Patient, Parent, and Provider Perceptions of Barriers to Pediatric Inflammatory Bowel Disease Care

Jennifer L Dotson; Josh Bricker; Deena J Chisolm; Laura M Mackner

doi:10.1097/PG9.0000000000000386

Patient, Parent, and Provider Perceptions of Barriers to Pediatric Inflammatory Bowel Disease Care

JPGN Rep. 2023 Nov 8;4(4):e386. doi: 10.1097/PG9.0000000000000386. eCollection 2023 Nov.

Authors

Jennifer L Dotson^{1

2}, Josh Bricker², Deena J Chisolm², Laura M Mackner³

Affiliations

¹ From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH.
² The Center for Child Health Equity and Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, OH.
³ The Center for Biobehavioral Health, The Research Institute, Nationwide Children's Hospital, Columbus, OH.

Abstract

Objectives: Children with inflammatory bowel disease (IBD) have a significant life-long burden as a result of disease, impacted by environmental and individual barriers. Successful health system interventions require a comprehensive approach, informed by various stakeholders. The main objective was to identify health system barriers and potential solutions from existing patients, families, and providers via focus groups.

Methods: Participants for the focus groups were existing English-speaking patients (ages 9-18) with IBD, their caregiver(s), and providers including multiple professions (eg, physician, nurse, pediatrician, social worker, care coordinator, scheduler, and psychologist). Separate focus groups were led by experienced personnel for parents, children, and providers, using a standardized interview guide. Sessions were recorded, transcribed, and verified. Using content analysis, we systematically classified data through coding and identified themes.

Results: Focus groups comprised (a) 3 patient groups (n = 20, 50% female, including 2 younger; mean age = 11.4 ± 1.5 years) and 1 older group (mean age = 15.6 ± 1.3 years), (b) 3 parent groups (n = 24, 83% female), and (c) 2 multidisciplinary provider groups (n = 19). Families shared several common concerns with providers (eg, school, care delay, psychosocial, and financial) but varied on specifics. Some barriers may be addressable through family or staff education, improved communication (eg, care delay/ access, transition), or training (eg, labs and diet), while others may require change at an institutional or policy level (eg, insurance).

Conclusions: This qualitative analysis identified several barriers to IBD care, some shared, some unique to patients, parents, and providers, highlighting the importance of obtaining multiple stakeholder perspectives when exploring barriers to care.

Keywords: barriers to care; children; focus group.

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.