P3.K201: "Ghosts in This Country": Pediatric Caregiver Perspectives on Immigration Status in the Healthcare Setting

Background: There are approximately 11.4 million undocumented immigrants (UI) in the United States. Immigration status (IS) is a unique social determinant of health that directly and indirectly impacts health and healthcare access. There are gaps in our understanding about how IS impacts health, particularly because it is not frequently discussed in the healthcare setting. This study expands our understanding of immigrant caregiver perceptions about discussing IS in the healthcare setting and provides insight into specific needs that we may not be currently addressing.

Methods: Setting: ED or Spanish-speaking majority pediatric clinic at Children's Mercy
Inclusion criteria: Caregivers who are 18+, identify as Latin/Hispanic, are Spanish-speaking, and do not have a social security number
Exclusion criteria (determined by study team): Caregivers of critically ill patients or patients undergoing sensitive exam, caregivers with developmental delays
Recruitment: Potential participants identified by Spanish preference on clinic schedule/ED tracking board. Confidentiality was stressed and a private setting was offered for interviews after screening/enrollment
Data Collection: Demographic data was collected using a REDCap-based survey. 20 interviews were conducted from April 7, 2023 to February 28, 2024. The interview guide was developed by iterative repetition by a diverse author group. All interviews were conducted in-person with bilingual individuals.
Remuneration: $50 gift card and list of resources in Spanish/English
Data Analysis: Interviews were recorded using an audio recorder and then transcribed into Spanish/English. 3 independent coders analyzed de-identified transcripts using an inductive approach.

Results: Theme 1: UIS negatively impacts multiple aspects of health, but many people do not connect UIS with health.
Theme 2: There are many perceived barriers to disclosure of UIS, but varied perspectives on whether providers should discuss IS in the healthcare setting.
Theme 3: There are many barriers to resource utilization for UI.
Theme 4: There are a variety of needs in the community and many UIS seek these resources from varied places, but many also don’t know where to go for information.
Theme 5: There are things that medical teams can do to facilitate resource utilization and discussion about IS in the healthcare setting, but one size does not fit all.

Conclusion: Caregivers offered perspectives on the impact of UIS on health and identified barriers to and facilitators of discussing immigration status while in
healthcare settings. Universal provision of resource information may more effectively support families with caregivers who are undocumented immigrants