title: GP care for moderate to severe asthma in children: what do infrequently attending mothers disagree with and why?
abstract: OBJECTIVE
  Our aim was to identify and account for areas of disagreement with GP care for moderate to severe child asthma among mothers who infrequently use this care. Identifying and understanding these areas of disagreement has the potential to improve child access to GP care.
  
  
  METHODS
  This qualitative study in Auckland, New Zealand, used a general inductive approach to analyse 23 semi-structured, personal interviews during March-October 2001 with samples of 11 mothers of children with moderate to severe asthma, and 12 medical providers (10 in general practice and two in hospital emergency departments). Disagreement was defined by mothers' non-acceptance or disapproval of aspects of GP care they reported getting for child asthma.
  
  
  RESULTS
  Mothers and providers described four areas in which some mothers disagree with aspects of GP care for child asthma. Contributing to infrequent attendance, the areas are the validity of the diagnosis, the level of service provision, the effectiveness of care and the level of respect from practice staff. These areas revealed three groups of mothers. GP factors contributing to disagreements among mothers were reported to be inconsistent care; information deficits on asthma and individual children; a lack of commitment to identifying the cause(s) and self-management of asthma in children; and an unmet need for asthma management plans that incorporate families' knowledge, goals and preferences.
  
  
  CONCLUSIONS
  Disagreement, among mothers, with areas of GP care for child asthma contributes to non-attendance for this care. This paper identifies opportunities for GPs to keep disagreements to a minimum and facilitate access.
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, New Zealand. s.buetow@auckland.ac.nz
authors.forename: Stephen
authors.initials: S
authors.lastname: Buetow
authors.forename: Vivienne
authors.initials: V
authors.lastname: Adair
authors.forename: Gregor
authors.initials: G
authors.lastname: Coster
authors.forename: Makere
authors.initials: M
authors.lastname: Hight
authors.forename: Barry
authors.initials: B
authors.lastname: Gribben
authors.forename: Ed
authors.initials: E
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000628:therapy*; D002648:Child; D005194:Family Practice; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009035:Mothers; D009520:New Zealand; D010342:Patient Acceptance of Health Care; D011368:Professional-Family Relations