Explaining culturally and linguistically diverse (CALD) parents’ access of healthcare services for developmental surveillance and anticipatory guidance: qualitative findings from the ‘Watch Me Grow’ study

Abstract

BackgroundRegular health visits for parents with young children provide an opportunity for developmental surveillance and anticipatory guidance regarding common childhood problems and help to achieve optimal developmental progress prior to school entry. However, there are few published reports from Australian culturally and linguistically diverse (CALD) communities exploring parents’ experiences for accessing child health surveillance programs. This paper aims to describe and explain parental experiences for accessing developmental surveillance and anticipatory guidance for children.MethodsQualitative data was obtained from 6 focus groups (33 parents) and seven in-depth interviews of CALD parents recruited from an area of relative disadvantage in Sydney. Thematic analysis of data was conducted using an ecological framework.ResultsAn overarching theme of “awareness-beliefs-choices” was found to explain parents’ experiences of accessing primary health care services for children. “Awareness” situated within the meso-and macro-systems explained parents knowledge of where and what primary health services were available to access for their children. Opportunities for families to obtain this information existed at the time of birth in Australian hospitals, but for newly arrived immigrants with young children, community linkages with family and friends, and general practitioner (GPs) were most important. “Beliefs” situated within the microsystems included parents’ understanding of their children’s development, in particular what they considered to be “normal” or “abnormal”. Parental “choices”, situated within meso-systems and chronosystems, related to their choices of service providers, which were based on the proximity, continuity, purpose of visit, language spoken by the provider and past experience of a service.ConclusionsCALD parents have diverse experiences with primary health care providers which are influenced by their awareness of available services in the context of their duration of stay in Australia. The role of the general practitioner, with language concordance, suggests the importance of diversity within the primary care health workforce in this region. There is a need for ongoing cultural competence training of health professionals and provisions need to be made to support frequent use of interpreters at general practices in Australia.

Use of health services by preschool-aged children who are developmentally vulnerable and socioeconomically disadvantaged: testing the inverse care law

“…A more complex picture emerged when we further examined the combination with socioeconomic disadvantage where we found that those children who were not developmentally vulnerable and not disadvantaged (lowest need) and those children who were developmentally vulnerable and not disadvantaged (middle need) had greater odds of using a GP than their developmentally vulnerable and disadvantaged counterparts (highest need). One could argue that although the majority of Australian GPs use Medicare,34 socioeconomic disadvantage remains a barrier to a child using a GP due to other out-of-pocket expenses, cultural barriers and parental health literacy as reported by some service providers and parents 12 35. This may be compounded in the context of developmental vulnerability, where families face a range or additional challenges and stressors and where financial strains may be further stretched because of the higher costs associated with higher care needs.…”

A case study of well child care visits at general practices in a region of disadvantage in Sydney

“…For infants presenting for immunisation qualitative research has highlighted that GPs may not necessarily ask many WCC questions during these visits [ 17 ]. It is possible that the conversation about WCC may differ for different immunisation visits at different ages.…”

“…The implication of this research is that access to WCC is driven by ecological variables of service availability, parent awareness and choice of services, and beliefs about their child’s health. It is, therefore, not surprising that vulnerable populations’ with lower health literacy are less likely to access WCC services than the socially advantaged groups [ 17 , 18 ].…”

The intersection of developmental vulnerability and socioeconomic disadvantage on access to health care for preschool aged children: evidence for the inverse-care law

“…(16) This paper examined household income as the measure of socioeconomic position whereas we used a composite measure that included education and occupation. One could argue that although the majority of Australian GPs do bulk bill using Medicare (30), socioeconomic disadvantage is a barrier to a child accessing a GP due to other out of pocket expenses, cultural barriers, and parental health literacy as reported by some service providers and parents (12,31). If there was true equity we would expect that the highest proportion of children reporting use of a GP in the last 12 months would be children who were developmentally vulnerable and who were disadvantaged, because these children have the highest health and social needs.…”