Spanish-speaking Mothers Research Articles

Abstract A22: Challenges using mobile technology for research participation in preventive health research: A preliminary investigation with Spanish-speaking Latinas

Abstract Technology offers significant contributions to improve health care. However, less than half of foreign-born Latinos utilize data applications. The acceptability and application of these new communication and data harnessing tools can present both opportunities and challenges for some. We report our observations of the challenges Latinas face using mobile technology. Latina mothers were recruited from a pilot diabetes risk reduction program. A total of 32 mothers participated in the program; 63% were Spanish speakers, 59% were foreign-born, 66% had ≤high school education, and 91% reported income <$40,000. Participants used a mobile device to perform two tasks: 1) complete an online survey on a tablet and 2) download and install a fitness tracker mobile application. Mothers rated their confidence in their ability to use mobile technology using a 4-point Likert scale. Participants with little/no confidence requested paper versions of the survey. Most mothers required staff assistance to complete the survey and set up their fitness tracker. Spanish-speaking mothers were more likely to report little/no confidence connecting to Wi-Fi (χ2=13.175, p<0.01), downloading an app (χ2=11.277, p=0.01), and creating an electronic account (χ2=7.882, p<0.05). Although participants were smartphone users, the majority needed dedicated, individual assistance to complete the tasks (e.g., survey and app). Growing evidence suggests that Latinos have the capacity to use mobile technology to increase healthy behaviors. Our findings suggest that lower-income Spanish speakers require more assistance with technology for research data collection. Studies and programs using mobile technology should account for the added staffing and resources required to conduct studies with this population. Citation Format: Alejandro Fernandez, Mayra Serrano, Marisela Garcia, Katty Nerio, Kimlin Ashing. Challenges using mobile technology for research participation in preventive health research: A preliminary investigation with Spanish-speaking Latinas [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A22.

A Qualitative Evaluation of Parenting to Support Early Development among Spanish-Speaking Legacy for Children™ Participants

Legacy for Children™ is a group-based parenting intervention that has been culturally adapted for Spanish-speaking mothers (Legacy Spanish). In the current study, we used qualitative methods to examine how Legacy Spanish informed parenting knowledge and practices related to early development. Fourteen low-income Spanish-speaking Latina mothers of children aged 21–31 months participated in focus groups that explored their experience in Legacy Spanish. A template analysis procedure was used to analyze focus group transcripts and identify themes. We identified five primary themes and two secondary themes. Mothers described gaining new knowledge about parenting and child development from Legacy Spanish and attributed positive changes in their parenting and self-efficacy to the program. Reported changes included use of more sensitive behavioral management strategies, increased maternal investment of time and energy, and improved mother-child communication. Mothers also attributed changes in their child’s cognitive and socioemotional development to Legacy Spanish, perceived long-term benefits of program participation, and shared lessons learned from Legacy Spanish with their social network. Additionally, mothers noted that Legacy Spanish provided a unique opportunity for one-to-one time with their child. To provide additional context for the focus group data, we present scores on an observational measure of parent-child interactions. Mean scores in the Affection, Responsiveness, and Teaching domains, which measure behaviors discussed in the focus groups, fell in the average score range. Together, these findings demonstrate that a culturally adapted parenting intervention has the potential to support nurturing parent-child relationships among low-income Spanish-speaking Latino families.

Abstract A055: A case study of co-occurring burdens experienced by a Hispanic mother diagnosed with cancer and its implications for a cancer education program in the U.S.-Mexico border region

Abstract Purpose: This study explored a cancer survivor’s description of the burdens she experienced in addition to her cancer diagnosis while participating in a cancer education program. While this case study’s primary aim was to identify these co-occurring burdens, the secondary aim was to develop responsive program protocols that would not interfere with program dosage and fidelity. Introduction: Several studies have assessed the significant burden that cancer poses to diagnosed individuals. While researchers have worked to develop programs that improve the survivorship experience, such efforts have largely been validated with non-Hispanic white patients who are more socially and economically privileged than cancer survivors from underserved populations. While there is some research on the cancer survivorship experiences of racial/ethnic minority groups, few programs are exclusively designed to address the burden that cancer poses in these already burdened groups. As researchers work to engage racial/ethnic minority participants in cancer education programs designed to improve cancer survivorship, they may encounter unexpected challenges when working with these new consumer groups. This case study explored the multiple burdens reported by a cancer diagnosed Hispanic woman participating in a cancer education program. Methods: The participant was a Spanish-speaking Hispanic mother diagnosed with cancer and residing on the U.S.-Mexico border. Baseline participant demographics, cancer fatalism, depression, anxiety, and acculturation levels were collected. In each of the five bi-weekly program sessions, the participant was asked to report any cancer-related emotional triggers she experienced since her last session. Each education session was audio recorded, transcribed, and translated to English. Two coders analyzed the translated transcriptions using inductive content analysis. The trustworthiness of the analysis was protected by coding to consensus, peer debriefing, and maintaining audit trails. Results: The participant exhibited clinical levels of both depression and anxiety, high cancer fatalism, and a low level of acculturation. Co-occurring burdens described by the participant included Low SES, Negative Cancer Effects, Domestic Violence, Family Concerns, and Issues with Communication and Isolation. This participant reported a variety of emotions and limited coping strategies in response to these burdens. Various protocols were developed to support participants with multiple burdens and to protect the fidelity of the original cancer education program. Conclusion: These findings revealed the excessive burden and challenges affecting the cancer survivorship of a Hispanic mother diagnosed with cancer. As other low-SES Hispanics cancer survivors may be facing similar challenges, researchers should be prepared to develop study protocols, particularly when implementing evidence-based programs validated with privileged populations. Citation Format: Adriena Hernandez, Isela Garcia, Clara Reyes, Rebecca Palacios. A case study of co-occurring burdens experienced by a Hispanic mother diagnosed with cancer and its implications for a cancer education program in the U.S.-Mexico border region [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A055.

Comparison of shared decision making in monolingual and bilingual health encounters

In the United States, Hispanics with limited English proficiency (LEP) experience disproportionate disparities in health services, a phenomenon that relates to communication and decision making. After a quality improvement review identified a disparity in obstetric services for Hispanic women with LEP, a pilot study discussed here explored how LEP and the presence of a medical interpreter affected shared decision making in comparisons of monolingual (English) and bilingual (English-Spanish) encounters with the same physician. A series of 16 prenatal encounters between physicians, patients, and medical interpreters were recorded. First, medical visits were recorded with eight Spanish-speaking mothers using a hospital interpreter to speak with their physician. The same physician was then recorded discussing a similar prenatal agenda with a primary language English-speaking patient. Discourse analysis was used to categorize discursive practices in social interaction. Both encounters were rated using the OPTION shared decision-making scale. Results portray how shared decision making shifts in second-language situations and the associated practices that distinguish monolingual and bilingual encounters. Examples of discursive practices suggest strategies that may mark ethnolinguistic identity and membership categorization indirectly during health encounters.

Culture, parenting, and language: Respeto in Latine mother-child interactions.

The cultural value of respeto (respect) is central to Latine parenting. Yet, how respeto manifests in the interactions of Latine parents and their young children remains unexamined. Low-income Mexican immigrant Spanish-speaking mothers and their 2.5-year-old toddlers (N = 128) were video-recorded during play (M age = 30.2 months, SD = 0.52), and two culturally informed items of respeto were coded: parent calm authority and child affiliative obedience. Respeto related to standard ratings of mother and child interactions (e.g., maternal sensitivity and child engagement) but also captured unique features of parent-child interactions. Respeto related to mothers' and toddlers' language production and discourse during the interaction, and explained unique variance in language variables above standard ratings of mother-child interaction. This is the first effort to document a culturally salient aspect of dyadic interaction in Mexican immigrant mothers and young children and to show that respeto relates to language use during mother- child interactions.

Understanding HPV vaccine initiation in Hispanic adolescents using social marketing theory

Objective: Human papillomavirus (HPV) vaccination rates among Hispanic adolescents in the USA are far below recommended levels. Using a social marketing theory framework, we assessed the four Ps (product, price, place and promotion) as they relate to efforts to promote HPV vaccine initiation. Design: Qualitative study involving in-depth interviews. Setting: A large Southern city in the USA. Method: Eighty-five in-depth qualitative interviews were conducted with Spanish-speaking Hispanic mothers divided into initiated and uninitiated market segments based on whether or not their adolescent child had received the first dose of the HPV vaccine. Data were analysed using directed qualitative content analysis. Results: Results suggest that the desire to prevent illnesses and protect their child drives the decision to vaccinate (product). Most initiated mothers did not experience barriers to vaccination, and market segments described different potential barriers (price). Both marker segments reported that they needed vaccine information before vaccinating (price). Finally, interventions should target clinics, schools and community centres to raise awareness about the importance of vaccinating against HPV (place and promotion). Conclusion: Findings from this formative study can inform the development of an intervention to increase HPV vaccine initiation among Hispanic adolescents.

Mothers’ Perceptions of the Cardboard Box as a Potential Sleep Space

ObjectiveDue to increasing popularity, our hospital began considering distributing cardboard boxes combined with safe sleep education to new mothers. As a first step in studying the impact of this intervention on bedsharing in our community, we sought to understand mothers’ perceptions of the cardboard box. MethodsWe recruited primarily low-income, English- or Spanish-speaking mothers of infants aged 2 to 16 weeks during routine primary care visits. Participants responding to a cross-sectional survey about infant sleep practices were invited to participate in in-depth interviews about the cardboard box. We used a grounded theory approach and the constant comparative method until saturation was reached. ResultsOf 120 participants in the survey, 50 (42%) participated in the qualitative study. Participants were mothers of infants aged ≤4 weeks (46%), 4 to 8 weeks (32%), and 16 weeks (22%). Of 50 participants, 52% said they would use the cardboard box for their infant to sleep in, if provided, compared with 42% who said they would not and 6% were unsure. Three themes emerged from the data: (1) safety of the cardboard box; (2) appearance, and (3) variation in planned use. Some participants planned to place the cardboard box in their bed. ConclusionsParticipants in our study were divided about whether they would use the cardboard box for their infant to sleep in. If distributed, hospital staff should advise families to not place the cardboard box in their bed. Next steps include determining bedsharing frequency among parents who choose to use the cardboard box for their infant.

Anglo-Latino differences in parental concerns and service inequities for children at risk of autism spectrum disorder

In an evaluation of Anglo and Latina mothers and their children at risk of autism, this study compared mother-reported child behavioral concerns to staff-observed symptoms of autism. Within Latina mothers, the impact of primary language (English/Spanish), mothers' education, and child age on ratings of developmental concerns was examined. Participants were 218 mothers (Anglo = 85; Latina = 133) of children referred to a no-cost autism screening clinic. Mothers reported on behavioral concerns, autism symptomology, and services received; children were administered the Autism Diagnostic Observation Schedule by certified staff. Results revealed that Anglo and Latino children did not differ by autism symptoms or classification. However, Anglo mothers reported significantly more concerns than Latina mothers. Within the Latina group, analyses revealed significant interaction effects of language and child age; Spanish-speaking mothers of preschoolers endorsed fewer concerns, while Spanish-speaking mothers of school-aged children endorsed more concerns. Despite these reports, Anglo children with a classification of autism spectrum disorder were receiving significantly more services than Latino children with autism spectrum disorder, suggesting early beginnings of a service divide as well as the need for improved parent education on child development and advocacy for Latino families.

‘Spanish at home, English at school’: how perceptions of bilingualism shape family language policies among Spanish-speaking parents of preschoolers

ABSTRACT In the United States nearly one third of children under five live in homes where a non-English language is spoken. However, many of these language-minority (LM) children shift towards English monolingualism after beginning school in early childhood. While language input and usage are central to acquisition and maintenance in each language, less is known about parents’ perceptions of bilingualism and how perceptions inform parents’ actions to support their child's bilingual development in early childhood. By applying a family language policy framework to data from 14 in-depth qualitative interviews, this study explores the beliefs and practices of Spanish-speaking mothers of preschoolers in a small northeastern US city. Thematic analyses revealed that mothers viewed Spanish maintenance alongside English acquisition as essential for economic opportunity and family communication, yet differed in their perceptions of how bilingualism was best supported. Some implemented a Spanish-only-at-home policy, delegating their child's English development to the school setting. Others avoided setting rigid boundaries, instead employing various discourse strategies to motivate their child's active Spanish use at home and seeking out school-based supports. Social pressures on the child, incomplete knowledge of local bilingual programs, and the current political climate countered mothers’ efforts to support their child's emergent bilingualism.

Engaging a Community Leader to Enhance Preparation for In-Depth Interviews With Community Members.

In-depth interviews allow for rich exploration of stakeholders' experiences. Preparation for in-depth interviews generally consists of literature reviews and researchers' review of their own culture and understanding of a topic. We supplemented these strategies with serial "ethnographic interviews" with a single community leader to enhance our preparation for community-based in-depth interviews with Latina, immigrant, Spanish-speaking mothers and to facilitate stakeholder engagement in a research project. After an extensive literature review, we conducted a series of four 1-hour interviews with a key informant in preparation for individual in-depth interviews with 12 parents. The ethnographic interviews with the community leader provided insight into environmental context, cultural categories, and stakeholder priorities, which helped shape the research question, in-depth interview guide, sampling strategy, and interpretive analytic process. We found that ethnographic interviews can provide critical insights for preparing in-depth interview guides and can enhance the information gained while facilitating meaningful stakeholder engagement.

Communication Between Spanish-Speaking Mothers and Their Children With Hearing Loss Who Use ASL

Only 15% of children with hearing loss who could receive a cochlear implant receive one leaving American Sign Language (ASL) as their access to communication. Spanish-speaking families face even greater challenges including learning different languages/cultures and lack of trained Hispanic professionals. This study identifies how Hispanic mothers communicate with their children with hearing loss who use ASL as their primary language. Data for this qualitative study were collected using in-depth, open-ended ethnographic interviews and limited participant observations and analyzed using grounded theory. Results indicated that many mothers did not learn ASL or learned it some years after the diagnosis of hearing loss in their child; therefore, many children had no or limited language early on and were excluded from conversations and activities. Often mothers learned ASL in Spanish resulting in communication that varied in grammar. Language confusion can result in children’s lower overall language skills and poor academic achievement.

Association between maternal acculturation and health beliefs related to oral health of Latino children

BackgroundThis report is presenting the association of maternal acculturation, measured by preferred language, and oral health-related psychosocial measures in an urban Latino population.MethodsA cross-sectional survey was conducted with 100 mother-child dyads from the Dental Center at the Children’s Hospital Colorado, the University of Colorado. A portion of Basic Research Factors Questionnaire capturing information about parental dental knowledge, attitudes, behavior and psychosocial measures was used to collect data from the participating mothers. Descriptive statistics were calculated for demographics and psychosocial measures by acculturation. A univariate linear regression model was performed for each measure by preferred language for primary analysis followed by adjusted model adjusting for parent’s education.ResultsThe mean age of the children was 3.99 years (SD = 1.11), and that of the mother was 29.54 years (SD = 9.62). Dental caries, measured as dmfs, was significantly higher in children of Spanish-speaking mothers compared to children of English-speaking mothers. English-speaking mothers had higher mean scores of oral health knowledge, oral health behaviors, knowledge on dental utilization, self-efficacy, and Oral Health Locus of Control as compared to Spanish-speaking mothers. Univariate analysis demonstrated significant association for preference for Spanish language with knowledge on dental utilization, maternal self-efficacy, perceived susceptibility and perceived barriers. The effect of language was attenuated, but significant, for each of these variables after adjusting for parent’s education.ConclusionThis study reported that higher acculturation measured by a preference for the English language had a positive association with oral health outcomes in children. Spanish-speaking mothers perceived that their children were less susceptible to caries. Additionally, they perceived barriers in visiting the dentist for preventive visits.

Breastfeeding Practices and Opinions of Latina Mothers in an Urban Pediatric Office: A Focus Group Study

IntroductionThe purpose of this qualitative study was to explore beliefs about breastfeeding among Latina mothers. The focus groups were part of a sequential mixed methods study. MethodsTwo focus groups were conducted. Participants were Spanish-speaking mothers with infants younger than 12 months. Focus groups were conducted in Spanish and audiorecorded. The researchers performed open coding of the data, compared and converged codes, and identified common themes and relationships among the themes. ResultsMothers described concerns about adequacy of breastfeeding for their infants' needs, the continued goodness of breast milk, and weaning. They expressed lack of knowledge about using breast pumps and other assists that could help them breastfeed. DiscussionCulturally tailored breastfeeding education and support have not been adequately implemented in this urban clinic and likely in other similar settings. More targeted attention to this population could improve exclusive breastfeeding of infants and ultimately result in better child health.

Assessing Spanish-speaking immigrant parents’ perceptions of climate at a New Language Immersion School: A critical analysis using “Thinking with Theory”

Parent involvement in schools is often developed through one-way, deficit-oriented relationships, where information flows from schools to families and parents are perceived to lack some capacity or knowledge. However, little is known about the conditions facing Spanish-speaking families at Spanish language immersion schools, which presumably might employ fewer deficit perspectives due to the language and culture focus of their educational model. In turn, this study asked: How does school climate discourse shape Spanish-speaking parents’ abilities to engage at a Spanish immersion elementary school (SIES)? Do parents enact relational power at SIES, and if so, how? Data analysis centered on school climate surveys completed by 19 Spanish-speaking mothers. Framed by Ecologies of Parental Engagement (EPE) and Foucault’s concepts of power, the study ultimately examined not only parent perceptions, but also the research project and its own deficit-driven norms. Findings include: While parents reported trusting the school and teachers, many felt discouraged in SIES’s climate. Some blamed their level of involvement on their own (lack of) language or ability. Analyses also explore how the language immersion school and design of the research project—despite good intentions—were not bridging the gap between hegemonic English-speaking society and Spanish-speaking families. The discussion then considers the implications for school climate, parent engagement policies, and research at diverse multilingual schools.

Parent Training and Skill Acquisition and Utilization Among Spanish- and English-Speaking Latino Families

In the U.S., there is a growing Latino population, in which parents primarily speak Spanish to their children. Despite the evidence that language preference is associated with level of acculturation and influences parenting practices in these families, no study has compared how Spanish-and English-speaking Latino families acquire and utilize the skills taught during parent-training programs such as Parent-Child Interaction Therapy (PCIT). Twenty-seven mother-infant Latino dyads received a home-based adaptation of the Child-Directed Interaction (CDI) phase of PCIT as part of a larger randomized control trial. Most infants were male (63%), and their average age was 13.7 months (SD = 1.43). Most families (52%) lived below the poverty line. The Dyadic Parent-Child Interaction Coding System-Third Edition (DPICS-III) was employed to evaluate PCIT skills at baseline and post-treatment, as well as at 3- and 6-month follow-up, assessments. We conducted multiple linear regression analyses among Spanish-speaking (55%) and English-speaking (45%) families to examine differences in acquisition and utilization of do and don't skills at each assessment while controlling for mother's education. Results yielded no group differences in the acquisition rate of do or don't skills at any time point. However, Spanish-speaking mothers used significantly more don't skills than English-speaking mothers at each assessment. Specifically, Spanish-speaking families used significantly more commands at baseline, post-treatment, and the 6-month followup assessments, as well as more questions at post-treatment and at the 6-month follow-up assessments. These findings highlight the importance of addressing cultural values such as respeto to ensure culturally robust parent-training programs for Latino families.

A qualitative study of cultural congruency of Legacy for Children™ for Spanish-speaking mothers

In recognition of the need to reach more families, the Legacy for Children™ (Legacy) program was translated and culturally adapted for Spanish-speaking Hispanic mothers and their infants. This study examined the cultural adaptations and logistical supports needed for successful implementation with Spanish-speaking mothers. The research team used purposive techniques to sample Hispanic bi-lingual providers (N=14) and supervisors (N=5) of local home-based parenting programs (Healthy Families, Parents as Teachers, and SafeCare®). The goal of the study was to determine from providers and supervisors the social validity (satisfaction, relevancy, importance, and acceptability of the intervention) and cultural congruency of the adapted Legacy curriculum. Researchers conducted a qualitative analysis of the transcriptions using a template approach within NVivo 10 software to identify broad themes within focus group data. Overall, results indicated many positive aspects of the Legacy program including content, approach, pace, topics, structure, social engagement, and straightforward curriculum language. Emergent themes from the focus groups included best practices in identifying, recruiting, and approaching Hispanic mothers, as well as key engagement strategies. Recommended revisions of the adapted Legacy curriculum focused on enhancing visual and auditory supplements, making minor improvements to lower the reading level, and reducing barriers to attendance. Implications for cultural adaptation of parenting programs are discussed.

Communal Coping Among Spanish-Speaking Mother–Child Dyads Engaging in Language Brokering: A Latent Class Analysis

Utilizing self-reported survey data from 120 low-income, Spanish-speaking mother–child dyads, this study examined different types of classes (i.e., subgroups) based on the ways in which mothers and adolescent children coped with language brokering, particularly when they found it stressful. Four classes emerged, listed from largest to smallest class: (a) communal coping mothers, (b) shared communal copers, (c) independent communal coping children, and (d) communal coping children. Mothers’ parent–child closeness predicted class membership, but adolescent children’s reported closeness was not a significant predictor. Nevertheless, adolescent children’s respect for family significantly predicted class membership, whereas mothers’ respect for family was not a significant predictor. Mothers who were members of the communal coping children class reported less frequent depressive symptoms, whereas children who were independent communal coping children reported more frequent depressive symptoms.

Mother-Child Communication Quality During Language Brokering

One hundred dyads of low-income, Spanish-speaking mothers and their bilingual children (age = 12-18; M = 14.12, SD = 1.89) who have language brokered for the mother (i.e., culturally or linguistically mediated between the mother and English speakers) were surveyed. Multiple goals theory posits that mothers and children who do not recognize and attend to instrumental, relational, and identity interaction goals during language brokering have lower communication quality and thus experience negative repercussions. Four instruments were developed and validated for situationally relevant brokering interaction goals (BIG) of children (BIG-C), mothers (BIG-M), child perception of mother goals (BIG-CM), and mother perception of child goals (BIG-MC). Each measure included a subset of goals (e.g., BIG-C included five goals: respect mother, respect English speaker, alter messages, act American, and act Latino/a). Mothers and children pursued multiple, conflicting goals, but inaccurately perceived each other’s goals. These measures provide brokering communication quality assessments and identify potential mother-child misunderstandings.

Testing Multiple Goals Theory With Low-Income, Mother-Child Spanish-Speakers: Language Brokering Interaction Goals and Relational Satisfaction

One hundred dyads of low-income, Spanish-speaking mothers and their bilingual children (age = 12-18) who act as language brokers (i.e., culturally/linguistically mediate between their mothers and English-speakers) were surveyed. Multiple goals theory was tested and extended by examining how mother and child perceptions of own and partner interaction goals across language brokering episodes were associated with mother-child relational satisfaction. An actor-partner interdependence model revealed that goals related to face, trust, and ethnic identity were associated with mother and child relational satisfaction. For both mothers and children, perceptions of own and partner goals (i.e., actor effects), and interactions between own reported and partner perceptions of the same goal (i.e., actor-partner effects) linked with mother-child relational satisfaction. Mother and child goal management during language brokering may have broader relational repercussions.

Cognitive Interviewing to Enhance Comprehension and Accuracy of Responses to a Spanish-Language Nutrition Program Evaluation Tool

ObjectiveTo cognitively test a Spanish translation of a questionnaire evaluating parent and child food and activity behaviors and assess accuracy of understanding and ease of answering. MethodsIterative rounds of cognitive interviewing, qualitative analysis, and revision were conducted with 19 low-income, native Spanish-speaking mothers of children aged 3–11 years, in 5 communities in New York. Key informant interviews were conducted with 2 Spanish-speaking nutrition educators experienced with the questionnaire. ResultsBased on responses, improvements were made to (1) ensure clear and familiar wording, (2) clarify time frames for specifying the frequency of behaviors, and (3) express constructs not amenable to direct translation or for which meanings differed by country of origin. Cognitive interviewing results also informed improvements to the English language version. Conclusions and ImplicationsEven after translation by native speakers, in-depth cognitive interviewing is needed to ensure that questionnaires are understood as intended by low-literacy, immigrant populations and to facilitate collection of valid evaluation data.