Maternal Perceptions of Developmental Assessment for Low-Income Latino Children
Background: Guidelines for well-child care recommend that pediatric development be routinely assessed to identify developmental risk factors, provide parents with appropriate anticipatory guidance, and secure adequate intervention to support optimal development. National data suggest that health care providers (HCP) do not adequately address parental concerns regarding pediatric development, behavior and mental health. Many children with problems remain undetected or do not receive referral until problems escalate. This is especially true for children from low-income and racial and ethnic minority families. Notably, Latino children are diagnosed with autism spectrum disorders 2.5 years later than white children and exhibit more severe symptoms at time of diagnosis. Similar delays are noted for other developmental, behavioral or mental health conditions.
During the pediatric well child visit, parents must provide information, and respond to questions, which guide assessment and plan of care. Individuals with low HL experience challenges in communicating with HCP, demonstrate poor comprehension of instructions, ask few questions within a clinical encounter, and report poor satisfaction with patient-provider communication. Low parental HL has been associated with suboptimal pediatric health outcomes, but whether parental HL plays a role in developmental assessment and referral remains poorly understood.
Methods: Low-income English- and Spanish-speaking Latina mothers of children aged three months to four years were recruited from WIC sites in Southern California (n= 124) to participate in this cross-sectional, correlational study. Maternal HL was measured using the Newest Vital Sign. Perception of pediatric developmental screening and receipt of information or referral was evaluated using the Promoting Health Development Survey. Demographic data included maternal acculturation status, child health insurance status, and whether the child received care from a regular place and regular provider.
Results: Fifty-three mothers were identified as having a “high likelihood of limited HL”, 43 with the “possibility of limited HL,” and 28 with “adequate HL.” Chi-square analysis revealed a significant association with moderate effect size between the level of maternal HL and maternal identification of child being at risk for developmental problems, χ2 (6) = 15.185, p = .019, ϕ = .238. Overall, 61 mothers identified their child as at “high risk” for a developmental concern; only 32 reported being asked by their HCP if they had such concerns, and 34 reported being provided with information to address these concerns. There was no association between identification of the child as “at risk” and whether the mother reported developmental assessment (χ2 (6) = 5.917, p = .433), or received information or referral (χ2 (3) = 6.794, p = .079).
Implications: Children who receive timely and appropriate assessments are more likely to receive needed services. Low maternal HL may be a risk factor for incomplete pediatric developmental assessment and referral among low-income Latino families. Providing culturally relevant, understandable anticipatory guidance materials to Latino families may be one way to reduce disparities in pediatric health care.