What determines immigrant caregivers’ adherence to health recommendations from child primary care services? A grounded theory approach

Abstract

AimTo investigate the diversity and specificity of the determinants of immigrant caregivers’ adherence to child primary care (CPC) health recommendations.BackgroundImmigrant caregiver’s adherence to CPC health recommendations is of utmost importance to minimize their children’s health-related vulnerabilities. Some research has been conducted on the determinants of immigrants’ access to health services, but much less is known about the determinants of their adherence to health professionals’ recommendations once they get there, especially in a primary health care context. This study contributes to bridge these gaps.MethodsInterviews and focus groups were conducted, with immigrant and non-immigrant caregivers living in Portugal (n=35), from heterogeneous socioeconomic backgrounds. Focus group and individual interview scripts were developed to explore caregivers’ understanding and use of CPC services and, particularly, their adherence to CPC recommendations. A socio-demographic questionnaire was also administered. Qualitative data were analyzed using a grounded theory methodology.Findings‘Adherence to CPC health recommendations’ is a core and multidimensional concept. Several determinants were identified at individual, interpersonal, organizational and structural levels. Some determinants were highlighted both by immigrant and non-immigrant caregivers: valuing children’s health, usefulness of recommendations, perceived health-care professionals’ competence, central role of vaccination in CPC and caregivers’ socio-economic conditions. Other determinants were specifically mentioned by immigrant caregivers: expectations about traditional versus pharmacological treatments, cultural mismatches in children’s care practices, perceived quality of Portuguese CPC services versus CPC from countries of origin. These results provide innovative theoretical and empirical contributions to the field of primary health care and, particularly, to immigrant caregivers’ adherence behaviors. Implications for research on treatment adherence in primary care contexts, the development of interventions that promote caregivers’ adherence to CPC health recommendations and for child protection will be discussed.

Assessing Caregivers’ Adherence to Child Primary Care Recommendations: Development and Validation of a Scale

“…As expected, as compared to non-immigrants, immigrant caregivers reported lower levels of adherence (H4), especially in what concerns nutritional counselling and paid vaccines. In fact, some feeding practices are particularly influenced by cultural health beliefs, which may lead to lower adherence, especially when these beliefs contrast with some health professionals' recommendations (Gurung, 2006;McNicholas, 2012;Mourão & Bernardes, 2019). Concerning paid vaccines, it is important to highlight that many individuals of minority ethnic groups most often present lower socio-economic conditions (Morrison & Bennet 2009;Straub 2012); which is also true to our subsample of immigrants when compared with the Portuguese subsample.…”

“…The selection of the CPC health recommendations to be included in the measure was also based on the information from a previous qualitative study (Mourão & Bernardes, 2019). In this study a sample of 35 immigrant and non-immigrant caregivers living in Portugal perceived adherence to CPC health recommendations as a complex and multidimensional concept, which included adherence to pharmacological recommendations (i.e.…”

“…Nevertheless, our results contrast with our initial hypothesis, as the caregivers with Portuguese nationality or European passport were the ones that reported lower adherence as compared to those with legalization in process or resident permission. This conclusion may reflect the influence of social desirability on participants in a more vulnerable condition in the host country, who may tend to hide their nonadherence behaviors for fear of facing health professionals' prejudice and discrimination (Hannan, 2015;Mourão & Bernardes, 2019). This is particularly relevant considering that some non-adherence behaviors could be interpreted as parental negligence (e.g.…”