Spanish-Speaking Caregivers’ Experience with an Emergency Department Pediatric Asthma-Care Bundle Quality Initiative

  • Claritsa Santos MalavéEmail author
  • Dominique Diggs
  • Esther M. Sampayo


Most pediatric emergency departments’ (ED) quality improvement (QI) initiatives for asthma aim to standardize care based on the priorities of healthcare providers. Perceptions and priorities of the caregiver rarely are addressed, especially in families with limited English-language proficiency. We explored Spanish-speaking caregivers’ perceptions, understandings, and barriers with the care they received for asthma, after exposure to an ED asthma-care bundle. This qualitative study was part of a larger QI initiative on Spanish-speaking caregivers of patients presenting to a children’s hospital ED with an asthma exacerbation. Patients were exposed to an asthma-care bundle, which included timely administration of medication, home dose of medications, an educational intervention, asthma action plans (AAPs), and discharge instructions. Through semi-structured interviews and qualitative analyses, we assessed the perceptions, understandings, and barriers caregivers reported during their ED experience. From January 2015 to October 2016, 492 patients received AAPs in the ED. Of 128 families that preferred Spanish, 88 (69%) received a Spanish AAP, 41 (32%) received Spanish discharge instructions, and 34 (27%) received discharge materials in both languages. Thirteen families were interviewed. Three themes emerged regarding the caregivers’ perceived barriers: (1) need for improved accessibility to medication, primary care, and insurance; (2) communication barriers, such as timeliness, availability of interpreters, and need for resources in their preferred language; and (3) uncertainty about the child’s diagnosis and acuity. Incorporating the caregivers’ perspectives into QI projects may yield valuable information when developing new interventions. In the ED, improving accessibility to interpreters and providing discharge materials in their preferred language, as well as addressing misconceptions about asthma, may enhance caregivers’ satisfaction.


Asthma Limited English proficiency Education Quality initiative Qualitative analysis 



The authors thank Dr. Lee Ligon of the Center for Research, Innovation, and Scholarship (CRIS), Department of Pediatrics, Baylor College of Medicine, for editorial assistance.

Compliance with Ethical Standards

This manuscript has not been published elsewhere and is not under submission elsewhere.

There are no conflicts of interest to disclose.

Each author participated in the development of this manuscript, including development and implementation of methods, analysis of data, and preparation of the manuscript. All authors have reviewed the submitted manuscript and approve the manuscript for submission.

Supplementary material

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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  • Claritsa Santos Malavé
    • 1
    Email author
  • Dominique Diggs
    • 1
  • Esther M. Sampayo
    • 1
  1. 1.Baylor College of MedicineTexas Children’s HospitalHoustonUSA

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