Factors That Matter to Low-Income and Racial/Ethnic Minority Mothers When Choosing a Pediatric Practice: a Mixed Methods Analysis

Abstract

Background: Pediatric practices' scores on healthcare quality measures are increasingly available to the public. However, patients from low-income and racial/ethnic minority populations rarely use these data. We sought to understand potential barriers to using quality data by assessing what factors mattered to women when choosing a pediatric practice.

Methods: As part of a randomized trial to overcome barriers to using quality data, we recruited women from a prenatal clinic serving an underserved population. Women reported how much 12 factors mattered when they chose a pediatric practice (5-point Likert scale), what other factors mattered to them, and which factors mattered the most. We assessed whether factor importance varied with selected participant characteristics and qualitatively analyzed the "other" factors named.

Results: Participants' (n = 367) median age was 23 years, and they were largely Hispanic (60.4%), white (21.2%), or black (16.9%). Insurance acceptance "mattered a lot" to the highest percentage of women (93.2%), while online information about what other parents think of a practice "mattered a lot" to the fewest (7.4%). Major themes from our qualitative analysis of "other" factors that mattered included physicians' interpersonal skills and pediatrician-specific traits. Factors related to access "mattered the most" to the majority of women.

Conclusions: Pediatrician characteristics and factors related to access to care may be more important to low-income and racial/ethnic minority women than more commonly reported quality metrics. Aligning both the content and delivery of publicly reported quality data with women's interests may increase use of pediatric quality data.

Clinical trial registration: Clinicaltrials.gov NCT01784575.

Keywords: Choosing a pediatric practice; Low income; Minority; Pediatric healthcare quality; Pregnant women.

Figure 1. Percent of women to whom each of 12 factors “Mattered a lot” by parity

Factor rated^§ 1: Office location – near home; 2: Office location – access to public transport; 3: Can easily contact someone in office; 4: Recommendation – friend; 5: Recommendation – family; 6: Recommendation – physician; 7: Already know the pediatrician; 8: Already know the office staff; 9: Office accepts patient’s insurance; 10: Information found on the pediatrician’s website; 11: Online data – clinical quality scores; 12: Online data – parent opinions