Table 3.

Parent Perspectives on the P-PAM: Themes 1 and 2^*.

Theme 1: Centrality of home/family unit to child health

Quote 1

Because you’re home with them. You’re with them all the time. You can’t expect a one-time visit to fix everything with the doctor. You’re the one that needs to care for them 24/7, so I feel like I am the big part of their health. -Activation Level 3

Quote 2

Porque nosotros somos los, nosotros somos los que tenemos que cuidar a los hijos, durante el día, al final del día, todo el día.  Because we are the ones who, we are the ones who have to care of our children during the day, at the end of the day, all day. -Activation Level 2

Quote 3

[…]yo trato de ser la mejor madre que puedo pues trato depues, ¿cómo se dice?De decirles lo que está bien, lo que no está bien, que se tienen que lavar sus manitas, todo eso acerca de la higiene y todo eso.  […] I try to be the best mother that I can so I try to, well, how do you say it? To tell them what’s good, what’s not good, that they have to wash their little hands, all of that regarding hygiene and everything.  -Activation Level 4

Quote 4

Porque ellos la pasan con uno las 24 horas del día, y uno, más que todo – bueno, hay cosas que uno no puede evitar, como la gripe o todo eso, pero enfermedades, porque cualquier enfermedad proviene de las comidas, la mala alimentación. Muchas enfermedades provienen de ahí , de la mala alimentación, que uno no come saludable. Entonces yo creo que ahí , yo pienso que ahí tiene mucho que ver. Si uno cuida lo que come uno se va a mantener saludable.  Because they’re with us 24 hours a day, and you mostly – well, there are some things that one can’t avoid, like the flu or whatnot. But as for diseases, because diseases can come from meals, bad nutrition. Many diseases come from that, a poor diet, when you don’t eat healthy. So I think that [diet], I think that has a lot to do with it. If you watch what you eat you will stay healthy. -Activation Level 2

Quote 5

Porque los padres siempre tienen más la responsabilidad de estar pendiente de lo que comen, elegir lo que les compras o no les compras en la casa. Porque depende de lo que tú les  – como padres, si yo les compro chucherías a los niños en la casa, van a comer puras cosas malas, si yo les compro cosas buenas pues van a poder elegir, entonces es mi responsabilidad.  Because the parents always have the main responsibility of being aware of what they eat, to choose what to buy them or not buy them at home. Because it depends on what you – as parents, if I buy the children junk food at home, they’re going to eat all bad things. If I buy them good things, well, they’re going to be able to choose. So, it’s my responsibility. -Activation Level 1

Theme 2: Healthcare system challenges can prevent or undermine activation

Quote 6

Le checo la temperatura y le doy Tylenol, que es lo que recomiendan, Tylenol o Motrin y le doy eso y ya si veo que no se le quita entonces ya decido llevarlo al doctor, pero si no yo lo mantengo en casa.  I check his temperature and I give him Tylenol, which is what they recommend, Tylenol or Motrin, and I give him that and if I see it’s not going away then I decide to go see a doctor, but if not I keep him at home. -Activation Level 2

Quote 7

Pues por lo mismo, una sabe cuando sus hijos se sienten bien, cuando yo puedo curarle la gripe o bajar la temperatura, entonces uno se lo hace en su casa. Cuando uno no puede, pues también es mejor acudir al doctor a que lo cheque, a que lo revise él y ya.  For the same reason, one knows when your children feel good, when I can cure a cold or lower their temperature, so you do it at home. When one can’t, it’s also better to go to the doctor to have it checked out, to have him check it out and that’s it.-  -Activation Level 4

Quote 8

Yeah. Most of the time I don’t bring him to the doctors because it’s the same thing over: a diaper rash, a fever. I have all the medicines for his symptoms. So I’m confident that I can take care of him rather than bringing him to the hospital unless he’s very ill like ear infections.- -Activation Level 4

Quote 9

I think I got better. I got better after each child. With the first, every little thing: emergency room … Because sometimes I think there’s something, you gotta give it time. Not every little prick, every little high temperature, you gotta run. Maybe you can control it at home, so I feel I strongly agree with that now. -Activation Level 3

Quote 10

[…] There’s no one else medically that I know that could help me, be like, “Okay, well, what else can I do?” There’s no one else besides calling them, and it’s not like you talk personally to the doctor. You get transferred to this person, transferred to that person, and you talk to the nurse. Then the nurse calls you back, so you never really talk to the doctor unless you really go in person and see them.  -Activation Level 3

Quote 11

Return phone calls in a more timely manner. The last time I called, I had called about – he had a really bad diaper rash, where you could see pink and skin was majorly coming off. And I called, and it took about four days for the clinic to call back. And by then I kinda got it under control, but I didn’t appreciate the four-day wait when the automated system says we’ll call you in 24 hours. So that could be done a lot better.- -Activation Level 3

Subtheme 1: Phone system challenges for Spanish-speakers

Quote 12

Uno puede llamar a las enfermeras, pero a veces es un poco difícil hablar con las enfermeras … Porque por la línea de teléfono que te contestan en inglés, luego te mandan a una línéa, luego te mandan a otra línéa, y luego hasta que ya te contesta la enfermera y te dice que tienes que esperar, si no hay una enferma en español no te atienden entonces.  One can call the nurses. But at times it’s a bit hard to speak with the nurses … Because they answer the telephone line in English. Then they send you to a line, then they send you to another line, and then until the nurse answers you and tells you that you have to wait. If there isn’t a nurse in Spanish then they don’t assist you. -Activation Level 1

Subtheme 2: Lack of prompt sick care availability

Quote 13

Porque muchas veces, como le digo, a veces los niños se resfrían y uno puede controlar eso en la casa, ya si como si los niños tienen demasiada fiebre entonces ya es como ahí llevarlos al hospital, pero hay veces que no es necesario porque siempre en las clínicas tienes que hacer cita y esperar 15 días, entonces tienes que llevarlo a emergencia, y en emergencia no te van a atender por una gripe…  Because many times, as I told you, at times the children catch a cold and one can control that at home. If the children have a high fever thenyou have to take them to the hospital. But there are times that it’s not necessary because in the clinics you always have to make an appointment and wait 15 days. So, you have to take them to the emergency room. And at the emergency room, they’re not going to treat you for a cold … -Activation Level 1

Quote 14

They take appointments, and they will see you for well child visits and immunizations, but I need a doctor for when my child is sick, most of all. And if I can’t take you to the doctor that I know, and the doctor that has the records, when my child is sick, it’s a little backwards. I’d rather take you to somebody that I don’t know for a shot, which is just a state standardized shot than taking them to somebody I don’t know for an actual health problem. It’s a little backwards.- -Activation Level 3

Subtheme 3: Difficulties with public health insurance

Quote 15

I did [miss appointments] because of the insurance being cut off. I did reschedule multiple times when I thought the thing was situated, and it never was. -Activation Level 3

^*Spanish language quotes indicate quote is from an interview conducted in Spanish.