Caregivers’ and healthcare professionals’ perspective of barriers and facilitators to health service access for asthmatic children: a qualitative study

BackgroundThere is a high burden of asthma morbidity and mortality in Latin America. It has been proposed that this relates to limited access to diagnostic tests, asthma medications and specialised doctors. However, little is known of what caregivers of asthmatic children and healthcare professionals (HCPs) perceive as barriers and facilitators to adequate care. We aimed to explore the barriers and facilitators to asthma care access from caregivers’ and HCP’s perspective in an Ecuadorian low-resource setting.MethodsIn 2017, we conducted 5 focus group discussions (FGD) with 20 caregivers of asthmatic children and 12 in-depth interviews with 3 paediatricians, 6 general doctors and 3 respiratory therapists in Esmeraldas city, Ecuador. FGDs and interviews were digitally recorded, transcribed, open-coded in QDA Miner, categorised using an interpretative phenomenological approach and analysed thematically. Barriers and facilitators were classified into availability, accessibility, acceptability and contact of healthcare services, based on Tanahashi model of health service access.ResultsLimited resources, use of alternative medicines, fear of medication side-effects and lack of specific training for doctors and knowledge in families were common barriers for both caregivers and HCPs. Caregivers and HCPs proposed the implementation of public health asthma-focused programmes that would include close community-based follow-up of people with asthma, educational sessions for their families and public engagement activities. HCPs also suggested implementing training programmes on asthma management for general doctors.ConclusionMultiple barriers identified by caregivers and HCPs referred to economic and health service organisational issues, fear of side effects of medication or ineffective self-management. Increasing caregivers and HCPs’ asthma knowledge, as well as HCPs’ communication skills to establish a patient-centred approach with a shared decision-making process could improve asthma care in this setting.

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‘I don’t think anybody explained to me how it works’: qualitative study exploring vaccination and primary health service access and uptake amongst Polish and Romanian communities in England

BMJ Open ◽

10.1136/bmjopen-2018-028228 ◽

2019 ◽

Vol 9 (7) ◽

pp. e028228 ◽

Cited By ~ 7

Author(s):

Sadie Bell ◽

Michael Edelstein ◽

Mateusz Zatoński ◽

Mary Ramsay ◽

Sandra Mounier-Jack

Keyword(s):

Health Service ◽

Qualitative Study ◽

Healthcare System ◽

Primary Healthcare ◽

Healthcare Services ◽

Vaccination Schedule ◽

Service Access ◽

Health Service Access ◽

Practice Nurses ◽

The Uk

ObjectivesThis study explored vaccination attitudes and behaviours among Polish and Romanian communities, and related access to primary healthcare services.DesignA qualitative study using in-depth semistructured interviews with Polish and Romanian community members (CMs) and healthcare workers (HCWs) involved in vaccination in areas with large Polish and Romanian communities. CMs discussed their vaccination attitudes and their experiences of accessing vaccinations in England. HCWs shared their experiences in vaccinating Polish and Romanian communities.SettingRecruitment focused on three geographical areas in England with large Polish and Romanian populations (in London, Lincolnshire and Berkshire).Participants20 Polish and 10 Romanian CMs, and 20 HCWs. Most CMs were mothers or pregnant women and were recruited from London or Lincolnshire. HCWs included practice nurses, health visitors and school nurses recruited from the targeted geographical areas.ResultsAlthough most CMs reported vaccinating according to the UK schedule, obstacles to vaccination were highlighted. CMs experienced difficulties navigating and trusting the English primary healthcare system, and challenges in accessing credible vaccination information in Polish and Romanian. CM vaccination expectations, largely built on knowledge and experiences from Poland and Romania, were often unmet. This was driven by differences in vaccination scheduling and service provision in England, such as nurses delivering vaccines instead of doctors. CMs reported lower acceptance of the influenza vaccine, largely due to perceptions around the importance and efficacy of this vaccine. HCWs reported challenges translating and understanding vaccination histories, overcoming verbal communication barriers and ensuring vaccination schedule completeness among families travelling between England and Poland or Romania.ConclusionsThis study identified vaccination uptake and delivery issues and recommendations for improvement. HCWs should discuss health service expectations, highlight differences in vaccination scheduling and delivery between countries, and promote greater understanding of the English primary healthcare system in order to encourage vaccination in these communities.

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