Perceived barriers to atopic dermatitis care among adults

Summary: Barriers to medical care for atopic dermatitis (AD) lead to suboptimal outcomes and contribute to disparities in disease burden. This study aimed to identify perceived barriers to care among an urban population of adults with AD. We performed a qualitative study of adults with AD in Philadelphia using freelisting, a method that identifies how individuals with similar experiences think about a topic. Participants listed things that prevent them from getting medical care for their AD. The most salient responses were identified using Smith’s Salience index (S). Relative salience (RS) was calculated by dividing the S of each response by the S of the most salient response, expressed as a percentage. We interviewed 46 adults with AD (15 White, 16 Black, 15 Hispanic). Median (interquartile range) age was 34 (28, 41) years; 72% were female; 63% had moderate/severe AD. "Nothing" (i.e., no reported barriers) was the most salient response among all participants and those with mild and moderate/severe disease. Among those with moderate/severe disease, additional salient barriers included “insurance” (e.g., no insurance; RS 93%), “finances” (e.g., visit costs; RS 77%), and “competing priorities/time” (e.g., work schedule; RS 76%). "Nothing" was also the most salient response among White and Black participants; however, among Hispanic participants, "insurance" was the most salient response followed by “nothing” (RS 72%). This aligned with quantitative data identifying the highest percentage of uninsured among Hispanic participants (13.3% White, 0% Black, 33.3% Hispanic). Notably, “lack of knowledge” (e.g., misdiagnosis) was the least salient response among White participants (White RS 7%, Black RS 30%, Hispanic RS 36%). Our study reveals differences in perceived barriers to care for AD by disease severity and race/ethnicity. The perceived absence of barriers was surprising among our study population that experiences a large burden of disease and suggests learned helplessness that will be examined in additional interview responses. N Martinez¹, W Pastard¹, H Gebru¹, L Bou Delgado², M Rivera Benito¹, FK Barg¹, Junko Takeshita¹ 1. University of Pennsylvania, Philadelphia, PA, United States. 2. Universidad Central Del Caribe, Bayamón, Puerto Rico. Minoritized Populations and Health Disparities Research