Spanish-Speaking Caregivers' and Clinicians' Perspectives on Barriers to Equitable Asthma Care: A Qualitative Study

Asthma is one of the most common chronic diseases of childhood, with notable racial and ethnic disparities in the United States. Spanish-speaking families experience barriers to receiving quality asthma care. No studies have concurrently explored the perspectives of Spanish-speaking caregivers and clinical staff on the delivery of equitable asthma care in the pediatric emergency department.

This qualitative study was conducted at a single urban, pediatric emergency department located within a tertiary care, freestanding children's hospital. We facilitated 2 focus groups between June 2022 and July 2022, one consisting of Spanish-speaking caregivers and one of emergency department clinical staff. Each 60-minute focus group was conducted and recorded through Zoom, transcribed verbatim, and coded using thematic analysis by teams of 2 study team members.

Focus groups included a total of 9 Spanish-speaking caregivers and 7 clinical staff. Seven themes emerged in the Spanish-speaking group and 6 themes in the clinical staff group. Overlapping themes across groups were those regarding delays in care, desiring accuracy in communication and value in bilingual providers. Notable unique themes to Spanish-speaking caregivers were perceived discrimination toward Spanish-speaking families and the importance of tone when communicating.

In this qualitative study, Spanish-speaking caregivers and clinical staff identified several barriers to equitable asthma care for Spanish-speaking families in the emergency department. This study creates a foundation for future work that can improve care, communication and mitigate inequities in asthma care for Spanish-speaking families in the emergency department.