Background
Communication between caregivers and healthcare providers is important in the delivery of high-quality healthcare for children with medical complexity (CMC). Hispanic children face many challenges in access to healthcare services. Our objective was to describe the communication challenges faced by Spanish-speaking parents with limited English proficiency (SSP-LEP).
Methods
This was a qualitative study of 70 children of Spanish-speaking caregivers, enrolled in a complex care program of a tertiary care children’s hospital in North Carolina. Secondary source data were abstracted logs of care coordination tasks maintained by the program’s two bilingual care coordinators for a median observation period of 45 months, and complemented by data from care coordinator interviews. Data were entered and coded in ATLAS.ti. Using thematic content analysis and an iterative process, we identified recurrent themes related to communication challenges of Spanish-speaking caregivers.
Results
Median age of children was 5 years; 51% were girls; 97% had Medicaid; and 3% were uninsured. Seven children died during the observation period. Three major themes were identified as follows: (1) caregivers faced many communication challenges primarily because of language barrier. (2) Multiple factors at caregiver, provider, and system levels, in addition to language barrier, contributed to communication challenges. (3) Communication challenges had serious consequences for CMC. These consequences were lessened by bilingual coordinators.
Conclusion
SSP-LEP face unique communication challenges resulting in negative impact on the healthcare of their CMC. Bilingual coordinators can help improve communication between SSP-LEP and their healthcare providers. Interventions to address communication challenges of Spanish-speaking caregivers are warranted.
Supplementary Information
The online version contains supplementary material available at 10.1007/s40615-021-01161-x.
Background: Children with medical complexity (CMC) are at increased risk of fragmented care. Communication between caregivers and healthcare providers is important in the delivery of high-quality healthcare for children with medical complexity (CMC). Latino CMC face greater challenges in access to healthcare services. Hispanic children face greater challenges in access to healthcare services. Our objective was to describe the communication challenges faced by Spanish-speaking parents/caregivers of CMC. Methods: This was a retrospective cohort study of 70 CMC enrolled in a complex care program of a tertiary care children’s hospital in western North Carolina. We reviewed the care coordination tasks from encounter logs maintained by the program’s two bilingual care coordinators for a median observation period of 45 months. Data were then validated by the care coordinators. Data containing care coordination tasks were entered into ATLAS.ti and coded. Qualitative data analysis was performed. Using thematic content analysis and an iterative process, we identified recurrent themes related to communication challenges of Spanish-speaking caregivers. Results: Median age of children was 5 years; 51% were girls; 97% had Medicaid; and 3% were uninsured. Seven children died during the observation period. Three major themes were identified: 1) Spanish-speaking caregivers faced many communication challenges primarily because of language barrier. 2) Multiple factors at caregiver-, provider-, and system-levels, in addition to language barrier, contributed to communication challenges. 3) Communication challenges had serious consequences for CMC. These consequences were lessened by bilingual care coordinators.Conclusion: Spanish-speaking caregivers of CMC face unique communication challenges resulting in negative impact on the healthcare of these children. Bilingual care coordinators can help improve communication between Spanish-speaking caregivers of CMC and their healthcare providers. Interventions to address communication challenges of Spanish-speaking caregivers are warranted.
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