Table 4.

Physician perspectives on sociocultural factors and barriers to care

Theme	Sample quotations
Demographic and Social Groups	• “We have a very large Hispanic population and they ask questions which the rest of the patients don’t. Like, is my child going to become sterile as a result of this? Is it safe to take the tonsils out and will taking the tonsils out make my child sick for the rest of his life?” – Pediatric otolaryngologist • “What are the cultural elements, what are the values that go into that decision-making?” – Pediatric otolaryngologist • “I think there can be sometimes cultural differences, and it’s hard because you’re going through interpreters but I think they are more concerned about the surgery than others.” – Sleep medicine/Pulmonologist • “In the Medicaid population, most of the questions are to do with how much time off work will I need? What would be the day-to-day care of the child?” – Pediatric otolaryngologist
Barriers to care	• “That set of barriers has a lot to do with demographics, socioeconomic status, things like that. We have educational barriers, we have patients who are simply not educated about their child’s care, about healthcare in general. There are language barriers.” – Pediatric otolaryngologist • “In certain cultures…the term ‘tonsillectomy’ literally as it’s translated in Spanish, somewhere along the way in grandparents’ generation has become manipulated to make them think that you’re sterilizing their children and will be unable to have children one day…because you’re removing two balls.” -- Pediatric otolaryngologist • “We have a lot of very difficult social situations where the children are in the care of the grandparents or the care of foster parents, or just the parents are no longer in the picture. They may bounce from home to home on a frequent basis, have in-complete follow-ups.” – Pediatric otolaryngologist • “[Racial minorities or low-income families] mostly come from places where they have very little access to medical care.” -- Pediatrician
Other social influences to care	• “It’s funny because I have a kid, when she was four, five, six her tonsils were so big and she was tiny, and we thought about it a lot…And her tonsils are smaller now…Ninety-five percent of what I do in my office on a regular basis I didn’t learn in residency…a lot of it is based on my experience with my own kids, and then just being in practice.” -- Pediatrician • “Sometimes there are barriers to obtaining the care even when they feel that they need the care, so their pediatricians don’t want to refer them, they don’t think it’s necessary, they think there are too many unnecessary surgeries being performed.” – Pediatric otolaryngologist