Methods. Data from 50,212 caregivers/families with children aged 0-17 years old were collected through mail and web-based surveys. Only caregivers whose children were aged 3 to 5 were included in the analyses (N=5,647). Caregivers/families were nested within states, thus two-level random-intercept models were used. Because caregivers’ frustration in getting health services for their child was measured as a 3-category ordinal outcome (Never 89.3%, Sometimes 9.9%, Usually/Always 0.8%), the ordinal logistic proportional odds model was used. In order to account for the possibility that associations between stressors/protective factors and frustration may differ on the lower end versus the higher end of frustration, non-proportional and partial-proportional odds models were examined.
Results. The partial proportional odds model fit the data best. Stressors associated with higher caregivers’ frustration included children’s physical or behavioral condition, parenting stress, parent job change, family adversities, food insufficiency, residential mobility, poverty, financial difficulty paying medical bills, and living in a neighborhood with more than one detracting elements. Protective factors associated with caregivers’ frustration included having their child insured continuously. The association between continuous insurance and the reduced level of frustration was stronger at the higher end than at the lower end of frustration. Living in a supportive neighborhood was significantly associated with caregivers’ frustration only at the lower end of frustration; while emotional support was significant only at the higher end of frustration. Other stressors and protective factors were examined but not significantly related to caregivers’ frustration.
Conclusions/Implications. Caregivers’ experiences with the healthcare system may be shaped by aspects of the child’s medical diagnosis condition and characteristics directly related to the healthcare system, such as continuous availability of insurance. Much of the frustration experienced by caregivers, however, is grounded in their daily experiences of family, economic, and community challenges. Healthcare social workers may be more effective at helping families navigate the healthcare system and reducing inequalities in service delivery and child health, if they are aware of the possible spillover of socioeconomic disadvantages and marginalities into the healthcare system. Moreover, social workers may have important roles to play, through providing emotional support, in ameliorating stress for the small group of caregivers experiencing high levels of distress while getting health services for their young children.