This study suggests that parents of black and Latino children with asthma tend to have lower expectations for their children’s functioning compared with white parents. In addition, parents of minority children in this study had more concerns about medications and higher levels of worry about competing life issues such as housing, income, safety, jobs, and family relationships; this was true even after controlling for income and education. These differences may influence differences in asthma management and levels of asthma status among minority children.
Our findings lend support to the hypothesis that parental health beliefs are factors in racial/ethnic variation in asthma care. Racial/ethnic differences in patient expectations and perceptions appear to play a role in variation in clinical care observed in other medical areas including arthritis, knee replacement, renal transplantation, and depression.29–33
In our study, parents of minority children had lower expectations for functioning, and a previous study found that lower expectations are associated with fewer prescriptions for preventive medications.13
Our finding that Latino parents expressed greater concerns about medications than other patients is consistent with a previous study of minority patients.12
Concerns about medications may limit adherence.24,34,35
Our study is unique in that we were able to compare black, Latino, and white parents in the same populations. Previous studies have examined the perspectives of either black or Latino parents of children with asthma,12,19
but few studies, if any, have compared these groups with each other or with white parents. In addition to having different expectations and concerns, minority parents in our study tended to have more competing family priorities than white families. These competing priorities might present barriers to optimal asthma management in both the home and clinical settings.
Racial/ethnic variation in diagnosis, treatment, and outcomes have been documented in many health fields.30,36,37
Potential reasons for these differences include minority patients having worse access to health care, having providers that are less likely to provide appropriate care, or having cultural or other beliefs that lead to less appropriate care.12–14
Our study did not attempt to measure provider-level or health care system–level factors that might vary among children of different racial/ethnic groups. We did find that most parents were satisfied with their interpersonal relationships with their children’s asthma providers, regardless of the children’s race/ethnicity, even though minority parents were more likely to report having experienced discrimination in the health care system at some time in the past. Future research that evaluates the influence of provider-level and system-level factors relative to parent expectations and beliefs is warranted.
This study has several limitations. In this study, we did not attempt to evaluate whether racial/ethnic variation in parental beliefs was associated with variation in asthma control or medication use. Our response rate, 72%, was reasonably high compared with other studies that include Medicaid populations, but many families had to be excluded because of nonworking telephones.38
Most of the survey questions in our study have been previously validated in other studies, but on the basis of our analyses of qualitative data in a preceding phase of this project, we created several questions whose properties have not been fully evaluated. All patients in our study population had either Medicaid or private insurance and were from a single geographic region, so the results may not be generalizable to uninsured children. In addition, the inclusion criteria were based on asthma health services use, ie, hospital-based services and/or medications. Thus, the children in our target population were selected to have more symptomatic asthma and may have higher utilization rates of medical services than a more general population of asthmatics.
In this study, we treated Latinos as a single group, but we recognize that individual Latino subgroups may have different experiences and outcomes,39,40
and Puerto Rican children may have higher morbidity rates from asthma.41
Furthermore, our study did not specifically address language barriers, which may be an important driver of communication gaps, although our multivariate models did adjust for fluency in English.42,43
We administered our survey in Spanish and English, but limited sample size precluded our analyzing the Spanish responses in detail. Because our Latino population was predominantly fluent in English, our study population of Latinos may be more acculturated than some inner-city populations.