Eliminating racial and ethnic disparities in health care is a national priority. Minority children bear a disproportionate share of the burden of asthma, a leading cause of childhood morbidity. Recent studies have found that African-American and Latino children are less likely to be using needed preventive asthma medications than White children are, even when health insurance is equalized. Culturally tailored interventions hold promise to close such gaps. However, scant information is available to suggest how such interventions should be designed. ? Specific Aims and Research Plan. This innovative project will pair qualitative and quantitative methods to study African-American, Latino, and White children with persistent asthma. We will: 1. Identify elements of effective communication in clinical interactions; 2. Determine other key factors leading to under-use of preventive medications; and 3. Lay the foundation for developing tools to enhance effective clinical decision-making that incorporates parent and child perspectives. In the Qualitative Phase, we will audiotape clinical interactions and conduct semi-structured interviews with parents and providers. The qualitative results will suggest specific possible interventions to reduce disparities. In the subsequent Survey Phase, we will test the generalizability of hypotheses from the qualitative research. We will conduct a retrospective cohort study in two large, diverse populations, linking data from telephone interviews with parents, surveys of providers, and computerized data on asthma medications and other health care use. The unique strengths of this research include our ability to study the parent-child-provider interaction using different and complementary data sources, our access to computerized data, and our plan to identify areas of similarity and contrast among different racial/ethnic groups using both qualitative and quantitative methods. ? Projected Findings and Policy Implications: Our results will identify specific elements of effective communication and decision making for African-American, Latino, and White families. This information is critical to the design of effective, culturally tailored interventions to eliminate disparities in health care for childhood asthma and other chronic diseases. ? ?
