Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. e1141-e1148 (doi:10.1542/peds.2007-3587)
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ARTICLE

"You Get What You Get": Unexpected Findings About Low-Income Parents' Negative Experiences With Community Resources

Michael Silverstein, MD, MPHa, Jacqueline Lamberto, MPHb, Kristina DePeau, MPHb and David C. Grossman, MD, MPHc

a Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, and Boston Medical Center, Boston, Massachusetts
b Maternal Child Health Department, Boston University School of Public Health, Boston, Massachusetts
c Group Health Cooperative, Boston, Massachusetts

CONTEXT. Community-based resources are considered a critical part of the American health care system. However, studies evaluating the effectiveness of such resources have not been accompanied by rigorous explorations of the perceptions or experiences of those who use them.

OBJECTIVES. We aimed to understand and classify types of negative perceptions that low-income parents have of community resources. This objective originated from a series of unexpected findings that emerged during the analysis of qualitative data that were initially collected for other purposes.

METHODS. We conducted in-depth qualitative interviews with urban low-income parents. Themes emerged through a grounded theory analysis of coded interview transcripts. Interviews took place in 2 different cities as part of 2 studies with distinct objectives.

RESULTS. We completed 41 interviews. Informants often perceived their interactions with people and organizations as a series of trade-offs, and often perceived important choices as decisions between 2 suboptimal options. Seeking help from community resources was seen in that context. The following specific themes emerged: (1) engaging with services sometimes meant subjecting oneself to requirements perceived as unnecessary and, in the extreme, having to adopt the value systems of others; (2) accepting services was sometimes perceived as a loss of control over one's surroundings, which, in turn, was associated with feelings of sadness, helplessness, or stress; (3) individuals staffing community agencies were sometimes seen as judgmental or intrusive, and when many services were accessed concurrently, information sometimes became overbearing or a source of additional stress; and (4) some services or advice received as part of such services were perceived as unhelpful because they were too generic or formulaic.

CONCLUSIONS. Our data suggest that definable patterns of negative perceptions of community resources may exist among low-income parents. Quantifying these perceptions may help improve the client-centeredness of such organizations and may ultimately help reduce barriers to engagement.

Key Words: community resources • access to care • qualitative interviews • qualitative research • vulnerable populations

Accepted Aug 22, 2008.


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