Service quality for Latin American families of children with intellectual and developmental disabilities: a mixed methods investigation of evaluations and context
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Citation
Abstract
Latine children with intellectual and developmental disabilities (IDD) have poor access to healthcare, developmental therapy, and support services, and often experience poor care quality when services are accessed. Improving service quality for Latine families of children with IDD is critical to promote service engagement; however, little is known regarding how to improve their care quality. This mixed-methods research explored how service quality is evaluated, including the cultural and contextual processes underlying perceptions of care quality for Latine families of children with IDD. Twenty-six participants (10 Latina mothers, 16 service providers) completed qualitative interviews, and providers completed quantitative burnout-engagement measures. Study 1 used qualitative methods to identify indicators of positive service quality and offer guidance to promote service quality for Latine families of youth with IDD. The most important indicator of service quality was providers' ability to build trusting relationships with families, which included using effective communication approaches, creating connectedness, and demonstrating commitment to families. Trusting relationships were valued over providers’ clinical expertise and cultural background. Study 2 qualitatively explored the culturally-driven expressions of service satisfaction among Latine parents of children with IDD. Participants described how Latine parents use overt expressions to convey service satisfaction, while expressions of dissatisfaction are subtle and easy for providers to overlook. Latine parents’ subtle expressions of dissatisfaction are often guided by Latine cultural values (e.g., simpatía) that prioritize interpersonal agreeableness and family bonds. Study 3 used mixed-methods to characterize IDD providers’ work burnout-engagement profiles and how burnout-engagement affects service delivery. Quantitatively, providers endorsed experiencing elevated work-related exhaustion, meaningful involvement with families, and personal achievement within their service roles. Qualitatively, providers described how this burnout-engagement profile impacts their service delivery, including how work-related exhaustion limits their ability to provide quality care, particularly for underserved patient populations. Together, findings suggest that Latine cultural values regarding prioritizing friendly, courteous personal relationships shape Latine parents’ service preferences and behaviors, and that IDD service providers’ well-being affects service delivery quality. This research contributes to our foundational understanding of “service quality” while highlighting targets of future intervention efforts to improve care for Latine families of children with IDD.