Immigrant Mothers’ Perspectives on Pediatric Primary Care: Challenges and Solutions to Improve Medical Home Utilization

Background: One in four children in the United States are children in immigrant families (CIF). Known barriers to accessing and navigating the healthcare system for immigrants include poverty, fear and stigma, mobility of the population, limited English proficiency, limited information about how the U.S. healthcare system works, and lack of access to insurance. These likely lead to decreased opportunities for establishing a medical home in CIF compared to children with U.S.-born parents, although the specific ways in which these obstacles contribute to medical home access is less well studied. Since children without medical homes are less likely to receive recommended preventive care and are more likely to access an emergency department for health services, understanding the challenges that lead to a lower rate of medical home establishment and identifying potential solutions are essential to improve CIF’s long-term health outcomes.

Methods: Four immigrant groups well represented in the U.S. were included: Congolese, Afghan, Syrian/Iraqi and Central American (specifically, Guatemalan, Salvadoran, or Honduran). Eight semi-structured interviews of key informants and four focus groups comprised of immigrant mothers were conducted. Interviews and focus groups were audio-recorded, transcribed, and coded by two independent researchers both manually and using Atlas.ti. Themes were drawn from an inductive process of data analysis.

Results: Five themes common to all groups emerged: 1) keeping children healthy is viewed as a familial, not clinical, role; 2) the U.S. approach to health and the structure of its health care system differ from those of most countries; 3) significant challenges exist at every stage of health care visits; 4) prior experiences with the U.S. healthcare system shape mothers’ perception of the care they receive as well as their continuity of care; and 5) beneficial health information is best received from trusted sources in a culturally appropriate manner. In addition, differences between the groups – in terms of level of education, cultural preferences, and immigration status – were revealed, indicating unique obstacles that would need to be addressed for individual populations.

Conclusion: Immigrant mothers face many similar challenges in obtaining primary care for their children, although important differences between groups also exist. Their perspectives reveal the barriers preventing medical home access for their children as well as offer ideas to reduce these barriers and create positive experiences that encourage primary care utilization. Decreasing health inequities in CIF through improved rates of medical home establishment requires tailored, immigrant-informed messaging; services specific to the target population; systems-level changes that facilitate health care usage; collaborations with trusted local leaders; and partnerships with immigrant mothers that reflect their integral role in their children’s health.