title: Barriers to asthma care in urban children: parent perspectives.
abstract: 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.
authors.affiliation: Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio 45229-3039, USA. mona.mansour@chmcc.org
authors.forename: M E
authors.initials: ME
authors.lastname: Mansour
authors.forename: B P
authors.initials: BP
authors.lastname: Lanphear
authors.forename: T G
authors.initials: TG
authors.lastname: DeWitt
mesh_terms: D000328:Adult; D001741:Black or African American; D001249:Asthma / Q000517:prevention & control / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009820:Ohio; D011788:Quality of Life; D012959:Socioeconomic Factors; D019037:Urban Health Services