Beyond interpreter services: Quality of parent/provider communication for racial and ethnic minority families during pediatric hospitalizations

Strong communication between providers and parents is critical for effective inpatient treatment for children from racial/ethnic minority backgrounds. Although interpreter services are necessary to facilitate care for families with limited English proficiency, translation in and of itself does not ensure adequate communication. A better understanding of parent communication preferences in racial/ethnic minority populations is necessary to improve cross cultural communication, reduce disparities in care, and improve family satisfaction.

The purpose of this qualitative analysis was to identify indicators of strong parent/provider communication for racial/ethnic minorities, over and above availability of language services. We analyzed semi-structured assessments from a quality improvement communication intervention in a large inner city pediatric hospital with a diverse sample of racial and ethnic minority families (n=40). Half of the sample was primarily Spanish speaking and required interpreter services to communicate with care personnel during the child's hospitalization. Twenty intervention families received a “Patient Passport” book that included pictures of the patient, family, and providers, laboratory and radiology results, and space to write down questions related to the child's hospitalization. Semi-structured assessments of quality and satisfaction with care were conducted at hospital discharge for intervention and control families. We conducted an inductive content analysis of these assessments to identify parent preferences for communication with the medical care team and compared these preferences across experimental and language conditions.

Four themes related to preferences for communication emerged in the analysis across all families: 1) accurate identification of the parent and the provider team; 2) clear understanding of the process of care; 3) answering questions about child's care; and 4) evidence of teamwork among providers. For families who participated in the intervention two other themes emerged: 1) being mentored or taught about their child's care; and 2) having providers ask for parents' input on their child's care. Beyond discussion about interpreter availability, there were few differences between Spanish and English speaking parents' communication preferences. However, Spanish speaking parents did not like the doctor communicating directly with their child whereas English speaking parents were more positive about direct patient/doctor interaction.

Although interpreter availability was critical for Spanish speaking parents, many other components of quality communication with providers were important to ensure a positive experience during their child's hospitalization. Trainings and interventions that focus on communication processes during pediatric hospitalizations are important to improve cross cultural communication and ensure quality care for both English and Spanish speaking racial/ethnic minority families.