Qualitative Study of Foster Caregivers' Views on Adherence to Pediatric Appointments

Abstract

The current study is a qualitative investigation of how foster caregivers, primarily Latinos, view adherence to pediatric appointments with the purpose of identifying how the child welfare system, pediatric clinics, and pediatric health providers serving foster children might promote appointment attendance. Participants in the study had a return appointment at an outpatient pediatric clinic that only served children in the child welfare system. Twenty-eight caregivers (13 related and 15 unrelated) participated in telephone interviews after the date of their scheduled pediatric appointment (32% missed their return appointment). Semistructured interview guides included general questions about what promotes attending the pediatric appointment, what makes it difficult to attend the pediatric appointment, and how pediatric care affects the foster child. Analysis of qualitative data using content analysis identified three themes: (a) multiple methods to attend appointments, which included caregivers’ organizational and problem-solving skills; (b) positive health care experiences, which consisted of caregivers’ personal relationships with providers and staff members and clinic organization; and (c) necessity of pediatric care, which included recognition of the need for health care, especially timely immunizations. All caregivers also reported that appointments reminders would be helpful. Unrelated caregivers more often said that appointment attendance was facilitated by clinic organization compared to related caregivers. Nonadherent caregivers mentioned their need to solve problems to attend appointments or reschedule appointments more than attenders. In summary, caregivers said they valued regular pediatric health care to treat their child’s chronic conditions and prevent illnesses, but they acknowledged that their home lives were hectic and attending scheduled appointments was sometimes difficult. Foster caregivers in this study identified the ideal pediatric clinic environment that encourages adherence to health care appointments. This environment is an organized clinic with easy access including parking, engaged pediatric health providers, ability to reschedule appointments when necessary, and an individualized and consistent appointment reminder system.

Mothers’ Perceived Barriers to and Recommendations for Health Care Appointment Keeping for Children Who Have Cerebral Palsy

“…Transportation support was noted as a facilitator to appointment keeping in two previous qualitative studies (Cameron et al, 2014; Schneiderman et al, 2017); however, the specific findings within the general category of transportation were different from our findings. Schneiderman et al (2017) identified ease of parking, and having a car as facilitators, while Cameron et al (2014) identified improved transport links as a facilitator.…”

“…In contrast, two previous qualitative studies, which also identified facilitators, focused on how parents themselves could facilitate attendance by addressing the competing priorities of the child and family. These two studies also identified that parents' motivation to "improve the health of their child" facilitated appointment keeping (Cameron et al, 2014;Schneiderman et al, 2017). In addition, health care professionals were interviewed in one study where they suggested that educating parents about the importance of attending appointments and consequences of nonattendance could influence attendance (Cameron et al, 2014).…”

“…Four qualitative studies have been conducted to explore appointment keeping in pediatric settings (Ballantyne, Benzies, Rosenbaum, & Lodha, 2015;Cameron et al, 2014;Schneiderman, Kennedy, & Sayegh, 2017;Touch & Berg, 2016). Three of these studies examined barriers and facilitators, however, with less attention to facilitators (Ballantyne et al, 2015;Cameron et al, 2014;Touch & Berg, 2016).…”

“…Three of these studies examined barriers and facilitators, however, with less attention to facilitators (Ballantyne et al, 2015;Cameron et al, 2014;Touch & Berg, 2016). Although one study was devoted exclusively to facilitators of attendance (Schneiderman et al, 2017), it was not conducted with children who had disabilities. These four qualitative studies were conducted in primary and specialty pediatric.…”

<p>Barriers and facilitators of follow-up among women with precancerous lesions of the cervix in Cameroon: a qualitative pilot study</p>

“…In addition, post-treatment appointments are usually given at 1 year. Such long appointments are associated with high rates of forgetfulness 31,32. Reminder phone calls, which emerged as a solution to this barrier, have been found to be effective 33,34.…”