Ethnicity and parental report of postoperative behavioral changes in children

Objectives To examine the role of ethnicity and language in parent report of children's postoperative behavioral recovery. Aim To compare incidence of new onset negative behavior change in English- and Spanish-speaking White and Hispanic children following outpatient surgery. Background Postoperative behavioral change in children is common; however, it is unknown whether cultural variables including ethnicity and language may influence parent report of children's behavioral recovery. Methods/Materials Participants included 288 parents (English-speaking White, English-speaking Hispanic, Spanish-speaking Hispanic parents) of children undergoing outpatient elective surgery. Parents completed the post-hospitalization behavior questionnaire (PHBQ) and parents' postoperative pain measure (PPPM) on postoperative days one, three, and seven at home. Results Most parents (83%) reported onset of new negative behavioral change in children postoperatively. Generalized estimating equations revealed significant group differences in overall behavior change [Wald 2(12)=375.69, P<0.0001] after controlling for demographic and socioeconomic differences. At all three postoperative days, Spanish-speaking Hispanic (SSH) parents reported lower negative behavioral changes in their children compared to English-speaking White (ESW) parents (day 1: P<0.01; day 3: P<0.001; day 7: P<0.10). On postoperative days one and three, SSH parents also reported lower total PHBQ scores than English-speaking Hispanic (ESH) parents [day 1: 2(1)=6.72, P=0.01; day 3: 2(1)=7.98, P=0.005]. Conclusion The present study provides evidence that parent report of children's postoperative behavioral recovery may be influenced by cultural variables, such as ethnicity and language. The present results contribute to a growing body of evidence that highlights the need for culturally sensitive assessment and care of families in the medical setting. The findings may reflect differences in cultural values such as stoicism; however, future studies would benefit from examination of the factors that may account for the differences in reported behavior change after surgery (i.e., report bias, cultural values).