Society for Medical Anthropology
Oral Presentation Session
Deshira Wallace (University of North Carolina at Chapel Hill)
Gabriela Stein (University of North Carolina at Greensboro)
Kathleen Thomas (UNC Eshelman School of Pharmacy)
Latino children with mental health needs are half as likely to use U.S. mental health services as white, non-Latino children. There is evidence that patient-provider communication is poorer among Latinos, possibly due to differences in communication style and patient preferences among this population. This study evaluated observed shared decision-making (SDM) between language congruent providers and Latino mothers of pediatric mental health patients. Our analysis used the OPTION-5 item instrument to assess observed skill at 5 elements of collaborative SDM in 100 mother-clinician conversations randomly selected from a larger randomized, controlled trial (n=184). Assessment occurred after mothers received a behavioral activation intervention to enhance involvement in their healthcare treatment at a psychiatric clinic in the southeastern United States. The Latino mother-clinician dyads in this sample achieved a mean OPTION5 score of 33.2 (SD=17.36), suggesting modest to moderate effort in achieving SDM. We found no difference in the level of SDM displayed in a visit by the intervention group vs. control (p=0.426). Mother-clinician dyads regularly succeeded in identifying treatment options and deliberating as a team. Nevertheless, the dyads struggled to regularly discuss parent preferences or integrate those preferences into their decisions regarding the child’s treatment despite the fact that one “right” answer rarely exists when addressing behavioral concerns in psychotherapy, and that the clinic provided structurally competent care. Concurrent conversational analysis identified visit content, composition, and tone and interpersonal engagement as factors that variably facilitated or challenged SDM in our data and were integral to collaborative, patient-centered care.