Impact of asthma education received from health care providers on parental illness representation in childhood asthma

A randomized controlled trial of a community health worker delivered home-based asthma intervention to improve pediatric asthma outcomes

OBJECTIVE

The objective of this study was to evaluate the effects of using Community Health Workers (CHWs) to deliver the home-based Wee Wheezers asthma education program on asthma symptoms among children with persistent asthma.

METHODS

In this randomized controlled trial of 151 children aged 2-9 years with persistent asthma, we assigned 75 to the intervention and 76 to the control. The primary outcome was caregiver-reported asthma symptom days. Secondary outcomes included asthma-related healthcare utilization, caregivers' asthma knowledge, illness perception and management behaviors, MDI-spacer administration technique, and home environmental triggers. Outcomes were collected at baseline, 3, 6, 9 and 12 months. A repeated measurements analytic approach with generalized estimating equations was used. To account for missing data, multiple imputation methods were employed.

RESULTS

At 3 and 6 months, improvement in symptom days was not significantly different between groups. However, at 9 and 12 months, the reduction in asthma symptom days was 2.15 and 2.31 days more respectively for those in the intervention group compared to the control. Improvements in MDI-spacer technique, knowledge and attitudes were significant throughout follow-up. Improvement in habits regarding MDI use was significant at 3 and 6 months, and asthma routines were improved at 3 months. However, there was no change in asthma-related healthcare utilization or home environmental triggers.

CONCLUSION

Using CHWs to deliver a home-based asthma education program to caregivers of children with persistent asthma led to improvements in symptom days and several secondary outcomes. Expanding the use of CHWs to provide home-based interventions can help reduce disparities in children's health outcomes.

Experiences of parents and carers in managing asthma in children: a qualitative systematic review

OBJECTIVE

The objective of the review was to identify, critically appraise and synthesize the best available qualitative evidence to understand the lived experiences of parents and carers caring for a child aged 0-18 years with asthma in any setting and managing their condition.

INTRODUCTION

Asthma affects around 14% of children and despite the availability of effective therapies, asthma control is suboptimal and hospitalization rates remain high. Mothers predominantly manage their child's asthma and experience stress and exhaustion due to complex treatments and balancing work and family life. This review provides an understanding of the barriers parents and carers face in managing their child's asthma and highlights the needs of families throughout their asthma journey.

INCLUSION CRITERIA

The review considered qualitative studies examining the experiences of parents and carers caring for a child with asthma, wheeze or bronchiolitis and managing their condition. Research designs included, but were not limited to, phenomenology, grounded theory, ethnography, and action and feminist research.

METHODS

A comprehensive search using PubMed, CINAHL, Embase, PsycINFO, Web of Science and ProQuest for published and unpublished studies was undertaken in June 2017 and December 2017. Studies published in English from 1972 to 2017 were included. The recommended Joanna Briggs Institute approach to critical appraisal, study selection, data extraction and data synthesis was used.

RESULTS

Seventy-seven qualitative studies were included in this review, including grounded theory, phenomenology and ethnography methodologies. From these 77 studies, 1655 participants from a variety of cultural backgrounds and socio-economic status groups were represented. The methodological quality of included articles was sound and participants' voices were strong. A total of 1161 findings (966 unequivocal and 195 credible) were extracted and grouped into 41 categories, based on similarity in meaning. From the 41 categories, seven synthesized statements were produced: i) Negotiating the meaning of having a child with asthma, ii) Impact on family life, iii) The process of getting a diagnosis and learning about asthma, iv) Relationships with healthcare professionals and the emergency department experience, v) Medication beliefs, concerns and management strategies, vi) With time, parents and carers become more comfortable managing their child's asthma, vii) The need for support.

CONCLUSIONS

This review highlights the difficulties parents and carers face when caring for a child with asthma and managing their child's condition. Attaining a definitive diagnosis of asthma can be challenging, and parents and carers express uncertainty and fear due to continuing symptoms and repeated hospitalizations. Healthcare professionals should ensure that a clear diagnostic strategy and treatment plan are communicated so parents and carers have an understanding of the pathway to receiving an actual diagnosis. Comprehensive asthma education is essential at the onset of asthma symptoms, with accurate, easy to understand and culturally relevant information. Supportive relationships, with healthcare professionals taking a partnership approach, ensuring adequate time, continuity of care, regular follow-up, and addressing the psychosocial and cultural needs and concerns of parents and carers, are recommended. Support groups and training for education staff is imperative to ensure they can support parents and carers, provide asthma friendly environments and respond appropriately in an asthma emergency.

Parental Depression is Prospectively Associated With Lower Smoking Cessation Rates and Poor Child Asthma Outcomes

Background

Depressive symptoms are elevated in parents of asthmatic children compared with parents of healthy children. The role of depression in smoking cessation and pediatric asthma outcomes in this population is unclear.

Purpose

To prospectively examine the effect of parent depression on smoking cessation and child asthma outcomes.

Methods

Secondary analysis from a cessation induction trial involving Motivational Interviewing (MI) and biomarker feedback on secondhand smoke exposure (SHSe). Parents (n=341) had an asthmatic child (mean age=5.2 years) and did not have to want to quit smoking to enroll. Intervention included asthma education, MI, and SHSe feedback plus randomization to six counseling (MI; repeated feedback) or control calls (brief check on asthma) for 4 months. Depressive symptoms were defined as scoring ≥22 on the Center for Epidemiologic Study-Depression scale. Smoking outcomes were bioverified 7- and 30-day point-prevalence abstinence (ppa). Child asthma outcomes were past month functional limitation, health care utilization, and number of days with asthma symptoms. Data were obtained at baseline, 2, 4, and 6 months.

Results

Parental depression was associated with lower odds of abstinence (7-day ppa odds ratio [OR]=0.38, 95% confidence interval [CI]=0.23, 0.64; 30-day ppa OR=0.27, 95% CI=0.15, 0.47), greater odds of child health care utilization for asthma (OR=1.71, 95% CI=1.01, 2.92), and greater child asthma functional limitation (B=0.16, SE=0.06, p=.03) even after controlling for smoking status. Depression predicted a greater number of child asthma symptom days (B=1.08, SE=0.44, p=.01), but this became nonsignificant after controlling for smoking status.

Conclusions

Among parents who smoke, both depressive symptoms and smoking should be targeted for treatment aimed at improving pediatric asthma.

Experiences of parents and carers in managing asthma in children: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE

The overarching objective of this review is to enhance understanding of the lived experiences of parents and carers in managing a child with asthma. Enablers and barriers encountered by parents will be examined and findings of the review will be used to develop recommendations for enhancing policy and practice aimed at improving asthma management for children and their families.The specific objective of this review is to critically appraise and synthesize the best available evidence based on qualitative studies exploring the experiences of parents and carers in managing their child's asthma.The primary question to be addressed is:Secondary questions to be addressed include.

"I Don't Think Of It As An Illness": Illness Representations in Mild to Moderate Dementia

The self-regulatory model proposes that illness representations influence adjustment and coping in chronic conditions. Better understanding of the illness representations held by people with dementia could help with targeting information and support so as to optimize adjustment and coping. In this mixed-methods study of illness representations among people with mild to moderate Alzheimer's, vascular, or mixed dementia we aimed to clarify the nature of the representations held, to determine whether specific profiles can be identified based on perceptions of the identity and cause of the condition, and to examine associations between these profiles and other participant characteristics. Data were collected in the second wave of the Memory Impairment and Dementia Awareness Study (MIDAS). Sixty-four people with dementia, who had been told their diagnosis at a memory clinic, completed interviews and responded to questionnaires. In each case a carer was also interviewed. Cluster analysis based on responses about identity and cause identified three profiles. 'Illness' cluster participants saw themselves as living with an illness and used diagnostic labels, 'ageing' cluster participants did not use diagnostic labels and viewed their difficulties as related to ageing, and 'no problem' cluster participants considered that they did not have any difficulties. 'Illness' cluster participants had better cognition and better awareness, but lower mood, and perceived more practical consequences, than 'ageing' cluster participants. Holding an 'illness' model may not be advantageous. Rather than encouraging adoption of such a model, it may be preferable to target information and select interventions in line with the person's representation profile.

Parent and child asthma illness representations: a systematic review

OBJECTIVE

The purpose of this article is to synthesize the current literature on parent and child asthma illness representations and their consequent impact on parent-child asthma shared management.

DATA SOURCES

This systematic review was conducted in concordance with the PRISMA statement. An electronic search of five computerized databases (PubMed, PsycINFO, CINAHL, Cochrane, and EMBASE) was conducted using the following key words: asthma, illness representation, and child. Due to the limited number of articles identified, the search was broadened to include illness perceptions as well.

STUDY SELECTIONS

Studies were included if they were specific to asthma and included parent and/or child asthma illness representations or perception, were published after 2000, and available in English. Fifteen articles were selected for inclusion. All of the articles are descriptive studies that used cross-sectional designs. Seven of the studies used parent and child participants, eight used parents only, and none used only child participants.

RESULTS

None of the selected studies describe child asthma illness representations, and only three describe parental asthma illness representations. Domains of illness representations, including symptoms, timeline, consequences, cause, and controllability were described in the remaining articles. Symptoms and controllability appear to have the most influence on parental asthma management practices. Parents prefer symptomatic or intermittent asthma management and frequently cite concerns regarding daily controller medication use. Parents also primarily rely on their own objective symptom observations rather than the child's report of symptoms.

CONCLUSION

Asthma illness representations are an important area of future study to better understand parent-child shared asthma management.

Using the Health Belief Model to Understand School Nurse Asthma Management

Ten million children in the United States have asthma. Since children are in school about 6 hr a day, school nurses are positioned to intervene and influence asthma outcomes. A descriptive correlational study was designed to investigate performance of school nurses' asthma management behaviors in relationship to asthma knowledge, asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors. Results indicated that asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors were associated with performance of asthma management behaviors. The higher the rating of importance of asthma management behaviors, the more likely school nurses were to perform the behaviors (p < .05). Higher levels of asthma self-efficacy were associated with performance of asthma management behaviors, indicating the importance of strengthening school nurses' asthma self-efficacy in asthma management. By understanding factors influencing performance of asthma management behaviors by school nurses, interventions can be implemented to increase asthma management behaviors, leading to improved outcomes for students with asthma.

What is left unsaid: an interpretive description of the information needs of parents of children with asthma

Parents of children with asthma provide the vast majority of day-to-day asthma care. Understanding their information needs is an essential step to provide meaningful and effective family-centered asthma education. To gain insight into the information needs and information deficits of parents of children with asthma, we conducted an interpretive descriptive study to capture the perspectives of 21 parents from diverse backgrounds whose 23 children with asthma had a range of illness trajectories and management scenarios. Parents were purposively sampled from two asthma clinics and one pediatric emergency department in a large urban center in North America. Semi-structured interviews were conducted in 2011-2012. In data analysis, parents' self-identified information needs were distinguished from analysts' interpretations of information deficits. Participants' knowledge did not always reflect time since diagnosis, and information needs and deficits persisted for years. Parents often reported receiving little or no little or no education about asthma and its management. An asthma management information hierarchy was identified, starting with the most foundational, recognizing severity; followed by acute management; prevention versus crisis orientation; and knowing "about" asthma. In the absence of adequate and accurate education, parents' beliefs about the nature of asthma as an acute rather than chronic condition shaped their asthma management decisions and information-seeking behaviors. Information deficits were affected by interactions with health care providers. These parents' pervasive unmet information needs and deficits highlight the need for comprehensive, problem-oriented asthma education.

Evidence-based asthma education for parents

PURPOSE

The purpose of this project was to develop and implement an evidence-based asthma education brochure for parents of pediatric asthma patients.

DESIGN AND METHODS

The asthma patients were 4-12 years old. The number of office sick visits, emergency room visits, and hospitalizations related to asthma were evaluated post-education, and then compared with the previous months.

RESULTS

Although there were no statistically significant results, there were notable trends that apply to asthma practice.

PRACTICE IMPLICATIONS

As a result of the project, there were positive changes noted within the pediatric clinic related to asthma education, and additional suggestions for future opportunities were made.

When independent healthcare behaviors develop in adolescents with inflammatory bowel disease

BACKGROUND

Patients with chronic health needs are expected to gradually assume responsibility for health maintenance behavior as they move toward adulthood. We sought to evaluate the influence of factors such as age, duration of disease, and gender by examining the self-reported health behaviors of adolescents with inflammatory bowel disease (IBD).

METHODS

Confidential voluntary surveys were administered to all IBD outpatients over age 10 during a 4-month period. Questions addressed responsibility for health behaviors such as medication, provider visits, and communication. Likert scales measured the degree of independence: 1 (my parents only) through 3 (parents share equally with me) to 5 (I do it myself). Patient participation during doctor visits was also assessed.

RESULTS

Of 358 patients approached, 294 (82%) returned completed surveys. Respondents were 51% male and 69% had Crohn's disease. Patients took increasingly active roles, but by ages 19-21 only 45% ordered medication refills, and 50% picked up medication from pharmacy. Only 35% of 19-21-year-olds scheduled appointments and 30% contacted providers between visits if problems arose. Most patients could answer provider questions (55% at age 16-18) but fewer asked questions of the provider (15% at the same age). Males were less likely to order their own prescription refills (P = 0.017) or prepare questions (P = 0.009). Duration of disease did not change skill acquisition.

CONCLUSIONS

Adolescents develop independence in managing their IBD slowly and many patients ≥ 18 years are still assisted by parents. Focus on specific skill acquisition may help patients with self-management skills expected in adult healthcare.

An Innovative Approach to Partnership in Asthma Care

Control of asthma symptoms is fundamental to asthma management. New asthma guidelines suggest that asthma control, for most patients, can be achieved through education aimed at improving management. This includes providing written asthma management plans from health care providers; instructions on proper inhaler use; education about early signs and symptoms of asthma, and how to respond appropriately; medication regimens that prevent misuse of medications; follow-up medical care for long-term management of asthma after any hospitalization due to asthma; and assistance with assessing and reducing exposure to environmental risk factors in patients’ home, school, and work environments. The Shared Medical Appointment (SMA) is a group appointment model that has the potential to change the management of children with asthma for the better by offering benefits to both the health care provider and the patient. The SMA for children with asthma and their caregivers is an innovative 90-minute medical appointment in which 4 to 9 patients and their parents are seen at the same time in a supportive group setting. In addition to having concerns and questions about asthma addressed, the SMA provides education on medications, monitoring symptoms, and the demonstration and distribution of devices. Supportive materials are provided and discussed and education is emphasized through open group discussion and the participation of both caregiver and child. A brief, focused medical examination is also conducted. In this study, the charts of children with asthma who attended an SMA were reviewed for specific asthma-related clinical outcomes as defined by the National Heart, Lung, and Blood Institute’s, Expert Panel Review-3 (NHLBI-EPR-3) in the 4-month period prior to attending an SMA and during the 4-month period after attending an SMA. The results showed that asthma education provided in an SMA, as compared with a usual appointment, resulted in a significant positive impact on asthma-related outcomes in meeting NHLBI-EPR-3 guidelines for asthma management.