Who Uses Services Overall and Within High-Need Families? Social Inequalities in Access to Early Support Services in Southern Germany.

The study is cross-sectional, so it cannot show that stress, education, income or migration status caused service use, or that services improved family or child outcomes. Service use was counted only as yes or no, so it did not capture which service, how often, how long, or when it was used. Families joined voluntarily through a paediatric practice app and completed digital questionnaires in German, so families with limited language proficiency, digital access or trust in institutions may be underrepresented. The migration measure only indicated whether at least one parent was born outside Germany, so it cannot capture language proficiency, time since migration, country of origin or the full range of migration-related disadvantage. Local service infrastructure, referral practices, knowledge of services and institutional trust were not measured, so observed differences may reflect access conditions rather than specific mechanisms. The high-need group was restricted to parents already in the highest stress category, so it cannot show whether even higher stress within that range leads to more use. The analysis used complete cases only, and although missingness was low, some selection due to dropping incomplete responses cannot be ruled out.

The authors declare no conflicts of interest and report nothing to report for funding.

Do not read this as evidence that early support services are effective or that education and migration status cause unequal access. The study is cross-sectional and only asks what families reported using, and the migration measure simply counted whether at least one parent was born outside Germany.