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Identifying barriers to obstructive sleep-disordered breathing care: Parental perspectives
W Nicholas Jungbauer1, Kathy Zhang1, Cathy L Melvin2
1Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Insights
Parents face significant practical barriers, like appointment availability and cost, when seeking pediatric obstructive sleep-disordered breathing (SDB) care. Middle-income families encounter the most challenges, and overall parental knowledge of SDB and tonsillectomy is low.
Area of Science:
- Pediatric Sleep Medicine
- Healthcare Disparities
- Public Health
Background:
- Pediatric obstructive sleep-disordered breathing (SDB) is common, yet disparities in care persist despite established guidelines.
- Parental experiences and perceived barriers to SDB evaluation and treatment are not well-documented.
- Understanding these barriers is crucial for improving equitable access to care.
Purpose of the Study:
- To assess parental knowledge of childhood SDB and tonsillectomy.
- To identify parent-perceived barriers to obtaining SDB evaluation and treatment for their children.
- To investigate socioeconomic predictors of these barriers.
Main Methods:
- A cross-sectional survey was administered to parents of children diagnosed with SDB.
- Validated questionnaires included the Barriers to Care Questionnaire and the Obstructive Sleep-Disordered Breathing and Adenotonsillectomy Knowledge Scale for Parents.
- Logistic regression analysis identified predictors of barriers and knowledge.
Main Results:
- Pragmatic challenges, such as appointment availability and healthcare costs, were the most reported barriers.
- Middle-income parents ($26,500-$79,500) had significantly higher odds of reporting barriers compared to higher and lower income tiers.
- Parents whose children underwent tonsillectomy scored an average of 55.7% on the SDB knowledge scale.
Conclusions:
- Practical and financial challenges significantly impede access to pediatric SDB care.
- Middle-income families face disproportionately greater barriers to SDB care.
- Low parental knowledge regarding SDB and tonsillectomy highlights a need for targeted educational interventions to promote equitable care.
Objective:
Despite established clinical practice guidelines for pediatric obstructive sleep-disordered breathing (SDB), disparities persist for this common condition. Few studies have investigated parental experiences about challenges faced in obtaining SDB evaluation and tonsillectomy for their children. To better understand parent-perceived barriers to treatment of childhood SDB, we administered a survey to assess parental knowledge of this condition.
Materials & Methods:
A cross-sectional survey was designed to be completed by parents of children diagnosed with SDB. Two validated surveys were administered: 1) Barriers to Care Questionnaire and 2) Obstructive Sleep-Disordered Breathing and Adenotonsillectomy Knowledge Scale for Parents. Logistic regression modeling was performed to assess for predictors of parental barriers to SDB care and knowledge.
Results:
Eighty parents completed the survey. Mean patient age was 7.4 ± 4.6 years, and 48 (60%) patients were male. The survey response rate was 51%. Patient racial/ethnic categories included 48 (60.0%) non-Hispanic White, 18 (22.5%) non-Hispanic Black, and 14 (17.5%) Other. Parents reported challenges in the 'Pragmatic' domain, including appointment availability and cost of healthcare, as the most frequently described barrier to care. Adjusting for age, sex, race, and education, parents in the middle-income bracket ($26,500 - $79,500) had higher odds of reporting greater barriers to care than parents in the highest (>$79,500) income tier (OR 5.536, 95% CI 1.312-23.359, P = 0.020) and lowest income tier (<$26,500) (OR 3.920, 95% CI 1.096-14.020). Parents whose children had tonsillectomy (n = 40) answered only a mean 55.7% ± 13.3% of questions correctly on the knowledge scale.
Conclusion:
Pragmatic challenges were the most encountered barrier that parents reported in accessing SDB care. Families in the middle-income tier experienced the greatest barriers to SDB care compared to lower and higher income families. In general, parental knowledge of SDB and tonsillectomy was relatively low. These findings represent potential areas of improvement to target interventions to promote equitable care for SDB.
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