Barriers to asthma care in urban children: Parent perspectives
Barriers to asthma care in urban children: Parent perspectives
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DOI：
10.1542/peds.106.3.512
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发表时间：
2000-09-01
期刊：
影响因子：
8
通讯作者：
DeWitt, TG
中科院分区：
文献类型：
--
作者：
Mansour, ME;Lanphear, BP;DeWitt, TG
背景尽管哮喘的治疗方案有所改进，但哮喘的患病率和发病率仍在增加，特别是在服务不足的少数民族儿童中。本研究的目的是确定城市，少数民族儿童的哮喘治疗的障碍，家长认为。从4所位于低收入、哮喘住院率高的城市地区的学校招募家长。使用标准化问卷调查对5至12岁哮喘儿童的父母进行了重点小组调查。通过分析家长的意见来识别障碍，并由3名独立评分员对家长的意见进行编码以评估解释的可靠性。代表47名儿童的40名家长参加了重点小组。所有的父母都说他们的种族背景是黑人。父母的平均年龄为36.8岁，92%为女性，70%未婚，38%的受教育程度低于高中。45%的儿童患有间歇性或轻度哮喘，55%患有中度至重度哮喘。父母发现的最常见的障碍类型是患者或家庭特征（43%），其次是环境（28%），医疗保健提供者（18%）和医疗保健系统（11%）。家长特别关注药物的使用、安全性和长期并发症、运动限制对孩子生活质量的影响以及他们自己的生活质量。与普遍认为获得医疗保健、健康保险和护理的连续性是高质量哮喘护理的主要障碍相反，父母最常报告的障碍与患者和家庭特征、健康信念或其社会和物理环境有关。为了改善城市少数民族哮喘儿童的哮喘管理和健康结果，有针对性地开展哮喘及其治疗教育，并解决儿童和父母的生活质量问题至关重要。
Background. Despite improved treatment regimens for asthma, the prevalence and morbidity from asthma are increasing, especially among under-served, 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.