Parental Perceptions of Culturally Sensitive Care and Well-Child Visit Quality

Published:December 17, 2019DOI:



      Incorporating culturally sensitive care into well-child visits may help address pediatric preventive care disparities faced by racial and ethnic minorities, families with limited English proficiency, and immigrants. We explored parents’ perspectives about the extent to which their children's pediatric care is culturally sensitive and potential associations between culturally sensitive care and well-child visit quality.


      We conducted cross-sectional surveys with parents attending a well-child visit for a child ages 3 to 48 months. To measure culturally sensitive care, we created a composite score by averaging 8 subscales from an adapted version of the Clinicians’ Cultural Sensitivity Survey. We assessed well-child visit quality through the Promoting Healthy Development Survey. Multivariate linear regression was used to understand associations between demographic characteristics and parent-reported culturally sensitive care. We used multivariate logistic regression to examine associations between culturally sensitive care and well-child visit quality.


      Two hundred twelve parents (71% of those approached) completed the survey. Parents born abroad, compared with those born in the United States, reported significantly higher culturally sensitive care scores (+0.21; confidence interval [CI]: 0.004, 0.43). Haitian parents reported significantly lower culturally sensitive care scores compared with non-Hispanic white parents (−0.49; CI: −0.89, −0.09). Parent-reported culturally sensitive care was significantly associated with higher odds of well-child visit quality including receipt of anticipatory guidance (adjusted odds ratio: 2.68; CI: 1.62, 4.62) and overall well-child visit quality (adjusted odds ratio: 2.54; CI: 1.59, 4.22).


      Consistent with prior research of adult patients, this study demonstrates an association between parent-reported culturally sensitive care and well-child visit quality. Future research should explore best practices to integrating culturally sensitive care in pediatric preventive health care settings.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. American Academic of Pediatrics (AAP). AAP Agenda for Children: Medical Home. 2019. Available at: Accessed January 22, 2020.

        • Flores G
        Racial and ethnic disparities in the health and health care of children.
        Pediatrics. 2010; 125: e979-e1020
        • Ragavan MI
        • Li W
        • Elwy AR
        • et al.
        Chinese, Vietnamese, and Asian Indian parents’ perspectives about well-child visits: a qualitative analysis.
        Acad Pediatr. 2018; 18: 628-635
        • Stevens GD
        • Shi L
        • Cooper LA
        Patient-provider racial and ethnic concordance and parent reports of the primary care experiences of children.
        Ann Fam Med. 2003; 1: 105-112
        • Brotanek JM
        • Seeley CE
        • Flores G
        The importance of cultural competency in general pediatrics.
        Curr Opin Pediatr. 2008; 20: 711-777
        • Raphael JL
        Observations from the balcony: directions for pediatric health disparities research and policy.
        J Appl Res Child. 2013; 4: 1-12
        • Cohen AL
        • Christakis DA
        Primary language of parent is associated with disparities in pediatric preventive care.
        J Pediatr. 2006; 148: 254-258
        • Committee on Pediatric Workforce
        Ensuring culturally effective pediatric care: implications for education and health policy.
        Pediatrics. 2004; 114: 1677-1685
        • Institute of Medicine
        Crossing the Quality Chasm: A New Health System for the 21st Century.
        The National Academies Press, Washington, DC2001 (Available at:)
        • Institute of Medicine
        Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
        The National Academies Press, Washington, DC2003 (Available at:)
        • Castro A
        • Ruiz R
        The effects of nurse practitioner cultural competence on Latina patient satisfaction.
        J Am Assoc Nurse Pract. 2009; 21: 278-286
        • Ng J
        • Popova S
        • Yau M
        • et al.
        Do culturally sensitive services for Chinese in-patients make a difference?.
        Soc Work Health Care. 2007; 44: 129-143
        • Lo MM
        Cultural brokerage: creating linkages between voices of lifeworld and medicine in cross-cultural clinical settings.
        Health. 2010; 14: 484-504
        • Hendson L
        • Reis M
        • Nicholas DB
        Health care providers’ perspectives of providing culturally competent care in the NICU.
        JOGINN. 2015; 44: 17-27
        • DeCamp LR
        • Kieffer E
        • Zickafoose JS
        • et al.
        The voices of limited English proficiency Latina mothers on pediatric primary care: lessons for the medical home.
        Matern Child Health J. 2013; 17: 95-109
        • Vaughn L.M.
        • Holloway M.
        West African immigrant families from Mauritania and Senegal in Cincinnati: a cultural primer on children’s health.
        J Commun Health. 2010; 35: 27-35
        • Napoles A.M.
        • Santoyo-Olsson J.
        • Farren G.
        • et al.
        A patient-reported Clinicians’ Cultural Sensitivity Survey: a field test among older Latino primary patients.
        Health Expect. 2012; 15: 63-77
        • Boudreau ADA
        • Fluet CF
        • Reuland CP
        • et al.
        Associations of providers’ language and cultural skills with Latino parents’ perceptions of well-child care.
        Acad Pediatr. 2010; 10: 172-178
        • Bethell C
        • Peck C
        • Schor E
        Assessing health system provision of well-child care: the promoting health development survey.
        Pediatrics. 2001; 107: 1084-1094
      2. The Child and Adolescent Health Measurement Initiative. Promoting Healthy Development Survey: Implementation Guidelines. 2006. Available at: Accessed January 27, 2020.

        • Andridge RR
        • Little RJ
        A review of hot deck imputation for survey non‐response.
        Int Stat Rev. 2010; 78: 40-64
        • Shwartz M
        • Restuccia JD
        • Rosen AK
        Composite measures of health care provider performance: a description of approaches.
        Milbank Q. 2015; 93: 788-825
        • Schulz KF
        • Grimes DA
        Multiplicity in randomised trials: endpoints and treatments.
        Lancet. 2005; 365: 1591-1595
        • McClafferty H
        • Vohra S
        • Bailey M
        • et al.
        Pediatric integrative medicine.
        Pediatrics. 2017; 140e20171961
        • Ziodeen KA
        • Misra SM
        Complementary and integrative medicine attitudes and perceived knowledge in a large pediatric residency program.
        Complement Ther Med. 2018; 37: 133-135
        • Reitmanova S
        • Gustafson DL
        “They can't understand it”: maternity health and care needs of immigrant women in St. John's Newfoundland.
        Matern Child Health J. 2008; 12: 101-111
        • Pavlish CL
        • Noor S
        • Brandt J
        Somali immigrant women and the American health care system: discordant beliefs, divergent expectations, and silent worries.
        Soc Sci Med. 2010; 71: 353-361
        • McKay S
        Immigrant children with special health care needs: a review.
        Curr Probl Pediatr Adolesc Health Care. 2019; 49: 45-49
        • Welterlin A
        • LaRue RH
        Serving the needs of immigrant families of children with autism.
        Disabil Soc. 2007; 22: 747-760
      3. Migration Policy Institute. Haitian Immigrants in the United States. 2017. Available at: Accessed April 16, 2019.

        • Romain F
        • Courtwright A
        Can I trust them to do everything? The role of distrust in ethics committee consultations for conflict over life-sustaining treatment among Afro-Caribbean patients.
        J Med Ethics. 2016; 42: 582-585
        • Wafula EG
        • Snipes SA
        Barriers to health care access faced by Black immigrants in the US: theoretical considerations and recommendations.
        J Immigrant Minority Health. 2014; 16: 689-698
        • Piheiro PS
        • Callahan KE
        • Ragin C
        • et al.
        Black heterogeneity in cancer mortality: US-black, Haitians, and Jamaicans.
        Cancer Control. 2016; 23: 347-358
        • Rubin V.
        • Ngo D.
        • Ross A.
        • et al.
        Counting a Diverse Nation: Disaggregating Data on Race and Ethnicity to Advance a Culture of Health.
        Policy Link, 2018 (Available at:)
        • Davis RE
        • Resnicow K
        • Couper MP
        Survey response styles, acculturation, and culture among a sample of Mexican American adults.
        J Cross Cult Psychol. 2011; 42: 1219-1236
        • Giguere B
        • Lalonde R
        • Lou E
        Living at the crossroads of cultural worlds: the experience of normative conflicts by second generation immigrant youth.
        Soc Pers Psychol Compass. 2010; 4: 14-29
        • Freeman BK
        • Coker TR
        Six questions for well-child card redesign.
        Acad Pediatr. 2018; 18: 609-619