Background: Medication errors and adverse drug events are common in the pediatric population. Parents with limited English proficiency have increased risk of management errors and nearly a third of low-income families failed to pick up their child’s prescriptions after hospital discharge, with non-adherence rates as high as 40%. The objective of this study is to examine medication barriers experienced by parents living in an underserved community. With a better understanding of parental barriers, we hope to improve provider practices and improve outcomes in underserved populations.

Methods: Using qualitative methods, we identified factors that may contribute to low medication adherence among underserved populations. Focus groups were conducted from December 2019 to September 2020. We recruited three groups of participants: English-speaking parents, Spanish-speaking parents, and pediatric medical providers from local community partners in underserved areas of San Diego and upon discharge from a local children’s hospital. Focus groups were recorded, transcribed, coded, and organized into themes using thematic analysis.

Results: Twenty-nine parents (19 ESP, 10 SSP) participated across five focus group discussions. Sixteen PMP participants participated across four focus group discussions. Table 1 summarizes parent and provider characteristics and questionnaire answers. The median number of medications per child was nine (Spanish-speaking group) and four (English-speaking group). Thirteen of 16 PMPs reported being unaware of any local pediatric medication education resources. Thematic analysis revealed six pediatric medication barriers for parents living in San Diego underserved communities. All participant groups identified common barriers: (1) knowledge/skill gap, (2) poor communication, and (3) attitudes and beliefs. Theme specific to English-speaking parents was slips and mistakes while that specific to Spanish-speaking parent was provider access difficulty. Providers identified lack of medication education resource as a parental barrier.

Conclusions: Parents living in underserved communities and medical providers described key barriers that parents face in managing their child’s medications. The compounding effects of these barriers: knowledge/skill gap, poor communication, attitude and beliefs, and lack of educational resources put these families at risk for medication error and suboptimal health outcomes. Our next step is to create a pediatric medication educational resources tailored to low health literacy, LEP, and diverse populations. Further research in health literacy, racial/ethnic disparities, and technology-based applications to potentially promote medication adherence are needed.

IMAGE 1: Barriers to medication management.

IMAGE 2: Characteristics of Parents, Their Children, and Pediatric Medical Provider Participants