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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. In-depth, semi-structured interviews of Hispanic and African American mothers about their beliefs surrounding developmental delay and utilization of Early Intervention services for their children revealed 5 major themes in the help-seeking pathway.

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2. One significant difference between Hispanic and African American mothers included their motivations for utilizing EI services- the former were motivated by a deference to social hierarchy, while the latter was motivated by a desire to avoid judgment.

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Evidence Rating: 3 (Average)

Study Rundown:

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Approximately 25% of children are at moderate to high risk of developmental delay (DD). Early Intervention (EI), when utilized, optimizes the well-being of children with DD; however, only 25% of eligible children use this program. This study explores maternal attitudes and health beliefs and how they shape decisions in utilizing services for children with DD. The population in question included low-income, African American or Hispanic mothers. Using semi-structured interviews, researchers revealed 5 main themes. These themes included observing other children and making comparisons to identify delays, perceiving that their child is different, relying more heavily on social networks rather than pediatricians to inform subsequent health-seeking routes, struggling to prioritize EI due to other stressors, and delaying or avoiding EI services due to lack of information. Several Hispanic mothers agreed to EI services though they were not concerned about their child’s development, nor did they feel that their child was delayed. They agreed to physician recommendations because “whatever the doctor says is fine,” while African American mothers agreed to services they felt their child did not need due to fear of judgment. Authors offer recommendations to providers on intervening within each of the identified themes to maximize understanding and utilization of EI services. While observations in this study are qualitative, the information provides a basis for further research.

In-Depth [cross-sectional]:

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This qualitative study included in-depth interviews of 22 low-income, African American (36%) and Hispanic (64%) mothers of children ages 0-36 months, who screened positive for DD in a Baltimore, Maryland practice. Five major themes spanning across the entire health-seeking pathway for children with DD. Mothers who, through comparison to other children, did not see their child as delayed, were not likely to utilize EI services. Even after identifying DD, mothers did not necessarily feel it was a problem, indicating a belief that children develop on their own time. The most consistent theme was mothers’ reliance on social networks to inform decisions about caring for their children and utilizing services. Few mothers could identify an in-depth conversation with their pediatrician about their child’s development. A family’s lack of socioeconomic stability contributed significantly to lack of EI utilization- another consistent theme across interviews. Finally, mothers’ lack of knowledge about the goals and logistics of EI services were a final, significant barrier to utilization even after understanding their child’s DD. One significant difference emerged when discussing utilization of EI services. Both Hispanic and African American mothers felt pressured to use these services, and Hispanic mothers acquiesced as a result of traditional social hierarchies while African American mothers did so out of fear of getting into trouble.

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