Barriers to asthma care in urban children: parent perspectives.

BACKGROUND Despite improved treatment regimens for asthma, the prevalence and morbidity from asthma are increasing, especially among underserved, minority children. OBJECTIVE The purpose of this study was to identify barriers to the treatment of asthma among urban, minority children as perceived by parents. METHODS Parents were recruited from 4 schools located in low-income, urban areas with high rates of asthma hospitalizations. Focus groups involving parents of children 5 to 12 years old with asthma were conducted using a standardized questionnaire. Parents' comments were analyzed to identify barriers, and 3 independent raters coded parents' comments to assess reliability of interpretation. RESULTS Forty parents who represented 47 children participated in the focus groups. All parents described their racial background as black. Parents' average age was 36.8 years, 92% were females, 70% were nonmarried, and 38% had less than a high school education. Forty-five percent of children had intermittent or mild asthma and 55% had moderate to severe asthma. The most frequent types of barriers identified by parents were patient or family characteristics (43%), followed by environmental (28%), health care provider (18%), and health care system (11%). Parents were specifically concerned about the use, safety and long-term complications of medications, the impact of limitation of exercise on their child's quality of life, and their own quality of life. CONCLUSIONS In contrast with the widespread beliefs that access to medical care, health insurance, and continuity of care are the major barriers to quality asthma care, the barriers most frequently reported by parents were related to patient and family characteristics, health beliefs, or to their social and physical environment. To improve asthma management and health outcomes for urban, minority children with asthma, it is critical to tailor education about asthma and its treatment, and address quality of life issues for both children and parents.

[1]  E. Fisher,et al.  A comparison of patient attitudes toward asthma self-management among acute and preventive care settings. , 1993, The Journal of asthma : official journal of the Association for the Care of Asthma.

[2]  P. Bijur,et al.  An estimate of the prevalence of asthma and wheezing among inner-city children. , 1994, Pediatrics.

[3]  H. Abbey,et al.  Prevalence of asthma and health service utilization of asthmatic children in an inner city. , 1982, The Journal of allergy and clinical immunology.

[4]  P. Newacheck,et al.  Childhood asthma and poverty: differential impacts and utilization of health services. , 1993, Pediatrics.

[5]  D. Mannino,et al.  Surveillance for asthma--United States, 1960-1995. , 1998, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[6]  P. Gergen,et al.  National survey of prevalence of asthma among children in the United States, 1976 to 1980. , 1988, Pediatrics.

[7]  G. Holden,et al.  Psychosocial characteristics of inner‐city children with asthma: A description of the NCICAS psychosocial protocol , 1997, Pediatric pulmonology.

[8]  E. Fisher,et al.  Targeting high risk groups: Neighborhood organization for pediatric asthma management in the neighborhood asthma coalition , 1994 .

[9]  W. Donnelly,et al.  Parental perceptions and attitudes toward asthma and its treatment: a controlled study. , 1987, Social science & medicine.

[10]  R. Mellins,et al.  A School Health Education Program for Children with Asthma Aged 8-11 Years , 1987, Health education quarterly.

[11]  P. F. Adams,et al.  Current estimates from the National Health Interview Survey, 1994. , 1995, Vital and health statistics. Series 10, Data from the National Health Survey.

[12]  Youth health report card: asthma. , 1993, Preventive medicine.

[13]  Articulation of asthma and its care among low-income emergency care recipients. , 1996, The Journal of asthma : official journal of the Association for the Care of Asthma.

[14]  R. Mellins,et al.  Managing better: children, parents, and asthma. , 1986, Patient education and counseling.

[15]  L. Kann,et al.  Characteristics of health education among secondary schools--School Health Education Profiles, 1996. , 1998, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[16]  S. Redline,et al.  Characteristics of inner‐city children with asthma: The National Cooperative Inner‐City Asthma Study , 1997, Pediatric pulmonology.

[17]  I. Mesters,et al.  Pediatric asthma, a qualitative and quantitative approach to needs assessment. , 1991, Patient education and counseling.

[18]  L. Cornelius.  Barriers to medical care for white, black, and Hispanic American children. , 1993, Journal of the National Medical Association.

[19]  S. Gortmaker,et al.  Racial, social, and environmental risks for childhood asthma. , 1990, American journal of diseases of children.

[20]  Randall Brown,et al.  Quality of care for preschool children with asthma: the role of social factors and practice setting. , 1995, Pediatrics.

[21]  P. Newacheck,et al.  Children's access to primary care: differences by race, income, and insurance status. , 1996, Pediatrics.

[22]  K. Weiss,et al.  Reported difficulties in access to quality care for children with asthma in the inner city. , 1998, Archives of pediatrics & adolescent medicine.

[23]  J. Blessing-Moore.  Does asthma education change behavior? To know is not to do. , 1996, Chest.

[24]  B. Bloom,et al.  Health Insurance and Utilization of Medical Care for Children with Special Health Care Needs , 1993, Medical care.

[25]  P. Newacheck.  Poverty and childhood chronic illness. , 1994, Archives of pediatrics & adolescent medicine.

[26]  K. Kolodner,et al.  Medications Used by Children With Asthma Living in the Inner City , 1998, Pediatrics.