers and their children from low- and middle-income families. Good interpersonal relationships with families, improved health literacy, readily available competent healthcare professionals, better access to social services and financial assistance, and enhanced health information technology help overcome challenges faced by low- to middle-income households.