P3.E094: The Health Capability Profile: A Mixed-Methods Framework for Child Development in Pediatric Medicine and Public Health

Background: Everyday decisions and actions play critical roles in children’s health and flourishing. Theoretical models governing community pediatrics and health policy including the social determinants of health (SDoH), socioecological models, and traditional health economics approaches have insufficiently captured the fundamental importance of developing agency in children, framing pediatric patients as passive recipients of health services and focusing narrowly on children’s health outcomes.

The Health Capability Model (HCM), first conceptualized two decades ago, integrates both health outcomes and health agency as health capability—an expansive normative concept describing the ability to be healthy. Health capability centers individuals’ agency to pursue health goals they value and their collective agency to shape their social conditions. The HCM provides an empirically grounded cradle-to-grave explanatory model for understanding and promoting children’s health and wellbeing at both individual and population levels. It theorizes health capability as fifteen distinct yet interrelated capabilities, both internal (individual) and external (societal) (https://www.healthequityandpolicylab.com/developing-health-capabilities). Measuring and utilizing health capability in pediatrics offers a robust and rigorous alternative to existing SDoH screening protocols. It provides greater analytic depth for longitudinally monitoring children’s health capability development, while integrating clinical medicine and public health perspectives to enhance partnership among pediatricians and public health practitioners.

Methods: Empirically applying the HCM, the Health Capability Profile (HCP) evaluates individuals’ health capability within their lived experiences and operationalizes each capability domain using quantitative methods (e.g., NIH PROMIS measures) and qualitative methods (e.g., deductive content analysis). A mixed-methods synergistic data analysis protocol then integrates qualitative and quantitative data from individual HCPs to generate health capability development scores (Figure 1) and analytical flow diagrams (Figure 2) to visualize interactions among health capabilities, combining subjective and objective measures of health and wellbeing.

Results: Preliminary evidence from recent HCP-based surveys in rural Senegal establishes proof-of-concept and demonstrates the HCP’s applicability for analyzing complex and dynamic relationships among internal and external health capabilities within individuals’ unique lived experiences, revealing individual strengths and vulnerabilities, and designing targeted interventions.

The HCP enables clinicians and policymakers to aggregate individual profiles to identify gaps between observed and optimal health capability development levels and strategically prioritize investment areas for equitably optimizing population health capability, thereby delivering truly person-centered pediatric care, policy, and programs. Lastly, the HCP demonstrates the repeatedly proven importance of designing health promotion programs and public health policies that target several vulnerabilities simultaneously.

Conclusion: Together, the HCM and HCP provide an integrative multidimensional framework for promoting collaboration among pediatricians and public health practitioners and the lifelong development of health capability, beginning in childhood. Future research may examine models for implementing HCP-based surveys into clinical workflows using machine learning and natural language processing for streamlined integration into patients’ electronic health records.