title: Barriers to care questionnaire: reliability, validity, and responsiveness to change among parents of children with asthma.
abstract: BACKGROUND
  Although it is well known which groups of children are more vulnerable to poor health care access, quality, and outcomes, less is known about how and why this occurs. Barriers to care-sociobehavioral processes that interfere with successful interaction with the health care system--may be a link between vulnerability and access, experiences, and outcomes.
  
  
  OBJECTIVE
  The aim of this study was to examine the reliability, validity, and responsiveness to change of the Barriers to Care Questionnaire (BCQ) in a sample of children with persistent asthma recruited from federally qualified health centers.
  
  
  METHODS
  Children (N = 252; aged 2-14 years) with persistent asthma and their parents (93.7% mother, 83.3% Hispanic, 76.9% Spanish speaking; 72.6% less than a high school diploma), enrolled in a clinical trial, and completed the BCQ, questions relating to access to care, the Parent's Perceptions of Primary Care Measure, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) at baseline and 3 months.
  
  
  RESULTS
  The BCQ demonstrated internal consistency reliability. Supporting construct validity, barriers to care were worse for children without health insurance or an identified provider and who had problems with care or foregone care. Higher barriers correlated with poorer primary care and lower patient health-related quality of life. The BCQ was responsive to change, showing within- and between-subject differences for subjects with improved realized access from baseline to 3 months.
  
  
  CONCLUSIONS
  The BCQ is a reliable, valid, and responsive measure of barriers to care for vulnerable children with asthma. Barriers to care were associated with poorer access, lower primary care quality, and worse health-related quality of life.
authors.affiliation: Division of Pulmonary Medicine, Center for Health Care Quality, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. michael.seid@cchmc.org
authors.forename: Michael
authors.initials: M
authors.lastname: Seid
authors.forename: Lisa
authors.initials: L
authors.lastname: Opipari-Arrigan
authors.forename: Leticia Reyes
authors.initials: LR
authors.lastname: Gelhard
authors.forename: James W
authors.initials: JW
authors.lastname: Varni
authors.forename: Kimberly
authors.initials: K
authors.lastname: Driscoll