3.0 Findings
Public Health Nurses staffing the C&BT phone line attempted to collect data between January and December 2012. Information was gathered from 122 callers (see Table 1). About one third were first-time callers. The majority of callers were women experiencing their first pregnancy (68%). The majority of callers were women (98%) between the ages of 25 and 34 years (69%). Most callers had graduated from college or university (75%) and of those participants who indicated their income range, 29% were in the 'greater than $80,000' bracket. Ninety-seven percent (97%) of callers were married or in a common-law relationship. Very few indicated they were a single parent (<5%). Ninety-five percent (95%) of callers have a family doctor for themselves and their child. We were unable to calculate each child's age at the time of the call as the date of the call was not recorded.
A separate analysis was done of first-time callers (see Table 1). Of the 37 callers, most were women but the two men that provided information were first-time callers. Sixty percent (60%) of the first-time callers were between the ages of 25 and 34 years. Seventy-six percent (76%) were married and 68% had graduated from college or university.
| Table 1: Characteristics of Child & Babytalk Survey Participants | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Figure 2 and Figure 3 show the geographic distribution of the sample of callers to the phone line using postal codes. Eighty-two of 124 callers provided an accurate six digital postal code. The majority of callers were from the City of Kingston and fewer were from Napanee or the rural areas of Frontenac County and Lennox & Addington County (see Figure 2). The distribution of callers within the City of Kingston is displayed in Figure 3. There are some areas of Kingston with fairly good use of the phone line, such as Grenville Park and Polson Park. However, there are high population density areas, such as Henderson, Reddendale, and Kingscourt, where we would hope to see more use of the phone line.
Postal codes were used to determine the distribution of callers by material and social deprivation (see Table 2). There is a larger proportion of callers in the 3rd quintile of the material deprivation index and slightly lower proportions in the 4th and 5th quintiles compared to the distribution of the general KFL&A population. Callers are overrepresented on the social deprivation index for the most deprived (4th and 5th quintiles) and underrepresented in the least deprived category. The material and social deprivation indices are measures of the socio-economic conditions attributed to small geographic areas.1 These small areas, called census dissemination areas (DA), usually have a population of 400 to 700 people. The material deprivation index is a blended measure of employment, education and income, and the social deprivation index combines measures of being separated, divorced or widowed, living alone, and family structure (e.g., single-parent family).
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| Table 2: Distribution of Callers by Deprivation Indices | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The topic of each call is categorized by the PHN for recording purposes. The PHN selects the primary reason for the call but may talk to a caller about other subjects. Therefore the numbers presented in Table 3 may underestimate how often a topic is discussed. The two most common topics discussed were general child health and breastfeeding. As displayed beside Table 3, the majority of these calls were dealt with by the PHN over the phone. Very few callers required a referral to another service or the direction to see their physician. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Table 3: Participants' primary reason for calling Child & Babytalk Phone line | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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First-time callers were most likely to call for information or advice about breastfeeding (41%) (see Table 4). Other reasons for calling included general child health questions and other questions about infant nutrition but not related to breastfeeding.
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| Table 4: Reason for call of First-time callers | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Thirteen percent (13%) of callers reported they learned about the C&BT phone line from information they received from the hospital when their child was born (see Table 5). Another 8% learned about the phone line in their prenatal class. Many callers could not recall where they heard about the phone line so that the frequencies presented may be higher. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Table 5: Source of referral to Phone line | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Callers were asked where else they may have sought information if they had not called the C&BT phone line (see Table 6). Forty-four percent (44%) reported they would have talked to their physician, midwife, or a nurse. The internet is a source of information for 29% callers and 19% would have asked a family member or friend. Table 6 also displays first-time callers' other sources of information if they had not called the phone line. Just over half of first-time callers (53%) indicated they would most likely call their doctor, midwife or a nurse. The next most commonly indicated information source was the internet (35%). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Table 6: Alternate sources of information and advice for all callers and first-time callers | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
*Total does not equal 100% as callers could select more than one option. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Discussion
The C&BT phone line is one of several services offered by KFL&A Public Health to parents, caregivers and health care providers to address common concerns in infant and child development, health and feeding. For this study, regularly collected data were augmented by asking additional questions of callers that would give a more complete picture of who was calling the phone line and why. The majority of calls were from parents and 94% of calls came from mothers. Most often, callers were married or in a common-law relationship and indicated their household income was middle to upper class. This finding of services being utilized more often by middle to upper class, highly educated, married families is common in public health programming. The geographic distribution of callers according to the material and social deprivation indices (MDI and SDI) presented a slightly different picture. According to the social deprivation index there was a greater proportion of callers coming from more socially deprived areas of KFL&A. There was also a larger proportion of callers from the middle quintile of the material deprivation index. This larger proportion was not reflected in callers' reported income or education levels. The geographic distribution of callers according to the MDI and SDI could indicate that the C&BT phone line has reach into the more deprived areas of KFL&A at least to some extent.
There is the hope that the people within these geographic areas would share the knowledge of this resource with their neighbours.
Other researchers have attempted to identify factors that determine who will access a phone line. Turnbull et al. investigated whether rural versus urban populations were more likely to use a telephone-based health service and found that the rural population was less likely to access the service.2 The authors speculated that accessing this service may be predicated on prior experience and contact with health services and that rural populations have less exposure to health services and therefore are less likely to use a less traditional service such as the telephone information line. A similar pattern of greater usage in our urban population versus rural was found in this sample. The notion that phone line usage hinges on prior experience with health services could extend to single parents and lower income families in the KFL&A area. They, perhaps, have less exposure to parenting and child health services because of their circumstances and so using a phone line is not on their 'radar' as a useful service.
Other authors have tried to identify whether there are cognitive barriers within individuals to calling a phone line.3 A study by the Nicotine & Tobacco Research Foundation identified 'poor fit with service', 'no need for assistance', and stigma as barriers to calling a smoking quitline.3 Although calling for assistance to quit smoking is far different from calling to ask for information on child care, perhaps there is a parallel; in certain parenting populations there could be an attitude of 'no need for assistance'/ 'I can do it on my own' and a related perceived stigma to asking for help.
When callers to the C&BT phone line were asked where they would have sought information if they hadn't called the phone line, the most frequent response was a doctor, nurse practitioner, or nurse, with the internet and family or friends coming second and third in frequency. Other researchers have also noted that 'people' remain the most frequently consulted and highly valued and trusted sources of health information over the internet or other print sources.