Selected Quotations on the Barriers to Well-Child Visit Attendance
| Participant and Theme | Code Definition | Quotation |
|---|---|---|
| Caregiver | ||
| Transportation | Method of getting to clinic, including cars, ride-sharing services, buses, walking, bicycling, and other means | “I had to miss [a well-child visit] because of transportation...me and my fiancé—or husband now—we only had 1 car. And, um, he had to use it for work, so, and I just did not want to take the bus to get there, or it cost too much for the cab to get from where we lived.” |
| Financial stress | Money, finances, resources, cash, income, or poverty | “I just have to pay to park, and sometimes I have to scrape up money to park because of the situation, because I’m not a wealthy individual.” “One day I had to borrow money from the parking attendant to get my car out of the lot because I didn’t have the money.” “Overworked, underpaid, not enough money to pay your bills, worry about food, your kids, and just everything in general.” “I’m on a fixed income…and the child support is not enough. Then I’m fighting trying to make sure we have food stamps.” |
| Time off from work | Inability to leave work (either paid time off or unpaid time off), difficulty arranging schedule with employment or employer | “I’ve actually had to reschedule some of her appointments just because they won’t allow me to take off to come take her.” |
| Child care | Care of other children in household, need to pick children up from school | “…when you’re juggling multiple kids and you’re trying to find a time that’s going to work…” |
| Clinician | ||
| Transportation | Method of getting to clinic, including cars, ride-sharing services, buses, walking, bicycling, and other means | “I think the barrier tends to be more with, um, prioritizing, transportation, and just that there’s a lot of other personal stressors that, um, bubble to the top, um, for these people.” |
| Financial stress | Money, finances, resources, cash, income or poverty | “…taking their kid to their well-child [visit] is maybe not as deserving of your attention when you’re figuring out, um, how you’re going to put food on the table or whatnot…” |
| Time off from work | Inability to leave work (either paid time off or unpaid time off), difficulty arranging schedule with employment or employer | “…[they’ve] missed too many days off from work because one of their kids has been sick and this is a preventative visit, that they might miss that preventative visit until they can reschedule for a day that might not have work.” |
| Lack of vaccinations | Included services within well-child visit | “When I tell someone they’re coming back for vaccines, that’s very clear to me. But, for example, at the 9-month well-child check, we don’t have vaccines, and the 2-year or 3-year [visits] often don’t require, unless you happen to fall within the winter season. So we’re not actually physically giving some-one something. And I think there is a sense that some of our patients that if we’re not giving a prescription or not giving a vaccine, and we’re just talking and weighing and measuring them, that we’re not doing ‘anything.’” |
| Immigration | Status of immigration or citizenship, fear of immigration authorities | “I think people who are undocumented are afraid to seek medical care. So a lot of the parents of our patients are undocumented, so I think they may hesitate to come in because often they need to show an ID for their children to be seen.” “If you’re an illegal immigrant or whatever, there is a lot of anxiety around coming to systems in America where you are worried you might get found out.” |
| Language | Communication with provider or staff, use of non-English language or interpretation | “For many of the patients I work with is that there’s a language barrier, um, not understanding when the next appointment is. A lot of them are Spanish speaking so, um, not understanding when the next appointment time is, um, getting that mixed up.” |