Objective To describe the prevalence of access and process barriers to health care and to examine their relationship to sociodemographic and disease factors in a large and diverse cohort of US youth with type 1 diabetes. Study design A cross-sectional analysis of 780 youth who participated in the SEARCH for Diabetes in Youth Study and were diagnosed with T1DM in 2002-2005. Experience of barriers to care was collected from parent report on questionnaires. Analyses include multivariate regression models to predict the presence of specific barriers to care. Results Overall, 81.7% of participants reported at least one barrier; the three most common were costs (47.5%), communication (43.0%) and getting needed information (48.4%). Problems with access to care, not having a regular provider, and receiving contextual care (care that takes into account personal and family context) were associated with poorer glycated hemoglobin levels. Adjusted multivariate models indicated that barriers related to access (regular provider, cost) were most likely for youth with low family income and those without public health insurance. Barriers associated with the processes of quality care (contextual care, communication) were more likely for Hispanic youth and those whose parents had less education. Conclusions This study indicates that a large proportion of youth with type 1 diabetes experience substantial barriers to care. Barriers to access and those associated with processes of quality care differed by sociodemographic characteristics. Future investigators should expand knowledge of the systemic processes that lead to disparate outcomes for some youth with diabetes and assess potential solutions.

Findings support the development of a clear and structured transition process to address patients' fears and worries through early communication, planning, and coordination for adult healthcare, highlighting the need for future research in this area.

Family support for diabetes is important for adherence among Hispanic youth with T1D. Research should examine aspects of recent immigration that contribute to better adherence and the impact of supportive interventions on diabetes care.

Present findings indicate that insulin pump therapy does not have negative implications for HRQOL. They also suggest that interventions aiming to improve HRQOL in this population should target child, parent, and family adjustment and not focus solely on disease-related outcomes.

Background Children from low-SES and ethnic minority backgrounds are at heightened risk for overweight, yet are underrepresented in the pediatric obesity literature. Methods The current paper describes strategies employed to minimize barriers to recruitment and retention of African-American families receiving WIC services in a longitudinal study examining caregiver feeding and child weight. Results Seventy-six families enrolled in the study over 3.5 years, and 50% of the families completed the study. Implications for Practice Despite effortful planning, unanticipated barriers likely contributed to lengthy recruitment and a modest retention rate. Future research should incorporate lessons learned to modify and develop effective strategies for increasing engagement of low-SES and ethnic minority families in research.