Cultural Influences on Health Care Use

Infants & Young Children, 2007

There is growing interest in the experiences of ethnically and linguistically diverse families of young children with special needs and the myriad of early intervention systems of care they encounter in the United States. The research on Latino families and their young children with special health and developmental needs highlights critical issues of language, culture, and family adaptation to a myriad of service delivery systems. This emerging area of research reveals that ethnically and linguistically diverse families may view difficulties as not inherent in their young children with special needs; rather the locus of hassles and stressors may be mediated to some extent by unresponsive service delivery systems. To this regard, the objective of this literature review is to synthesize salient themes from the extant research about the experiences of Latino families and their young children with early intervention systems of care in order to illuminate guiding implications for policy, research, and practice.

BMC Health Services Research

Background: Immigrants and their Norwegian-born children make up approximately 18% of the total population in Norway. While several studies have been conducted on immigrants' utilization of healthcare services, immigrant families are systematically underrepresented in international studies of children with disabilities. By focusing on experiences of immigrant parents of children with disabilities navigating health and rehabilitation services in Norway, this study generated knowledge of how accessible and tailored the services were from their point of view. Methods: This study took a qualitative approach, using semi-structured interviews to explore the experiences of immigrant parents of children with disabilities from non-Western countries. The interviews were transcribed, coded, and analyzed via an inductive thematic analytic approach. Results: The findings show how the "immigrant experience" influenced the way the parents looked at, experienced, and even praised the services. The parents appreciated the follow-up services provided by the pediatric rehabilitation centers, which they experienced as predictable and well-organized. While navigating the services, they experienced several challenges, including the need for information, support, and timely help. They felt exhausted because of years of struggle in the healthcare system to access the help and services they needed. They expressed how this struggle had affected their own health. The feeling of being treated differently from the majority was another challenge they experienced while navigating the services. The findings also show how parents' experiences of communication with healthcare providers were influenced not only by their own language and communication skills but also by the healthcare providers' intercultural communication skills and dominant organizational culture. Conclusions: The parents' experiences show that there is still a gap between the public ideal of equal healthcare services and the reality of the everyday lives of immigrant families of children with disabilities. By exploring immigrant parents' experiences, this study highlights the importance of mobilization at both the individual and systemic levels to fill the current gap and provide tailored and accessible services to the entire population.

Academic Pediatrics, 2010

Objective.-To assess the associations of parent-primary care provider language concordance and providers' self-rated cultural competency items with Latino parent report of well-child care quality. Methods.-A cross-sectional survey of parents with children 10-50 months old and their children's providers in 3 community health centers. We used the mean scores of quality domains of the Promoting Healthy Development Survey to examine associations of parent-provider language concordance and providers' self-rated cultural competency items with the quality of well-child care provided (all scales range 0-100). Results.-Results are based on 462 Latino parent responses and 22 provider responses. Latino parents in language concordant patient-provider relationships did not report higher-quality well-child care. Higher parent-reported quality of care was associated with provider self-reported effectiveness in treating Latino patients in the domains of family-centered care (mean 80.5 vs 70.6; P ¼ .02) and helpfulness of care (mean 84.2 vs 67.9; P ¼ .02). A language-cultural competency summary scale was associated with the domain assessing family risk factors (þ11.2 points; P ¼ .02) and its subdomain of emotional assessment (þ16.1 points; P ¼ .02). Conclusions.-Language concordance was not associated with parental reports of quality of well-child care. Provider selfperceived cultural competency was associated with higher scores in domains related to how content is delivered-that is, helpful and family-centered. The language-cultural competency summary score was associated with discussion of sensitive topics. These findings indicate that provider characteristics other than language concordance have greater association with quality of care and may offer opportunities to strengthen cultural competency, even among monolingual providers.

PEDIATRICS, 2010

We examined the specific health care needs of Hispanic children with special health care needs (CSHCN) from Spanishlanguage households, and we compared the needs for children in this group to those for Hispanic and non-Hispanic white CSHCN from English-language households.

American Journal on Intellectual and Developmental Disabilities, 2012

This study examines access to, utilization of, and quality of health care for Latino children with autism and other developmental disabilities. We analyze data from the National Survey of Children with Special Health Care Needs (N = 4,414 children with autism and other developmental disabilities). Compared with White children, Latino children with autism and other developmental disabilities had a consistent pattern of worse health care access, utilization, and quality. We then test mediation models to determine if health care quality mediates the relationship between ethnicity and health care utilization disparities. Three of four quality indicators (provider does not spend enough time with child, provider is not culturally sensitive, and provider does not make parent feel like a partner) were significant mediators. These analyses suggest that interventions targeted at improving providers' cultural sensitivity and behavior during the clinical encounter may reduce disparities i...

Maternal and Child Health Journal, 2011

To better understand if reported delayed/forgone care and dissatisfaction with care for children with special health care needs (CSHCN) are associated with the parent's perception of health care providers' cultural competency. National survey. Fifty United States and the District of Columbia yielding 750 families per state and District of Columbia with CSHCN B 18 years participated in the 2005-06 National Survey of CSHCN. Outcome measures were delayed/forgone care in the past 12 months (yes or no) and dissatisfaction (very dissatisfied to very satisfied). Demographic/clinical characteristics and the parent's perception of health care providers' cultural competency were examined. Perception of cultural competency was defined by questions related to time spent with child, respect for family values, listening to the family, sense of partnership, and information provided. Delayed/ forgone care and dissatisfaction with care were associated with perceived health care provider cultural competency. Parents whose children were older, whose children's condition affected their ability to do things, whose interviews were not conducted in English, and were from certain racial and ethnic groups reported more delayed or forgone care and were more dissatisfied with their children's health care. Delayed/forgone care and dissatisfaction with care were associated with perceived cultural competency of health care providers. This did not appear to differ consistently by racial or ethnic group. Further research using more refined instruments and longitudinal designs is needed to assess the effects of health care providers' cultural competency and other cultural factors on the delayed/forgone care for CSHCN and on the dissatisfaction with care of parents with CSHCN.

Archives of pediatrics & adolescent medicine, 1998

Background: Latinos will soon be the largest minority group in the United States, but too little is known about major access barriers to health care for this group and whether these barriers result in adverse consequences. Objective: To identify important access barriers to health care for Latino children, as cited by parents. Design: Cross-sectional survey of parents of all 203 children coming to the pediatric Latino clinic at an innercity hospital. Questions focused on barriers to health care experienced prior to receiving care at the Latino clinic. Results: Parental ethnicity included Dominican (36%), Puerto Rican (34%), Central American (13%), and South American (11%). Only 42% of parents were American citizens, whereas 36% had green cards, and 13% had no documentation. Eight percent of parents and 65% of the children were born in the United States. Parents rated their ability to speak English as follows: very well/well, 27%; not very well, 46%; and not at all, 26%. The median annual household income was $11 000; 40% of parents never graduated from high school, and 49% headed singleparent households. Forty-three percent of the children were uninsured. A sick child was routinely brought to hospital clinics by 56% of parents, to the emergency department by 21%, and to neighborhood health centers by 21%. When asked to name the single greatest barrier to health care for their children, parents cited language problems (26%), long waiting time at the physician's office (15%), no medical insurance (13%), and difficulty paying medical bills (7%). When parents were asked if a particular barrier had ever caused them not to bring their children in, transportation was cited by 21%; not being able to afford health care, 18%; excessive waiting time in the clinic, 17%; no health insurance, 16%; and lack of cultural understanding by staff, 11%. Some parents who spoke little or no English reported that medical staff not speaking Spanish had led to adverse health consequences for their children, including poor medical care (8%), misdiagnosis (6%), and prescription of inappropriate medications (5%). Multivariate analyses of selected health outcomes using 7 independent variables showed that low family income was significantly associated with greater odds of a child's having suboptimal health status (odds ratio, 1.5; 95% confidence interval, 1.04-2.2) and an increased number of physician visits in the past year (PϽ.04), but reduced odds (odds ratio, 0.6; 95% confidence interval, 0.4-0.9) of the child's being brought to the emergency department for a routine sick visit. Children whose parents had resided in the United States for fewer than 8 years were at reduced odds (odds ratio, 0.5; 95% confidence interval, 0.2-0.9) for having spent a day or more in bed for illness in the past year. Conclusions: Parents identified language problems, cultural differences, poverty, lack of health insurance, transportation difficulties, and long waiting times as the major access barriers to health care for Latino children. Language problems can result in adverse health consequences for some children, including poor medical care, misdiagnosis, and inappropriate medication and hospitalization. Low family income is an important independent risk factor among Latino children for suboptimal health and high utilization of health services.

American Behavioral Scientist, 2014

There are approximately 2.3 million mixed-status families in the United States, containing varied combinations of citizens, permanent legal residents, undocumented immigrants, and individuals in legal limbo. These families offer an opportunity to examine the functioning of the contemporary state and its penetration at the household level. For many Latino youth, experiences are framed not only by their own but other family members’ legal status. This article reports on health care seeking experiences of mixed-status families in the Lower Rio Grande Valley of South Texas and the impact of the recent health care reform (Affordable Care Act). We utilized qualitative ethnographic methods including 55 semistructured interviews with mixed-status families and 43 interviews with health care providers, caseworkers, and public health officials. Results indicate that changes accompanying the reform directly and indirectly affect mixed-status households’ ability to access care. We describe strat...

Ambulatory Pediatrics, 2004

Objective.-To examine the association between the parent's language of interview and the access to care for children with special health care needs (CSHCN).

Journal of immigrant and minority health / Center for Minority Public Health, 2014

In Canada little is known about the challenges immigrant mothers of children with disabilities encounter in accessing formal and informal social support. This paper presents the perspectives of service providers on the mothers' challenges. Data was collected from 27 service providers in Toronto, Canada in 2012 through in-depth interviews. The interview guide was informed by published literature on families of children with special needs. Level one analyses entailed descriptive analyses; and level two consisted of applying House's 4 domains of social support to organize the themes. Following House's domains, challenges to (1) Structural support, (2) Instrumental support, (3) Emotional support, and (4) Perception of support were identified. Among providers who work with families of children with disabilities there is recognition of the mothers' particular challenges in light of their immigration status. Language and communication are significant barriers for immigrant ...