Table of Contents

INTRODUCTION ………………………………………………………………………………………… 1
Theoretical framework for Trust in Healthcare ……………………………………………… 1
Trust and Vulnerability ………………………………………………………………………………. 2
Structural Vulnerability and Structural Competency ………………………………………. 3
Distrust in Healthcare ………………………………………………………………………………… 4
Association of Trust and healthcare utilization in the pediatric population ……….. 6
The Study of Attitudes and Factors Effecting Infant care Practices (SAFE) ……… 7
Well-child care redesign and the triple aim …………………………………………………… 9
Group well-child care as a clinical redesign to serve minority populations ……… 10
METHODS ………………………………………………………………………………………….. 12
Setting ……………………………………………………………………………………………………. 13
Participants ……………………………………………………………………………………………… 14
Measures ………………………………………………………………………………………………… 14
Procedures ………………………………………………………………………………………………. 15
Bilingual analyses ……………………………………………………………………………………. 15
RESULTS …………………………………………………………………………………………….. 17
Participant characteristics …………………………………………………………………………. 17
Theme 1: Group dynamic flattens traditional hierarchies in care ……………………. 18
Theme 2: “The best of both worlds” Cross-validation and triangulation of
information ……………………………………………………………………………………………… 21
Theme 3: Structural competency and Trust …………………………………………………. 26
1: Development of trusting and open space in GWCC ……………………….. 27
2 and 3: Providers elicit social barriers faced by families, and provide
support and resources when able …………………………………………………….. 29
DISCUSSION ……………………………………………………………………………………… 33
Theme 1: Group dynamic flattens traditional hierarchies in care ……………………. 33
Theme 2: “The best of both worlds” Cross-validation and triangulation of
information ……………………………………………………………………………………………… 35
Theme 3: Structural competency and Trust …………………………………………………. 38
Table 1. Social vulnerabilities identified in the group ………………………… 45
Figure 1. Bronfenbrenner’s ecological model adapted for structures of
Immigration and health ………………………………………………………………….. 48
CONCLUSION ………………………………………………………………………………….. 49
Strengths and Limitations …………………………………………………………………………. 50
Future work: ……………………………………………………………………………………………. 52
REFERENCES ……………………………………………………………………………………….. 54