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 under-served, mi nority children. Objective. The purpose of this study was to identify barriers to the treatm ent 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 p arents of children 5 to 12 years old with asthma were conducted using a sta ndardized questionnaire. Parents' comments were analyzed to identify barrie rs, and 3 independent raters coded parents' comments to assess reliability of interpretation. Results. Forty parents who represented 47 children participated in the focu s 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 i ntermittent or mild asthma and 55% had moderate to severe asthma. The most frequent types of barriers identified by parents were patient or family cha racteristics (43%), followed by environmental (28%), health care provider ( 18%), and health care system (11%). Parents were specifically concerned abo ut the use, safety and long-term complications of medications, the impact o f limitation of exercise on their child's quality of life, and their own qu ality 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 q uality asthma care, the barriers most frequently reported by parents were r elated to patient and family characteristics, health beliefs, or to their s ocial and physical environment. To improve asthma management and health out comes for urban, minority children with asthma, it is critical to tailor ed ucation about asthma and its treatment, and address quality of life issues for both children and parents.