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

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.

Conceptualizing the Pathways and Processes Between Language Barriers and Health Disparities: Review, Synthesis, and Extension

“…These policies highlight accessibility to healthcare and reduce the perceived difficulties in communicating their medical providers. However, when the LEP individuals have to call (e.g., for making a reservation), challenges still remain because most medical institutions do not have front staffs who can speak multiple languages [36].…”

“…That being said, language-discordance does not always influence clinician-patient interactions negatively. A study showed that patients' satisfaction in clinician-patient interactions could be achieved despite linguistic and cultural differences [36].…”

“…Because clinicians are often not trained to collaborate with professional medical interpreters, they underuse professional interpreters and either get by with their own second language skills or employ ad hoc interpreters (e.g., family members, friends, or staff members in the hospital) because of (a) the positive beliefs about one's own proficiency in patients' native language, (b) their and patients' preference for direct clinician-patient communication, (c) the perceived convenience and effectiveness of ad hoc interpreters, (d) the perceived long waiting time to utilize medical interpreters, (e) their unfamiliarity with and distrust of medical interpreters, (f) perceived cost for hiring professional interpreters, and/or (g) their concerns for the colleagues' (medical interpreters') busy schedule [5,38,55,[65][66][67][68][69]. Despite clinicians' positive perceptions toward ad hoc interpreters [36], they do not provide optimal effectiveness because ad hoc interpreters are less likely to be continuously present in every procedure (e.g., exam room). Thus, the interventions disrupt the flow of communication and medical procedures [36].…”

“…Despite clinicians' positive perceptions toward ad hoc interpreters [36], they do not provide optimal effectiveness because ad hoc interpreters are less likely to be continuously present in every procedure (e.g., exam room). Thus, the interventions disrupt the flow of communication and medical procedures [36]. Moreover, when using ad hoc interpreters, the accuracy of information exchanges is lower compared to the one assisted by professional ones [57,70].…”

Exploring the Patient and Staff Experience With the Process of Primary Care

“…9 Patient experience surveys, however, have been used primarily with Medicare and privately insured populations, leaving the voices of patients in the lowest socioeconomic status underrepresented. 10 Qualitative studies suggest that vulnerable patients place a high value on access to care, care coordination, and continuity, 11,12 but may perceive primary care to be less accessible and of lower technical quality than hospital care. 6 Patient experience is rarely compared with clinician experience, despite the fact that job satisfaction of both primary care clinicians and support staff has been correlated with patient satisfaction.…”