Barriers to Care Questionnaire: Reliability, Validity, and Responsiveness to Change Among Parents of Children With Asthma
Received 16 September 2008; accepted 2 December 2008. published online 23 January 2009.
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.
Method
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.
Conclusion
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.
Division of Pulmonary Medicine (Dr Seid), Center for Health Care Quality, Division of Health Policy and Clinical Effectiveness, (Dr Seid), Division of Behavioral Medicine and Clinical Psychology (Dr Opipari-Arrigan), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; School of Social and Family Dynamics, Arizona State University, Tempe, Ariz (Ms Reyes Gelhard); Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Tex (Dr Varni); and Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, Fla (Dr Driscoll)
Address correspondence to Michael Seid, PhD, 3333 Burnet Ave, ML 2021, Cincinnati, Ohio 45229-3039.
Dr Varni holds the copyright and the trademark for the PedsQL and receives financial compensation from the Mapi Research Trust, which is a nonprofit research institute that charges distribution fees to for-profit companies that use the Pediatric Quality of Life Inventory. No other authors have any relevant financial interests. The Bureau of Maternal and Child Health, U.S. Health Resources and Services Administration, had no role in design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.
ABSTRACT