Childcare Barriers and Appointment Nonadherence Among Women in a Safety-Net Health System

Importance: Health-related social needs (HRSNs) contribute to appointment nonadherence. Childcare needs are an underrecognized HRSN that particularly affect women. Objective: To determine whether self-reported childcare barriers were associated with appointment nonadherence among women. Design, Setting, and Participants: This cross-sectional study used linked survey and electronic health record (EHR) data. Survey data were collected from November 2023 to May 2024 and EHR data were extracted for the 1 year prior to the survey date for each participant. Data were analyzed between June and September 2024. This single-center study was conducted in a safety-net health system in Dallas County, Texas. EHR data included ambulatory care encounters. Eligible participants included women aged 18 years or older referred to gynecology for abnormal cervical cancer screening who reported having childcare responsibilities. Exposure: Self-reported childcare barriers to appointments in the past year. Main Outcomes and Measures: Regression analysis was used to evaluate the primary outcome of appointment nonadherence rate during the year prior to survey date. Results: Of 1264 women eligible for the survey, 836 were successfully reached by telephone, of whom 671 women (53.1% of eligible sample) were included in the sample. Among the 671 initial respondents, 486 women reported having childcare responsibilities (72.4%). The mean (SD) age of the study sample was 34.8 (8.6) years, 405 (83.3%) identified as Hispanic, and 349 (71.8%) preferred Spanish. Additionally, 105 women reported childcare barriers to attending appointments in the past year (21.6%). Women with self-reported childcare barriers were mean 2.9 years younger and more likely to receive Medicaid (38 36.2%) than women without childcare barriers (89 23.4%). Women with self-reported childcare barriers were more likely to care for an increased number of children and younger children than women without. The mean (SD) appointment nonadherence rate was 25.1% (21.8%) among women with self-reported childcare barriers compared with 15.2% (22.1%) among women without. The adjusted difference in appointment nonadherence was 8.8 (95% CI, 3.6-14.0) percentage points (P = .001) higher among women with self-reported childcare barriers. Conclusions and Relevance: In this cross-sectional study of women in a safety-net health system, self-reported childcare barriers were associated with increased appointment nonadherence. Younger women with younger children were most likely to report childcare barriers to appointments. These findings highlight the importance of childcare needs as a HRSN that warrants screening and intervention.