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Barriers to Care Questionnaire: Reliability, Validity, and Responsiveness to Change Among Parents of Children With Asthma

  • Michael Seid
    Correspondence
    Address correspondence to Michael Seid, PhD, 3333 Burnet Ave, ML 2021, Cincinnati, Ohio 45229-3039.
    Affiliations
    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)
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  • Lisa Opipari-Arrigan
    Affiliations
    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)
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  • Leticia Reyes Gelhard
    Affiliations
    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)
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  • James W. Varni
    Affiliations
    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)
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  • Kimberly Driscoll
    Affiliations
    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)
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Published:January 23, 2009DOI:https://doi.org/10.1016/j.acap.2008.12.003

      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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