Turer Christy B, Montaño Sergio, Lin Hua, Hoang Kim, Flores Glenn
Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Children's Medical Center Dallas, Dallas, Texas;
School of Medicine, University of Texas Southwestern, Dallas, Texas; and.
Pediatrics. 2014 Nov;134(5):892-9. doi: 10.1542/peds.2014-1282. Epub 2014 Oct 13.
To examine pediatrician weight-management communication with overweight Latino children and their parents and whether communication differs by pediatrician-patient language congruency.
Mixed-methods analysis of video-recorded primary care visits with overweight 6- to 12-year-old children. Three independent reviewers used video/transcript data to identify American Academy of Pediatrics-recommended communication content and establish communication themes/subthemes. Language incongruence (LI) was defined as pediatrician limited Spanish proficiency combined with parent limited English proficiency (LEP). Bivariate analyses examined associations of LI with communication content/themes.
The mean child age (N = 26) was 9.5 years old; 81% were obese. Sixty-two percent of parents had LEP. Twenty-seven percent of pediatricians were Spanish-proficient. An interpreter was used in 25% of LI visits. Major themes for how pediatricians communicate overweight included BMI, weight, obese, chubby, and no communication (which only occurred in LI visits). The pediatrician communicated child overweight in 81% of visits, a weight-management plan in 50%, a culturally relevant dietary recommendation in 42%, a recommendation for a follow-up visit in 65%, and nutrition referral in 50%. Growth charts were used in 62% of visits but significantly less often in LI (13%) versus language-congruent (83%) visits (P < .001).
Many overweight Latino children do not receive direct communication of overweight, culturally sensitive dietary advice, or follow-up visits. LI is associated with a lower likelihood of growth chart use. During primary care visits with overweight Latino children, special attention should be paid to directly communicating child overweight, formulating culturally sensitive weight-management plans, and follow-up. With LEP families, vigilance is needed in providing a trained interpreter and using growth charts.
研究儿科医生与超重的拉丁裔儿童及其父母之间关于体重管理的沟通情况，以及沟通是否因儿科医生与患者语言匹配度而异。
对超重的6至12岁儿童的初级保健就诊视频记录进行混合方法分析。三名独立评审员使用视频/文字记录数据来确定美国儿科学会推荐的沟通内容，并确立沟通主题/子主题。语言不匹配（LI）定义为儿科医生西班牙语水平有限且家长英语水平有限（LEP）。双变量分析检验了LI与沟通内容/主题之间的关联。
儿童平均年龄（N = 26）为9.5岁；81%为肥胖。62%的家长有LEP。27%的儿科医生精通西班牙语。25%的LI就诊使用了口译员。儿科医生沟通超重情况的主要主题包括体重指数、体重、肥胖、胖乎乎，以及无沟通（仅发生在LI就诊中）。儿科医生在81%的就诊中沟通了儿童超重情况，在50%的就诊中制定了体重管理计划，在42%的就诊中给出了符合文化背景的饮食建议，在65%的就诊中建议进行随访，在50%的就诊中进行了营养转诊。62%的就诊使用了生长图表，但LI就诊（13%）显著低于语言匹配就诊（83%）（P < .001）。
许多超重的拉丁裔儿童没有得到关于超重的直接沟通、符合文化敏感性的饮食建议或随访。LI与使用生长图表的可能性较低相关。在对超重的拉丁裔儿童进行初级保健就诊期间，应特别注意直接沟通儿童超重情况、制定符合文化敏感性的体重管理计划以及随访。对于有LEP的家庭，需要警惕提供训练有素的口译员并使用生长图表。
