Journal of Racial and Ethnic Health Disparities

, Volume 4, Issue 6, pp 1051–1060 | Cite as

Factors That Matter to Low-Income and Racial/Ethnic Minority Mothers When Choosing a Pediatric Practice: a Mixed Methods Analysis

  • Sarah L. Goff
  • Kathleen M. Mazor
  • Haley Guhn-Knight
  • Yara Youssef Budway
  • Lorna Murphy
  • Katharine O. White
  • Tara Lagu
  • Penelope S. Pekow
  • Aruna Priya
  • Peter K. Lindenauer



Pediatric practices’ scores on healthcare quality measures are increasingly available to the public. However, patients from low-income and racial/ethnic minority populations rarely use these data. We sought to understand potential barriers to using quality data by assessing what factors mattered to women when choosing a pediatric practice.


As part of a randomized trial to overcome barriers to using quality data, we recruited women from a prenatal clinic serving an underserved population. Women reported how much 12 factors mattered when they chose a pediatric practice (5-point Likert scale), what other factors mattered to them, and which factors mattered the most. We assessed whether factor importance varied with selected participant characteristics and qualitatively analyzed the “other” factors named.


Participants’ (n = 367) median age was 23 years, and they were largely Hispanic (60.4%), white (21.2%), or black (16.9%). Insurance acceptance “mattered a lot” to the highest percentage of women (93.2%), while online information about what other parents think of a practice “mattered a lot” to the fewest (7.4%). Major themes from our qualitative analysis of “other” factors that mattered included physicians’ interpersonal skills and pediatrician-specific traits. Factors related to access “mattered the most” to the majority of women.


Pediatrician characteristics and factors related to access to care may be more important to low-income and racial/ethnic minority women than more commonly reported quality metrics. Aligning both the content and delivery of publicly reported quality data with women’s interests may increase use of pediatric quality data.

Clinical Trial Registration NCT01784575


Pediatric healthcare quality Choosing a pediatric practice Low income Minority Pregnant women 



We would like to thank the staff at the Wesson Women’s Clinic for their gracious welcoming of our presence in their clinic during the course of this study and Massachusetts Health Quality Partners for their assistance with technical aspects of the data.

Compliance with Ethical Standards

Funding Sources

This study was funded by the Agency for Healthcare Research and Quality (AHRQ) R21HS021864. AHRQ did not have any involvement in the study design, data collection, analysis, manuscript, or submission decisions. Dr. Goff is currently supported by the National Institute of Child Health and Human Development Award Number K23HD080870. Dr. Lagu is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health Award Number K01HL114745.

Conflicts of Interest

Dr. White is a consultant for Actavis.

Supplementary material

40615_2016_309_MOESM1_ESM.docx (635 kb)
ESM 1 (DOCX 635 kb)


  1. 1.
    NCQA > HEDIS & Quality Measurement [Internet]. [cited 2013 Oct 1];Available from:
  2. 2.
    Scholle SH, Vuong O, Ding L, et al. Development of and field test results for the CAHPS PCMH Survey. Med Care. 2012;50(Suppl):S2–10.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Berwick DM, James B, Coye MJ. Connections between quality measurement and improvement. Med Care. 2003;41(1 Suppl):I30–8.PubMedGoogle Scholar
  4. 4.
    Fung CH, Lim Y-W, Mattke S, Damberg C, Shekelle PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med. 2008;148(2):111–23.CrossRefPubMedGoogle Scholar
  5. 5.
    Ketelaar NABM, Faber MJ, Flottorp S, Rygh LH, Deane KHO, Eccles MP. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Cochrane Database Syst Rev. 2011;11:CD004538.Google Scholar
  6. 6.
    Hibbard JH, Peters E, Dixon A, Tusler M. Consumer competencies and the use of comparative quality information: it isn’t just about literacy. Med Care Res Rev MCRR. 2007;64(4):379–94.CrossRefPubMedGoogle Scholar
  7. 7.
    Lagu T, Lindenauer PK. Putting the public back in public reporting of health care quality. JAMA. 2010;304(15):1711–2.CrossRefPubMedGoogle Scholar
  8. 8.
    Hibbard JH, Slovic P, Jewett JJ. Informing consumer decisions in health care: implications from decision-making research. Milbank Q. 1997;75(3):395–414.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Yegian JM, Dardess P, Shannon M, Carman KL. Engaged patients will need comparative physician-level quality data and information about their out-of-pocket costs. Health Aff Proj Hope. 2013;32(2):328–37.CrossRefGoogle Scholar
  10. 10.
    Bornstein BH, Marcus D, Cassidy W. Choosing a doctor: an exploratory study of factors influencing patients’ choice of a primary care doctor. J Eval Clin Pract. 2000;6(3):255–62.CrossRefPubMedGoogle Scholar
  11. 11.
    Arora R, Singer J, Arora A. Influence of Key Variables on the Patientsʼ Choice of a Physician: Qual Manag Health Care. 2004;13(3):166–73.PubMedGoogle Scholar
  12. 12.
    Engstrom S, Madlon-Kay DJ. Choosing a family physician. What do patients want to know? Minn Med. 1998;81(12):22–6.PubMedGoogle Scholar
  13. 13.
    Harris KM. How do patients choose physicians? Evidence from a national survey of enrollees in employment-related health plans. Health Serv Res. 2003;38(2):711–32.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Hill C, Garner S. Factors influencing physician choice. Hosp Health Serv Adm. 1990;36(4):491–503.Google Scholar
  15. 15.
    McGlone TA, Butler ES, McGlone VL. Factors influencing consumers’ selection of a primary care physician. Health Mark Q. 2002;19(3):21–37.CrossRefPubMedGoogle Scholar
  16. 16.
    Mercado F, Mercado M, Myers N, Hewit M, Haller NA. Patient preferences in choosing a primary care physician. J Prim Care Community Health. 2012;3(2):125–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Coker TR, Chung PJ, Cowgill BO, Chen L, Rodriguez MA. Low-income parents’ views on the redesign of well-child care. Pediatrics. 2009;124(1):194–204.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Freed GL, Dunham KM, Clark SJ, Davis MM. Research Advisory Committee of the American Board of Pediatrics. Perspectives and preferences among the general public regarding physician selection and board certification. J Pediatr. 2010;156(5):841–5. 845.e1CrossRefPubMedGoogle Scholar
  19. 19.
    Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Parental awareness and use of online physician rating sites. Pediatrics. 2014;134(4):e966–75.CrossRefPubMedGoogle Scholar
  20. 20.
    Kapphahn CJ, Wilson KM, Klein JD. Adolescent girls’ and boys’ preferences for provider gender and confidentiality in their health care. J Adolesc Health Off Publ Soc Adolesc Med. 1999;25(2):131–42.CrossRefGoogle Scholar
  21. 21.
    Turow JA, Sterling RC. The role and impact of gender and age on children’s preferences for pediatricians. Ambul Pediatr Off J Ambul Pediatr Assoc. 2004;4(4):340–3.Google Scholar
  22. 22.
    Goff SL, Mazor KM, Pekow, PS, et al. (2016) Patient navigators and parent use of quality data: A Randomized Trial. PediatricsGoogle Scholar
  23. 23.
    Giordano LA, Elliott MN, Goldstein E, Lehrman WG, Spencer PA. Development, implementation, and public reporting of the HCAHPS survey. Med Care Res Rev MCRR. 2010;67(1):27–37.CrossRefPubMedGoogle Scholar
  24. 24.
    Elliott MN, Zaslavsky AM, Goldstein E, et al. Effects of survey mode, patient mix, and nonresponse on CAHPS hospital survey scores. Health Serv Res. 2009;44(2 Pt 1):501–18.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Rosal MC, Carbone ET, Goins KV. Use of cognitive interviewing to adapt measurement instruments for low-literate Hispanics. Diabetes Educ. 2003;29(6):1006–17.CrossRefPubMedGoogle Scholar
  26. 26.
    Carbone ET, Campbell MK, Honess-Morreale L. Use of cognitive interview techniques in the development of nutrition surveys and interactive nutrition messages for low-income populations. J Am Diet Assoc. 2002;102(5):690–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Shah LC, West P, Bremmeyr K, Savoy-Moore RT. Health literacy instrument in family medicine: the “newest vital sign” ease of use and correlates. J Am Board Fam Med JABFM. 2010;23(2):195–203.CrossRefPubMedGoogle Scholar
  28. 28.
    Glaser BG. The constant comparative method of qualitative analysis. Soc Probl. 1965;12(4):436–45.CrossRefGoogle Scholar
  29. 29.
    Victoor A, Delnoij DMJ, Friele RD. Rademakers JJDJM. Determinants of patient choice of healthcare providers: a scoping review BMC Health Serv Res. 2012;12:272.PubMedGoogle Scholar
  30. 30.
    Patient Satisfaction Measurement: Current Issues and Implications : Professional Case Management [Internet]. LWW. [cited 2015 Feb 2];Available from:
  31. 31.
    Marshall M, Davies H. Public release of information on quality of care: how are health services and the public expected to respond? J Health Serv Res Policy. 2001;6(3):158–62.CrossRefPubMedGoogle Scholar
  32. 32.
    Schlesinger M, Kanouse DE, Martino SC, Shaller D, Rybowski L. Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior. Med Care Res Rev MCRR. 2014;71(5 Suppl):38S–64S.CrossRefPubMedGoogle Scholar
  33. 33.
    Lagu T, Goff SL, Craft B, et al. Can social media be used as a hospital quality improvement tool? J Hosp Med. 2016;11(1):52–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Lagu T, Goff SL, Hannon NS, Shatz A, Lindenauer PK. A mixed-methods analysis of patient reviews of hospital care in England: implications for public reporting of health care quality data in the United States. Jt Comm J Qual Patient Saf Jt Comm Resour. 2013;39(1):7–15.Google Scholar
  35. 35.
    Emmert M, Schlesinger M. Hospital quality reporting in the United States: does report card design and incorporation of patient narrative comments affect hospital choice? Health Serv Res 2016;Google Scholar
  36. 36.
    Physician Compare Initiative - Centers for Medicare & Medicaid Services [Internet]. [cited (2016) Feb 17];Available from:
  37. 37.
    Moore T, Kotelchuck M. Predictors of urban fathers’ involvement in their child’s health care. Pediatrics. 2004;113(3 Pt 1):574–80.CrossRefPubMedGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2017

Authors and Affiliations

  • Sarah L. Goff
    • 1
    • 2
    • 3
    • 4
  • Kathleen M. Mazor
    • 5
    • 6
  • Haley Guhn-Knight
    • 1
    • 2
  • Yara Youssef Budway
    • 7
  • Lorna Murphy
    • 8
  • Katharine O. White
    • 9
    • 10
  • Tara Lagu
    • 1
    • 2
    • 3
  • Penelope S. Pekow
    • 1
    • 10
  • Aruna Priya
    • 1
  • Peter K. Lindenauer
    • 1
    • 2
    • 3
  1. 1.Center for Quality of Care ResearchBaystate Medical CenterSpringfieldUSA
  2. 2.Department of MedicineBaystate Medical CenterSpringfieldUSA
  3. 3.Department of MedicineTufts University School of MedicineBostonUSA
  4. 4.SpringfieldUSA
  5. 5.University of Massachusetts Medical SchoolWorcesterUSA
  6. 6.Meyers Primary Care InstituteUniversity of Massachusetts Medical SchoolWorcesterUSA
  7. 7.Massachusetts General HospitalBostonUSA
  8. 8.Renal and Transplant Associates of New EnglandSpringfieldUSA
  9. 9.Department of Obstetrics and GynecologyBoston Medical CenterBostonUSA
  10. 10.University of Massachusetts School of Public Health and Health SciencesAmherstUSA

Personalised recommendations