title: Deficiencies in culturally competent asthma care for ethnic minority children: a qualitative assessment among care providers.
abstract: BACKGROUND
  Asthma outcomes are generally worse for ethnic minority children. Cultural competence training is an instrument for improving healthcare for ethnic minority patients. To develop effective training, we explored the mechanisms in paediatric asthma care for ethnic minority patients that lead to deficiencies in the care process.
  
  
  METHODS
  We conducted semi-structured interviews on care for ethnic minority children with asthma (aged 4-10 years) with paediatricians (n = 13) and nurses (n = 3) in three hospitals. Interviews were analysed qualitatively with a framework method, using a cultural competence model.
  
  
  RESULTS
  Respondents mentioned patient non-adherence as the central problem in asthma care. They related non-adherence in children from ethnic minority backgrounds to social context factors, difficulties in understanding the chronic nature of asthma, and parents' language barriers. Reactions reported by respondents to patients' non-adherence included retrieving additional information, providing biomedical information, occasionally providing referrals for social context issues, and using informal interpreters.
  
  
  CONCLUSIONS
  This study provides keys to improve the quality of specialist paediatric asthma care to ethnic minority children, mainly related to non-adherence. Care providers do not consciously recognise all the mechanisms that lead to deficiencies in culturally competent asthma care they provide to ethnic minority children (e.g. communicating mainly from a biomedical perspective and using mostly informal interpreters). Therefore, the learning objectives of cultural competence training should reflect issues that care providers are aware of as well as issues they are unaware of.
authors.affiliation: Department of Public Health, Academic Medical Centre/University of Amsterdam, PO Box 22660, 1100, DD, Amsterdam, the Netherlands. m.c.seeleman@amc.uva.nl
authors.forename: Conny
authors.initials: C
authors.lastname: Seeleman
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.forename: Wim
authors.initials: W
authors.lastname: van Aalderen
authors.forename: Marie-Louise Essink
authors.initials: ML
authors.lastname: Bot
mesh_terms: D001249:Asthma / Q000208:ethnology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D054521:Cultural Competency; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007407:Interviews as Topic; D007802:Language; D008297:Male; D008913:Minority Groups; D009426:Netherlands; D010349:Patient Compliance / Q000208:ethnology; D010372:Pediatrics / Q000592:standards; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology / Q000592:standards*; D015272:Pulmonary Medicine / Q000592:standards; D036301:Qualitative Research