Medical University of South Carolina Lake Elmo, Minnesota
Introduction: Obstructive sleep-disordered breathing (SDB) disproportionately affects low-resourced and Black children; however, research has shown that such groups do not receive equitable care for SDB. The drivers behind these disparities remain unknown. The purpose of this study is to investigate parental knowledge, attitudes, and perceived barriers to care for pediatric SDB.
Methods: Parents of children with SDB evaluated at a tertiary care pediatric otolaryngology office from March to December 2020 were invited to complete an electronic survey. All parents completed the validated 39-item Barriers to Care Questionnaire (BCQ). Parents of children who were recommended tonsillectomy were also asked to complete the Adenotonsillectomy Knowledge Scale for Parents (ATKS). Demographic information was obtained including race, parental income, and insurance status. Univariate analysis was conducted using BCQ and ATKS scores as primary outcomes. Logistic regression was used to investigate factors associated with BCQ scores.
Results: Of 155 eligible patients, 80 (51.6%) parents completed the BCQ survey. Half of respondents (n=40) had children who underwent tonsillectomy and thus completed the ATKS. Mean age was 7.4 ± 4.6 years old and 48 (60.0%) were male. Racial/ethnic categories included 48 (60.0%) non-Hispanic White, 18 (22.5%) non-Hispanic Black, 12 (15.0%) Other, and 2 (2.5%) Hispanic. Increased parental level of education was associated with higher ATKS scores (p=0.016). The categories associated with the greatest barriers were ‘appointment availability’, ‘cost of care’, and ‘healthcare system communication’. Adjusting for age, sex, race, and education, parents with household incomes between 100 and 300% of the poverty line ($26,500 - $79,000) were less likely to report minimal barriers to care (OR 0.26, 95% CI 0.07-0.91, p=0.036) than parents in higher income brackets.
Conclusion: This validated survey of parents showed that income impacted barriers to care for children with SDB and that most barriers were related to appointment availability, cost of care, and healthcare system communication. Parents with higher levels of education tended to have greater knowledge of adenotonsillectomy. These results may be used to inform targeted interventions to improve equitable care for children with SDB.