Latinx children face significant inequities in developmental and health outcomes, beginning as early as infancy. For many outcomes, family’s immigration status also plays an important role in children’s health. Disparities in Latinx children’s health and development emanate from the social and economic vulnerability faced by Latinx families and caregivers. To address these challenges, pediatric primary care innovations (PPCI) focused on social determinants of health (SDOH) are one promising strategy to address the social and economic hardships faced by many Latinx families and enhance caregivers’ capacity to care for their children. Nonetheless, questions abound as to whether PPCIs can mitigate the significant social and political barriers that impact these families in order to move the needle on health inequities, and if so, how? As such, this study aimed to understand the extent to which a PPCI focused on screening and referring for social and material needs, called DULCE, promotes health equity for Latinx families.
We used secondary quantitative data analysis and original qualitative data collection in a mixed-methods study. Quantitative analysis was restricted to only Latinx families (n=372) and examined the association of DULCE participation with Latinx family resilience, stress, and depression. The analytic design included a combination of multi-level modeling and quasi-experimental methods. Immigration status was included as a moderator. Using results from the quantitative data analysis, we developed sampling strategies and interview protocols for qualitative data collection. We interviewed 20 Latinx caregivers and asked in-depth questions about their experiences with DULCE and its perceived impact.
Results of quantitative analysis showed that Latinx families participating in DULCE report significantly higher resilience after DULCE participation, compared to Latinx families not participating in DULCE. The increase in resilience is particularly strong for immigrant families. DULCE participation had no effect on outcomes of depression or stress. Results of qualitative interviews found that immigrant families benefitted significantly from the DULCE intervention due to its focus on relationship-building and service connection. Compared to non-immigrant Latinx families, immigrant families described a greater sense of perseverance and ability to face life’s challenges as they occur. They attributed this attitude to the supports and skills they gained from the DULCE program, as well as other social supports.
Conclusions and Implications
The study suggests participation in a PPCI has a positive effect on Latinx families’ resilience. The effect of DULCE on resilience is particularly strong for immigrant families, as seen in the quantitative and qualitative findings. These results have implications for the design and implementation of PPCIs, providing evidence for the value of interventions focused on relationship-building and service linkage to positively impact Latinx and immigrant families, ideally mitigating future health disparities for Latinx caregivers and children.