The impact of asthma risk factors on home management of childhood asthma

Evaluating the effect of an asthma self-management intervention for rural families

OBJECTIVE

To present outcomes of an asthma self-management educational intervention delivered to children (grades 2-5) at school and to parents in a home visit.

METHODS

The intervention effectiveness was tested in a 12-month longitudinal study with randomization by elementary schools into treatment and attention-control groups with 183 children who had a diagnosis of asthma. Data were collected at four time points. Change over time was examined with linear mixed models.

RESULTS

Quality of life (QOL), hospitalizations, and emergency department visits improved significantly for all the children. African American and Mexican American children had worse asthma-related QOL than did White children. Asthma management behaviors, asthma self-efficacy, and coping likewise improved with girls improving significantly more than the boys. Significant improvements in inhaler skill and asthma severity were seen in the treatment group children when compared to the control group. Treatment group parents showed significant improvements in home asthma management and self-efficacy.

CONCLUSIONS

The improvement in inhaler skill is an important finding for practitioners as this is a behavior that can be addressed in the clinical setting. The reduction in the treatment group's asthma severity scores may reflect the improvement in medication delivery as their inhaler skill improved. The differential improvement between boys and girls points to the need for testing other formats in asthma education that can address different learning styles. The individualized parent asthma education enabled the intervener to incorporate neighborhood and home environmental information thereby allowing for tailoring of parental instruction.

Parenting asthmatic children: identification of parenting challenges

Asthma is the most common chronic illness of childhood, affecting up to 14% of children. Poor asthma management and non-adherence to treatment regimens are a pervasive problem in this population and are related to exacerbation of symptoms. Effective management of pediatric asthma involves a complex set of interactions between the parent and child, yet there is a paucity of literature examining these interactions. The main purpose of this study was to identify the child behavior and asthma management tasks parents experience difficulty with. It was hypothesized that the more asthma behavior problems reported, the more problems parents experience in asthma management tasks. Participants in this study were 255 parents of 2-to 10-year-old asthmatic children, recruited via an advertisement placed in school newsletters throughout Australia. Results indicated that the most problematic child asthma behaviors were oppositional behavior, hyperactivity, and aggression, and anxiety was also identified by parents as a concern. The main problematic asthma parenting tasks were entrusting the school, entrusting caregivers, identifying unique symptoms, and identifying and avoiding triggers. More problem asthma behaviors were associated with higher levels of parenting difficulty and more general levels of behavior problems. Parents who reported more dysfunctional parenting styles reported more difficulties with their child's asthma behavior. Based on the results it is suggested that an appropriate parenting intervention program would target basic behavioral management skills, in addition to applying these behavior management principles to asthma management.

Measuring asthma severity: instrument refinement

The focus of this study is to evaluate a brief parent-report instrument, the Severity of Chronic Asthma (SCA) scale, that conforms to the national guidelines for assessing asthma. Convergent validity was found between the SCA and other measures related to asthma severity including an illness severity scale (How Bad is the Asthma?), asthma management scales for parents and children, and the pediatric quality-of-life scale. The SCA is a multidimensional scale with appropriate evidence of reliability and validity that may be a heuristic and effective measure in both clinical practice and research endeavors.

Effect of education on school-age children's and parents' asthma management

ISSUES AND PURPOSE

Asthma affects 7.4% of school-age children, with poor children or members of ethnic minorities disproportionately affected.

DESIGN AND METHODS

A quasiexperimental, year-long pilot study tested the effectiveness of an intervention that included school-based small-group education for children with home-based education for parents. Pretest and two posttest measures were collected.

RESULTS

Forty-four families completed the study (41% African American, 36% European American, 23% Mexican American), with 46% coming from poor or working-class families. Asthma management in the treatment group was lower than the comparison group at baseline, but improved significantly at 6 months and stabilized at 12 months, a trend that was most pronounced among the poorer children.

PRACTICE IMPLICATIONS

Improvements in asthma management point to the need for ongoing asthma education to address learning needs of the children and families.

Problems with parsimony in research on socioeconomic determinants of health

Despite growing evidence that social and economic factors are important determinants of health disparities, there is a lack of understanding of how these factors operate in relation to health. This article explores 3 conceptual and methodological issues impeding nursing research in this area: (1) ambiguity surrounding socioeconomic status (SES), both conceptually and as a scientific indicator; (2) the narrow focus on biological and behavioral risks for chronic disease development; and (3) the persistent centrality of individual behavior in studies examining SES-health contextual relationships. A brief overview of emerging approaches for enhancing nursing science in the area of SES and health disparities is presented.