{"id":{"repo_id":"utswmed","oai_identifier":"oai:utswmed-ir.tdl.org:2152.5/10608"},"canonical_url":"https://search.dev.ndltd.org/etd/utswmed/oai:utswmed-ir.tdl.org:2152.5/10608","repository":{"repo_id":"utswmed","name":"University of Texas Southwestern Medical Center","base_url":"https://utswmed-ir.tdl.org/server/oai/request"},"display":{"title":""¿Hacia Donde Vamos?": Interventions to Improve Pediatric Subspecialty Care for Immigrant Children in the Dallas-Area as Informed by Caregiver Experiences","abstract":"BACKGROUND: It is widely known that immigrants in the United States have insufficient access to health care and that these issues extend across the lifespan. Immigrant children, who represent approximately a quarter of all children in the US, are significantly more likely to be uninsured and to experience more difficulties accessing health care compared to their non-immigrant counterparts. Barriers to care range from language discordance, to fear, to lack of transportation and other social and structural determinants of health. In Texas specifically, immigrant children have limited insurance options available to cover non-emergency health care, and the systems for low-cost accessible care in Dallas, particularly subspecialty care, are often piecemeal at best. OBJECTIVE: This qualitative study aims to identify the needs, barriers, existing systems, and potential interventions related to accessing pediatric subspecialty care for immigrant children in the Dallas-area based on the lived experiences of caregivers who participated in community focus groups and then provide and discuss potential research-informed interventions. METHODS: A phenomenological approach was chosen, emphasizing individuals' lived experiences. Ten standardized questions were developed in consultation with immigrant-serving community organizations to serve as an interview guide. Participants were recruited through snowball sampling and community organizations. Four focus groups were conducted in Spanish with seventeen participants in total. Transcripts were coded, generated into themes, and then sorted into predetermined domains: barriers, existing systems, solutions, conditions, and specialties. RESULTS: Dentistry and dermatology were the most common specialty needs. Commonly mentioned barriers to accessing pediatric subspecialty care included high costs, fear and distrust surrounding the healthcare system, insufficient insurance, and difficulty navigating the complex healthcare system. Participants reported commonly accessing pediatric subspecialty care through emergency departments or inpatient admissions and relying on social networks for guidance. They also note that there are unique challenges related to being a cultural/ethnic minority when approaching health care as immigrants. Potential solutions discussed were streamlined processes of healthcare navigation, increased access to health information, health education, adequate insurance, and low-cost health care. CONCLUSIONS: Identification of barriers to and existing systems for accessing pediatric subspecialty care for immigrant children is necessary for the design and implementation of high-quality, community-level interventions. Proposed interventions focus on nine areas: flexible scheduling and after-hours care, provider support and initiatives, accessible health information, addressing language and cultural discordance, improved information sharing and building trust, community health navigational support, academic community partnerships, financial assistance, and more accessible insurance and legislative changes. The challenges and solutions explored in this paper are relevant and applicable for Dallas as it seeks to better serve immigrant children who call the city home and can be relevant to other major diverse, urban, and metropolitan areas throughout the country.","abstract_html":"BACKGROUND: It is widely known that immigrants in the United States have insufficient access to health care and that these issues extend across the lifespan. Immigrant children, who represent approximately a quarter of all children in the US, are significantly more likely to be uninsured and to experience more difficulties accessing health care compared to their non-immigrant counterparts. Barriers to care range from language discordance, to fear, to lack of transportation and other social and structural determinants of health. In Texas specifically, immigrant children have limited insurance options available to cover non-emergency health care, and the systems for low-cost accessible care in Dallas, particularly subspecialty care, are often piecemeal at best. OBJECTIVE: This qualitative study aims to identify the needs, barriers, existing systems, and potential interventions related to accessing pediatric subspecialty care for immigrant children in the Dallas-area based on the lived experiences of caregivers who participated in community focus groups and then provide and discuss potential research-informed interventions. METHODS: A phenomenological approach was chosen, emphasizing individuals' lived experiences. Ten standardized questions were developed in consultation with immigrant-serving community organizations to serve as an interview guide. Participants were recruited through snowball sampling and community organizations. Four focus groups were conducted in Spanish with seventeen participants in total. Transcripts were coded, generated into themes, and then sorted into predetermined domains: barriers, existing systems, solutions, conditions, and specialties. RESULTS: Dentistry and dermatology were the most common specialty needs. Commonly mentioned barriers to accessing pediatric subspecialty care included high costs, fear and distrust surrounding the healthcare system, insufficient insurance, and difficulty navigating the complex healthcare system. Participants reported commonly accessing pediatric subspecialty care through emergency departments or inpatient admissions and relying on social networks for guidance. They also note that there are unique challenges related to being a cultural/ethnic minority when approaching health care as immigrants. Potential solutions discussed were streamlined processes of healthcare navigation, increased access to health information, health education, adequate insurance, and low-cost health care. CONCLUSIONS: Identification of barriers to and existing systems for accessing pediatric subspecialty care for immigrant children is necessary for the design and implementation of high-quality, community-level interventions. Proposed interventions focus on nine areas: flexible scheduling and after-hours care, provider support and initiatives, accessible health information, addressing language and cultural discordance, improved information sharing and building trust, community health navigational support, academic community partnerships, financial assistance, and more accessible insurance and legislative changes. The challenges and solutions explored in this paper are relevant and applicable for Dallas as it seeks to better serve immigrant children who call the city home and can be relevant to other major diverse, urban, and metropolitan areas throughout the country.","abstract_has_math":false,"creators":["Herrera, Ashley Elizabeth"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Loria, Hilda","Chang, Mary","Gimpel, Nora"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-06-03T19:52:42Z","date_published":"2025-06-03T19:52:42Z","updated_at":"2026-07-24T05:52:20Z","subjects":["Child","Delivery of Health Care","Emigrants and Immigrants","Ethnic and Racial Minorities","Health Knowledge, Attitudes, Practice","Health Services Accessibility","Medically Uninsured","Dallas (Tex.)"],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["1522122355"],"render_values":[{"text":"1522122355","href":null,"code":true}]}]},"links":{"outbound_url":"https://hdl.handle.net/2152.5/10608","outbound_label":"Handle","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Loria, Hilda","Chang, Mary","Gimpel, Nora"]},{"key":"dc:creator","label":"Author","values":["Herrera, Ashley Elizabeth"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2025-06-03T19:52:42Z","2023-05","May 2023"]},{"key":"dc:type","label":"Dc Type","values":["Thesis","text"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Child","Delivery of Health Care","Emigrants and Immigrants","Ethnic and Racial Minorities","Health Knowledge, Attitudes, Practice","Health Services Accessibility","Medically Uninsured","Dallas (Tex.)"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://hdl.handle.net/2152.5/10608","1522122355"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["BACKGROUND: It is widely known that immigrants in the United States have insufficient access to health care and that these issues extend across the lifespan. Immigrant children, who represent approximately a quarter of all children in the US, are significantly more likely to be uninsured and to experience more difficulties accessing health care compared to their non-immigrant counterparts. Barriers to care range from language discordance, to fear, to lack of transportation and other social and structural determinants of health. In Texas specifically, immigrant children have limited insurance options available to cover non-emergency health care, and the systems for low-cost accessible care in Dallas, particularly subspecialty care, are often piecemeal at best. OBJECTIVE: This qualitative study aims to identify the needs, barriers, existing systems, and potential interventions related to accessing pediatric subspecialty care for immigrant children in the Dallas-area based on the lived experiences of caregivers who participated in community focus groups and then provide and discuss potential research-informed interventions. METHODS: A phenomenological approach was chosen, emphasizing individuals' lived experiences. Ten standardized questions were developed in consultation with immigrant-serving community organizations to serve as an interview guide. Participants were recruited through snowball sampling and community organizations. Four focus groups were conducted in Spanish with seventeen participants in total. Transcripts were coded, generated into themes, and then sorted into predetermined domains: barriers, existing systems, solutions, conditions, and specialties. RESULTS: Dentistry and dermatology were the most common specialty needs. Commonly mentioned barriers to accessing pediatric subspecialty care included high costs, fear and distrust surrounding the healthcare system, insufficient insurance, and difficulty navigating the complex healthcare system. Participants reported commonly accessing pediatric subspecialty care through emergency departments or inpatient admissions and relying on social networks for guidance. They also note that there are unique challenges related to being a cultural/ethnic minority when approaching health care as immigrants. Potential solutions discussed were streamlined processes of healthcare navigation, increased access to health information, health education, adequate insurance, and low-cost health care. CONCLUSIONS: Identification of barriers to and existing systems for accessing pediatric subspecialty care for immigrant children is necessary for the design and implementation of high-quality, community-level interventions. Proposed interventions focus on nine areas: flexible scheduling and after-hours care, provider support and initiatives, accessible health information, addressing language and cultural discordance, improved information sharing and building trust, community health navigational support, academic community partnerships, financial assistance, and more accessible insurance and legislative changes. The challenges and solutions explored in this paper are relevant and applicable for Dallas as it seeks to better serve immigrant children who call the city home and can be relevant to other major diverse, urban, and metropolitan areas throughout the country."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":[""¿Hacia Donde Vamos?": Interventions to Improve Pediatric Subspecialty Care for Immigrant Children in the Dallas-Area as Informed by Caregiver Experiences"]}]}],"canonical_facts":{"dc:contributor":["Loria, Hilda","Chang, Mary","Gimpel, Nora"],"dc:creator":["Herrera, Ashley Elizabeth"],"dc:date":["2025-06-03T19:52:42Z","2023-05","May 2023"],"dc:description":["BACKGROUND: It is widely known that immigrants in the United States have insufficient access to health care and that these issues extend across the lifespan. Immigrant children, who represent approximately a quarter of all children in the US, are significantly more likely to be uninsured and to experience more difficulties accessing health care compared to their non-immigrant counterparts. Barriers to care range from language discordance, to fear, to lack of transportation and other social and structural determinants of health. In Texas specifically, immigrant children have limited insurance options available to cover non-emergency health care, and the systems for low-cost accessible care in Dallas, particularly subspecialty care, are often piecemeal at best. OBJECTIVE: This qualitative study aims to identify the needs, barriers, existing systems, and potential interventions related to accessing pediatric subspecialty care for immigrant children in the Dallas-area based on the lived experiences of caregivers who participated in community focus groups and then provide and discuss potential research-informed interventions. METHODS: A phenomenological approach was chosen, emphasizing individuals' lived experiences. Ten standardized questions were developed in consultation with immigrant-serving community organizations to serve as an interview guide. Participants were recruited through snowball sampling and community organizations. Four focus groups were conducted in Spanish with seventeen participants in total. Transcripts were coded, generated into themes, and then sorted into predetermined domains: barriers, existing systems, solutions, conditions, and specialties. RESULTS: Dentistry and dermatology were the most common specialty needs. Commonly mentioned barriers to accessing pediatric subspecialty care included high costs, fear and distrust surrounding the healthcare system, insufficient insurance, and difficulty navigating the complex healthcare system. Participants reported commonly accessing pediatric subspecialty care through emergency departments or inpatient admissions and relying on social networks for guidance. They also note that there are unique challenges related to being a cultural/ethnic minority when approaching health care as immigrants. Potential solutions discussed were streamlined processes of healthcare navigation, increased access to health information, health education, adequate insurance, and low-cost health care. CONCLUSIONS: Identification of barriers to and existing systems for accessing pediatric subspecialty care for immigrant children is necessary for the design and implementation of high-quality, community-level interventions. Proposed interventions focus on nine areas: flexible scheduling and after-hours care, provider support and initiatives, accessible health information, addressing language and cultural discordance, improved information sharing and building trust, community health navigational support, academic community partnerships, financial assistance, and more accessible insurance and legislative changes. The challenges and solutions explored in this paper are relevant and applicable for Dallas as it seeks to better serve immigrant children who call the city home and can be relevant to other major diverse, urban, and metropolitan areas throughout the country."],"dc:format":["application/pdf"],"dc:identifier":["https://hdl.handle.net/2152.5/10608","1522122355"],"dc:language":["en"],"dc:subject":["Child","Delivery of Health Care","Emigrants and Immigrants","Ethnic and Racial Minorities","Health Knowledge, Attitudes, Practice","Health Services Accessibility","Medically Uninsured","Dallas (Tex.)"],"dc:title":[""¿Hacia Donde Vamos?": Interventions to Improve Pediatric Subspecialty Care for Immigrant Children in the Dallas-Area as Informed by Caregiver Experiences"],"dc:type":["Thesis","text"]},"updated_at":"2026-07-24T05:52:20Z"}