Table 2

Selected Quotations on the Barriers to Well-Child Visit Attendance

Participant and ThemeCode DefinitionQuotation
Caregiver
TransportationMethod 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 stressMoney, 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 workInability 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 careCare 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
TransportationMethod 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 stressMoney, 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 workInability 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 vaccinationsIncluded 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.’”
ImmigrationStatus 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.”
LanguageCommunication 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.”