Lay evaluation of services for childhood asthma

Users' views on health services are increasingly valued, but insufficient attention has been given to evaluations of childhood services. Asthma, the most common chronic childhood disease, is an significant condition around which to explore views of childhood services, especially since most care is provided in the community rather than in hospital. The aim of the present study was to investigate the views of children, young people and their parents on primary care services for childhood asthma, to explain how they should be characterised as evaluators of health services, and to identify the dimensions of care which they see as important. The authors conducted semi-structured interviews with 20 families recruited from responders to a respiratory symptoms questionnaire and from two general practices. Data were analysed using the constant comparative method. Children and young people identified outcomes of care, quality of care, communication and the professional-patient relationship, and organisation and access to healthcare as the key dimensions of their experiences of health services. They were active and critical, judging the performance and delivery of health services against standards which drew on lay knowledge and experience. Parents also emphasised outcomes, quality, organisation and access to healthcare as important, and drew attention to the complex and challenging nature of the professional-parent relationship. Parents had several roles, seeing themselves as carers and advocates as well as users of health services. They also drew on lay standards to evaluate care. Children and young people are willing and able to give active and critical views on health services. Parents' views should also be sought in their own right.