• Kori B Flower, Samuel Wurzelmann, Christine Tucker, Claudia Rojas, Maria E Díaz-González de Ferris, and Francisco Sylvester.
• Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics (KB Flower, ME Díaz-González de Ferris), University of North Carolina at Chapel Hill. Electronic address: kflower@unc.edu.
• Acad Pediatr. 2020 Oct 20.

Background And ObjectiveChildren of Spanish-speaking caregivers face multiple barriers to care in academic medical centers. This study identified barriers and facilitators of health care and described use of health information technology in order to guide interventions and optimize services.MethodsIn-depth, audiotaped interviews were conducted with monolingual Spanish-speaking caregivers (N = 28) of children receiving care in academic medical center clinics using a structured interview guide. Interviews were transcribed in Spanish, and key themes were identified using thematic analysis. Illustrative quotes for each theme were translated into English.ResultsLanguage-specific barriers included arrival/registration occurring in English, lack of bilingual personnel, heavy reliance on interpreters, long wait times, and challenging phone communication. Non-language-specific barriers included medical center size and complexity, distance to services, lack of convenient and coordinated appointments, missing work/school, and financial barriers including insurance coverage or lack of citizenship. Caregivers identified interpreters, bilingual physicians and staff, and written materials in Spanish as facilitators of care. Most caregivers had internet access and expressed interest in health information technology, including patient portals, to communicate about their children's health.ConclusionsCaregivers of Spanish-speaking children encounter many language-specific barriers, which are compounded by non-language-specific barriers arising from complex health systems and social needs. Caregivers with limited resources described working hard to meet children's complex health care needs despite these barriers. Most caregivers had internet access and interest in patient portals. Academic medical centers may need multifaceted interventions that improve the availability of bilingual staff and interpreters and also address caregivers' social and informational needs.Copyright © 2020 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

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