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Understanding of Asthma Management^*

Medicaid Parents’ Perspectives

^* From the Department of Pediatrics (Dr. Cabana, Ms. White, and Ms. Heidmann), University of Michigan Health System, Ann Arbor, MI; Division of Pediatric Critical Care Medicine (Dr. Bratton), Department of Pediatrics, University of Utah, Salt Lake City, UT; and^{^}Department of Health Behavior and Health Education (Ms. Valerio and Dr. Brown), University of Michigan School of Public Health, Ann Arbor, MI.

Correspondence to: Melissa Valerio, MPH, Department of Health Behavior and Health Education, School of Public Health, University of Michigan Health System, Ann Arbor, MI 48109; e-mail: mvalerio{at}umich.edu

Abstract

Objective: This article explores parental caregiver perspectives on barriers to asthma care in the Medicaid system.

Methods: Focus groups were held for parents of children with persistent asthma to identify barriers to asthma care for children insured by Medicaid in the Ypsilanti, MI area. Semistructured questions regarding health goals, asthma care, and access were used. Themes were defined as distinct categories or concepts regarding aspects of asthma care and coded.

Results: Thirty-six adults participated in four focus groups, 89% were the biological mother, and 64% were African American. Major themes identified included caregiver emotions, caregiver/patient knowledge, environmental issues, school/daycare support, Medicaid health-care system issues, the role of medical providers, and emerging adolescence. Parents demonstrated asthma awareness but were not confident in their role as the child’s disease manager. A specific gap was seen in the caregiver’s level of self-efficacy to control exposure to asthma triggers, monitor the child’s symptoms, and modify medications based on asthma symptoms.

Conclusion: Medicaid-insured families face unique barriers related to income and insurance limitations as well as issues common to others with asthma. Caregivers demonstrated a high level of asthma knowledge, but like other caregivers gaps between knowledge and behavior existed. Barriers to asthma care that may be specific to Medicaid-insured patients included difficulty maintaining continuity of care due to physician participation in Medicaid programs, and concerns about possible differences in asthma care from health-care providers due to their Medicaid insurance status.

Key Words: asthma • barriers to care • caregiver • Medicaid

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