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. ? ?

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD044070-02
Application #
6752913
Study Section
Special Emphasis Panel (ZRG1-SNEM-4 (01))
Program Officer
Haverkos, Lynne
Project Start
2003-06-01
Project End
2006-05-31
Budget Start
2004-06-01
Budget End
2005-05-31
Support Year
2
Fiscal Year
2004
Total Cost
$494,825
Indirect Cost
Name
Harvard Pilgrim Health Care, Inc.
Department
Type
DUNS #
071721088
City
Boston
State
MA
Country
United States
Zip Code
02215
Yinusa-Nyahkoon, Leanne S; Cohn, Ellen S; Cortes, Dharma E et al. (2010) Ecological barriers and social forces in childhood asthma management: examining routines of African American families living in the inner city. J Asthma 47:701-10
Galbraith, Alison A; Smith, Lauren A; Bokhour, Barbara et al. (2010) Asthma care quality for children with minority-serving providers. Arch Pediatr Adolesc Med 164:38-45
Cohn, Ellen S; Cortes, Dharma E; Hook, Julie M et al. (2009) A narrative of resistance: presentation of self when parenting children with asthma. Commun Med 6:27-37
Sawicki, Gregory S; Smith, Lauren; Bokhour, Barbara et al. (2008) Periodic use of inhaled steroids in children with mild persistent asthma: what are pediatricians recommending? Clin Pediatr (Phila) 47:446-51
Wu, Ann Chen; Smith, Lauren; Bokhour, Barbara et al. (2008) Racial/Ethnic variation in parent perceptions of asthma. Ambul Pediatr 8:89-97
Smith, Lauren A; Bokhour, Barbara; Hohman, Katherine H et al. (2008) Modifiable risk factors for suboptimal control and controller medication underuse among children with asthma. Pediatrics 122:760-9
Bokhour, Barbara G; Cohn, Ellen S; Cortes, Dharma E et al. (2008) Patterns of concordance and non-concordance with clinician recommendations and parents'explanatory models in children with asthma. Patient Educ Couns 70:376-85