Abstract
Racial, ethnic and language-based disparities occur throughout the US health system. Pediatric prehospital emergency medical services are less likely to be used by Latinos. We identified perceptions of and barriers to prehospital pediatric emergency care (911) access among Spanish-speaking parents. A qualitative study involving six focus groups was conducted. Spanish-speaking parents participated with a bilingual moderator. Topics discussed included experiences, knowledge, beliefs, fears, barriers, and improvement strategies. All groups were audiotaped, transcribed, and reviewed for recurring themes. Forty-nine parents participated. Though parents believed 911 was available to all, many were uncertain how to use it, and what qualified as an emergency. Barriers included language discordance, fear of exposing immigration status, and fear of financial consequences. Parents strongly desired to learn more about 911 through classes, brochures, and media campaigns. Prehospital emergency care should be available to all children. Further quantitative studies may help solidify the identified barriers and uncover areas needing improvement within Emergency Medical Systems. Addressing barriers to 911 use in Spanish-speaking communities could improve the equity of health care delivery, while also decreasing the amount of non-emergency 911 use.
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Acknowledgments
The authors would like to thank the American Academy of Pediatrics for providing the CATCH (Community Access to Child Health) grant which funded this study. Also, a special thanks to Cielo Fernandez for helping coordinate the study at the community centers.
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Appendix: Discussion Guide
Appendix: Discussion Guide
Introduction
As physicians in the Emergency Department, we are interested in how families get the care they need when their children are sick, especially when English is not their primary language.
We are gathered here to talk about your thoughts on using 911. We will start with your general thoughts and gradually get more specific in what we talk about.
Ice Breaker
Has anyone had an experience where your child is at home and needed immediate medical attention?
What did you do?
Probes: call your husband/wife/family member, call the doctor, call 911, rush to the ER?
How did you get to medical care (office, ER, etc.)?
Probes: personal car, bus, taxi, wait for a ride
Knowledge/Beliefs
What do you know about 911?
Probes: What is 911 for?
When would you think about calling 911?
What happens when you call 911? (who gets the call, how do they help you)
Who is allowed to use it? (children, people who do not speak English, undocumented citizens)
Who pays for it?
Barriers
Has anyone ever thought about calling 911 but didn’t?
Probe: Why?
Can anyone tell me about any problems they you have had, or your friends/family have had, with calling 911?
Can you think of any barriers that you or your family/community members may have in calling 911?
Can you think of any reasons you would not call 911?
Do you think the majority of your community knows about 911 and how to use it?
Probes: Why? Why not?
Ways to Improve
How could the 911 system be improved?
Probe: What needs to be changed for you to use 911?
How would you see that being accomplished?
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Watts, J., Cowden, J.D., Cupertino, A.P. et al. 911 (Nueve Once): Spanish-Speaking Parents’ Perspectives on Prehospital Emergency Care for Children. J Immigrant Minority Health 13, 526–532 (2011). https://doi.org/10.1007/s10903-010-9422-9
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DOI: https://doi.org/10.1007/s10903-010-9422-9