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The Voices of Limited English Proficiency Latina Mothers on Pediatric Primary Care: Lessons for the Medical Home

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Abstract

The objective of this study is to inform medical home implementation in practices serving limited English proficiency Latino families by exploring limited English proficiency Latina mothers’ experiences with, and expectations for, pediatric primary care. In partnership with a federally-qualified community health center in an urban Latino neighborhood, we conducted semi-structured interviews with 38 low-income Latina mothers. Eligible participants identified a pediatric primary care provider for their child and had at least one child 3 years old or younger, to increase the probability of frequent recent interactions with health care providers. Interview transcripts were coded and analyzed through an iterative and collaborative process to identify participants’ satisfaction with and expectations for pediatric primary care. About half of the mothers interviewed were satisfied with their primary care experiences. Mothers suggested many ways to improve the quality of pediatric primary care for their children to better meet the needs of their families. These included: encouraging providers to invest more in their relationship with families, providing reliable same-day sick care, expanding hours, improving access to language services, and improving care coordination services. Limited English proficiency Latina mothers expect high-quality pediatric primary care consistent with the medical home model. Current efforts to improve primary care quality through application of the medical home model are thus relevant to this population, but should focus on the parent-provider relationship and timely access to care. Promoting this model among practices that serve limited English proficiency Latino families could improve engagement and satisfaction with primary care.

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Acknowledgments

This work was funded by Robert Wood Johnson Foundation Clinical Scholars Program.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Johns Hopkins University, Center for Child and Community Health Research, Mason F Lord Bldg, Ste. 4200, 5200 Eastern Ave, Baltimore, MD, 21224, USA

    Lisa Ross DeCamp

  2. School of Social Work, University of Michigan, Ann Arbor, MI, USA

    Edith Kieffer

  3. Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA

    Joseph S. Zickafoose & Matthew M. Davis

  4. RWJF Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA

    Sonya DeMonner, Matthew M. Davis & Michele Heisler

  5. Veterans’ Affairs Center for Clinical Management Research, Ann Arbor, MI, USA

    Sonya DeMonner & Michele Heisler

  6. Community Health and Social Services Center, Detroit, MI, USA

    Felix Valbuena

Authors
  1. Lisa Ross DeCamp
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  2. Edith Kieffer
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  3. Joseph S. Zickafoose
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  4. Sonya DeMonner
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  5. Felix Valbuena
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  6. Matthew M. Davis
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  7. Michele Heisler
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Corresponding author

Correspondence to Lisa Ross DeCamp.

Appendix: Interview Guide

Appendix: Interview Guide

Section A: Primary Care Clinic and Providers

  1. 1.

    Tell me more about the place where you take your child/children for check-ups.

  2. 2.

    What made you decide to take your child/children to that clinic?

(If they use different clinics for each child begin focus on youngest child here.)

    • Recommendation from: Nursery staff, OB, friends/family, Insurance list, Phonebook

    • Clinic Features: Location, hours of the clinic, wait time for appointments, appointments available when you need them, after-hours line (ability to contact clinic/doctors after the clinic closed), friendliness of the staff and doctors, reputation in the community, Spanish speaking doctors/staff, Latino doctors/staff

  • Explore what things were most important to them when choosing a clinic and why

  • If they use different clinics for different children, explore why

 

  1. 3.

    Have you always taken your child to this clinic for check-ups?

    • Explore why they decided to leave the other clinic(s)/switch to the current clinic.

  2. 4.

    Explore what they like and dislike about their current primary care clinic and why.

  3. 5.

    Explore providers that see the child for appointments.

    • Do they have a usual provider or many different providers?

    • How did they choose the usual provider?

    • What are the things that you like about the provider(s)?

      • Manner or style of provider practice

      • Personality of provider

      • Perceived time spent with the family

      • Type of advice they give the family

      • Any negatives?

  4. 6.

    If they describe continuity with a provider, explore their opinion about having continuity with one provider. If they don’t have continuity explore why they do not have continuity and any potential benefits of continuity.

    • Probes for benefits of continuity. Provider…

      • Knows the child

      • Knows the child’s health problems

      • Knows the family and their situations

      • Understands the mother better

      • Treats the mother with more kindness or more respect

      • Any negatives?

  5. 7.

    Tell me about the last check-up for your youngest child.

    (Define check-up-“physical”, “shots”, “appointment when the child is not sick”)

    • Explore what takes place and topics discussed during check-ups

      • Vaccines

      • Physical Exam

      • Advice about: Growth, Development, Behavior, Sleep habits, Nutrition, Parenting

    • What are some other things that you would like to know about taking care of your child/children’s health?

    • Besides your child’s health care providers, where else do you get advice/information about your child/children’s health?

      • People (Friends, Relatives, Child Care Providers)

      • Media (TV, Books, Internet, Radio, Pamphlets)

    • Explore what kind of advice/information that they obtain from these other sources.

      • Advice about what to do when child is sick

      • Advice about feeding/nutrition

      • Advice about development

      • Advice about discipline

    • Explore if they receive different advice from different sources and which advice they follow/trust the most when the advice/information is different?

  6. 8.

    Tell me about how important it is to you to have a provider that speaks Spanish.

    • Explore the differences between having a provider that speaks Spanish and having an interpreter.

    • Ask for stories about problems they have faced because they need/prefer services in Spanish

    • Explore whether or not it is important to them to have a provider that is Latino.

      • Understands your culture/religion/beliefs

      • Speaks Spanish the same way you do

  7. 9.

    Explore what other services are offered by the clinic beside appointments.

      • WIC

      • Laboratory

      • Nutritionist

      • Social Worker

      • Child development/behavior specialist

    • Explore how often and why they use these services.

    • Explore what other services they think the clinic should offer and why they might beneficial

Section B: Health Care During Illnesses

  1. 1.

    When your child is sick how do you decide where to go for health care?

    • Explore the process of getting sick care at the primary care clinic

      • Call in or walk-in for appointment

      • Availability of same day appointments

      • Wait time for appointments once they arrive

      • Understands your culture/religion/beliefs

      • Speaks Spanish the same way you do

    • Explore whether barriers to getting sick care at the primary clinic have caused them to go other places for sick care

    • Explore where they chose to go and why

      • Places: Emergency room, urgent care, drugstore/pharmacy, chiropractor, hospital, traditional healer

      • Reasons to go: Felt the problem was too urgent to arrange an appointment at the clinic, could not get an appointment at the clinic, would have had to wait too long for an appointment at the clinic, clinic was not open

  2. 2.

    Has your child needed to see a specialist? How has it been taking your child to an appointment with a specialist?

      • How did they arrange the appointment with the specialist (Did they call to make appt or did clinic call?)

      • Was transportation to get to the specialist a problem?

      • Was there an interpreter available to them?

      • Did the specialist know why they had the appointment?

    • Explore if the primary doctor knew what happened at the specialist appointment

    • If they report care with many different doctors explore how they keep track of the appointments and what each doctor asks them to do

      • Explore if they would like someone from the clinic or community help them managing the health care of their child.

      • What should this person do to help?

Section C: CHASS (Only If Families Do Not Go to CHASS)

  1. 1.

    Did you consider using CHASS for check-ups for your child?

    • Explore why they decided not to use CHASS

    • Explore what changes CHASS would have to make to be a place they would want to use for health care for their child/children

Section D: Conclusion Questions

  1. 1.

    Describe the perfect pediatric clinic for their children and family.

    • What would the building look like (waiting room etc.)

    • Hours

    • How would you make appointments

    • Kinds of providers

    • Services

    • What would they use it for…appointments, education, parent groups?

    • Would it serve the whole family or just kids

  2. 2.

    Is there anything else that you can think of that clinics and doctors could do to help families take care of their children’s health?

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DeCamp, L.R., Kieffer, E., Zickafoose, J.S. et al. The Voices of Limited English Proficiency Latina Mothers on Pediatric Primary Care: Lessons for the Medical Home. Matern Child Health J 17, 95–109 (2013). https://doi.org/10.1007/s10995-012-0951-9

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