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.
Key Words
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Article Info
Publication History
Published online: January 23, 2009
Accepted:
December 2,
2008
Received:
September 16,
2008
Footnotes
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.
Identification
Copyright
© 2009 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
