The relationship between acculturation and healthcare provider relationship on pediatric asthma outcomes among Latinx children

Abstract

Introduction: Acculturation and immigration-related factors have shown conflicting evidence for health outcomes among Latinx individuals in the United States (U.S.), with less known regarding pediatric asthma outcomes. Healthcare provider relationship can often impact the process of healthcare (quality of and access to treatment) for families and may help explain asthma outcomes related to acculturation. This study examined the association between acculturation, asthma control and medication adherence among Latinx parent-child dyads (ages 10-17 for children) within the Bronx, NY. In addition, direct and indirect pathways of acculturation on pediatric asthma outcomes including asthma related quality of life and emergency room visits through healthcare provider relationship were investigated. ¶ Methods: This cross-sectional study recruited parent-child dyads (child ages 10-17) from primary care, allergy and asthma clinics affiliated with hospitals in the Bronx, NY. Parents’ preferred language (English or Spanish) was used as a proxy for acculturation. Parent-healthcare provider (HCP) relationship was measured by a subscale of the Asthma Illness Representations Scale instrument (AIRS). Asthma outcome measures included: asthma control, adherence to inhaled corticosteroids (ICS) and/or leukotriene receptor antagonists (LTRA) medication, asthma-related ER visits, and pediatric asthma-related quality of life. Asthma control was measured by the self-reported Asthma Control Test questionnaire (ages 12-17) and the Child Asthma Control Test (ages 10-11). Medication adherence was measured by daily use of controller medication recorded by electronic devices. Parent self-report of asthma-related ER visits that occurred within the last 12 months was collected. Children’s daily functioning and impairment due to asthma symptoms was measured by the Pediatric Asthma-Related Quality of Life (PAQLQ) self-report parent questionnaire. ¶ Results: The sample was comprised of 219 parent-child dyads [child age = 13.1 years (±2.2), parent age = 42.3 years (± 8.2)]. Parents’ ethnicity was 50.2% Puerto Rican, 26.5% Other Latinx, and 23.3% Dominican with 140 dyads with English preference and 79 dyads with Spanish preference. Spanish preference was associated with worse LTRA medication adherence (R2change = .08, p = .007). Worse healthcare provider (HCP) relationship mediated the relationship between Spanish preference and worse reported asthma related quality of life (indirect effect = -.19 p < .05, CI: -0.33, -0.08). Spanish preference was associated with less reported asthma-related ER visits (path c’, B = -1.05, p = .049). Non-significant main analyses revealed language preference was not associated with ICS medication adherence (R2change =.008, p = .274). Asthma control was also not found to be associated with language preference (OR =.95, p = .872). HCP relationship was not associated with ER visits (path b: B = -.10, p = .825) and the indirect pathway was not significant (indirect effect = .03, 95% CI: -.18, .26), demonstrating that HCP relationship was not a mediator for language preference on reported asthma-related ER visits. ¶ Conclusion: Decreased acculturation measured by Spanish preference was associated with worse LTRA medication adherence and less reported asthma-related ER visits. Healthcare provider relationship mediated the relationship between language preference and asthma-related quality of life, suggesting the role that providers can have on asthma outcomes related to acculturation variables. Future studies should examine other important immigration-related factors to provide further clarity into the complex effects of acculturation and inform efforts to provide culturally sensitive interventions to different Latinx subgroups living in the U.S.