Community-based participatory research: an innovative approach for improving perioperative care of underserved children.

Pediatric disparities disproportionately affect Latino youth undergoing surgery and their families. As such, there is a critical need for culturally relevant frameworks that can advance perioperative intervention approaches in this population and reduce these disparities. In the following article, we first describe the methodological process of community-based participatory research (CBPR) and next report the results of the CBPR process that was conducted in this population. An interdisciplinary group of investigators, Latina mothers, and various other stakeholders met for a series of CBPR-based structured meetings. Qualitative data collection and analyses of the CBPR process were guided by principles of grounded theory that employs inductive techniques and constant comparison analyses until reaching saturation of data. Barriers identified in the process can be grouped within the following domains: child-related factors, family-related factors, health care provider factors, and hospital system factors. Family system factors category (coded references = 136) had the highest number of coded references; this category was found to be best described by the value of familismo or familism, including a duty to help family members when in need. The health care provider category (coded references = 42) was ranked second by frequency. Within this category, two major themes surfaced: health care provider cultural competence and overestimating health literacy. All barriers identified will be next incorporated in an innovative behavioral intervention that is currently being developed. We conclude that the model of CBPR can be used within the context of perioperative care of children and their families.

Postoperative Pain Management in Children of Hispanic Origin: A Descriptive Cohort Study.

BACKGROUND: It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations. METHODS: This study included 105 families of children aged 2 to 15 years of Hispanic origin and low income undergoing outpatient tonsillectomy and adenoidectomy surgery. Participating parents completed baseline and demographic packets. Recorded postoperative pain ratings and administration of analgesics at home for 1 week were collected during home visits. RESULTS: Despite the high (70%; 99% confidence interval [CI], 57%-82%) incidence of significant pain in the first 24 hours home, 32% (95% CI, 20%-45%) of the children received 0 to 1 dose of analgesia. Overall, 21% children (99% CI, 11%-35%) received 4 or less total doses of pain medication over the entire week after surgery. Of the total analgesic doses administered to children in the week after surgery, only 44% (99% CI, 40%-47%) were in accepted ranges. CONCLUSIONS: Despite experiencing significant postoperative pain, Hispanic children assessed in this study received suboptimal analgesic therapy at home.

An examination of child temperament as a predictor of parental post-operative analgesic administration.

BACKGROUND/PURPOSE: The purpose of this study was to examine children's temperament as a predictor of post-operative analgesics administered by parents after controlling for post-operative pain severity, surgery severity, and parental misconceptions regarding pain medication for children. METHODS: Participants included 286 Spanish- and English-speaking parents of children ages 1-18 (IQR: 3-8) undergoing outpatient elective surgery. Parents completed measures of baseline temperament, parental medication attitudes, and demographics preceding their child's surgery and recorded pain intensity and doses of analgesics administered (nonopioid and opioid) on postoperative days 1, 3, and 7. RESULTS: Pearson product-moment correlations revealed that emotionality was significantly associated with acetaminophen, ibuprofen and hydrocodone and shyness was significantly associated with acetaminophen and hydrocodone. Hierarchical linear regression analysis revealed emotionality as a significant independent predictor of acetaminophen, ibuprofen and hydrocodone administered (F(4, 72)=2.82, F(4, 73)=1.53, F(4, 58)=8.75, respectively). CONCLUSION: Dimensions of children's temperament, specifically emotionality, predict analgesic administration by parents following surgery even after controlling for confounding variables. These findings highlight the need for tailored interventions targeting management of children's pain in the home setting and suggest that both proximal (e.g., pain severity) and distal (e.g., child temperament) factors may be necessary intervention components.