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Shepperd JA, Hunleth JM, Maki J, Prabakaran S, Pogge G, Webster G, Ruiz S, Waters EA. Interpersonal comparison among caregivers of children with asthma. Psychol Health 2024; 39:969-988. [PMID: 36147010 PMCID: PMC10030381 DOI: 10.1080/08870446.2022.2125514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Objective: We examined the extent to which caregivers of children with asthma used interpersonal comparisons-a novel comparison process that parallels social comparison and temporal comparison-to form judgments about their child. Methods & Measures: Using semi-structured interviews adapted from the McGill Illness Narrative Interview, we examined the interpersonal comparisons that caregivers of a child with asthma (n = 41) made regarding their child. Results: Interpersonal comparisons influenced caregiver thoughts, feelings, and behavior. They helped caregivers distinguish asthma from other breathing problems, evaluate the severity of the asthma, and understand their child's experience. However, they also created uncertainty by highlighting the complex, unpredictable nature of asthma. Interpersonal comparisons were a source of gratitude and hope, but also worry and frustration. Finally, interpersonal comparisons influenced caregivers' decisions and actions, resulting in decisions that aligned with and, at times, ran counter to biomedical models of asthma care. In some instances, caregivers used interpersonal comparisons to motivate their child's behavior. Conclusion: The interpersonal comparisons served as a source of information for caregivers trying to understand and manage their child's asthma. Investigating these comparisons also expands how we think about other comparison theories.
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Affiliation(s)
- James A. Shepperd
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Jean M. Hunleth
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Julia Maki
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Sreekala Prabakaran
- Department of Pulmonology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gabrielle Pogge
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Gregory Webster
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Sienna Ruiz
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Erika A. Waters
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
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Waters EA, Pachur T, Pogge G, Hunleth J, Webster GD, Fedele DA, Shepperd JA. Managing children's asthma: what role do caregivers' mental representations of trigger and symptom management behaviors play? Psychol Health 2024:1-21. [PMID: 38682920 DOI: 10.1080/08870446.2024.2347657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Pediatric asthma management is challenging for parents and guardians (hereafter caregivers). We examined (1) how caregivers mentally represent trigger and symptom management strategies, and (2) how those mental representations are associated with actual management behavior. METHODS In an online survey, N = 431 caregivers of children with asthma rated 20 trigger management behaviors and 20 symptom management behaviors across 15 characteristics, and indicated how often they engaged in each behavior. RESULTS Principal components analysis indicated 4 dimensions for trigger management behaviors and 3 for symptom management behaviors. Bayesian mixed-effects models indicated that engagement in trigger management behavior was more likely for behaviors rated as affirming caregiver activities. However, trigger management behavior did not depend on how highly the behavior was rated as challenging for caregiver, burdensome on child, or routine caregiving. Engagement in symptom management behavior was more likely for behaviors rated as affirming and common and harmless to the child, but was unrelated to how highly a behavior was rated as challenging for caregivers. CONCLUSION These results suggest that interventions might be particularly useful if they focus on the affirming nature of asthma management behaviors. However, such interventions should acknowledge structural factors (e.g. poverty) that constrain caregivers' ability to act.
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Affiliation(s)
- Erika A Waters
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, Saint Louis, MO, USA
| | - Thorsten Pachur
- School of Management, Technical University of Munich, Munich, Germany
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Gabrielle Pogge
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Jean Hunleth
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, Saint Louis, MO, USA
| | - Gregory D Webster
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - David A Fedele
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - James A Shepperd
- Department of Psychology, University of Florida, Gainesville, FL, USA
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Bunkley EN, Asante C, Burack S, Kaufman L, Miti S, Hunleth J. A Heart for the Care: Affect, Kin, and Care Work in a Zambian Hospital. Med Anthropol Q 2024; 38:54-66. [PMID: 38112051 PMCID: PMC10922508 DOI: 10.1111/maq.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/21/2023] [Indexed: 12/20/2023]
Abstract
At the only standalone pediatric hospital in Zambia, patient wellbeing often rests in the hands of bedsiders. Bedsiders are caregivers, often family, who sit at the patient's bedside, feeding, cleaning them, and running medical errands. Bedsiders are critical human infrastructure for the hospital and its staff. In our research, we heard repeatedly that bedsiders must have a "heart" for caregiving, taking on unremunerated and exhausting informal labor. We draw on Wendland's "heart for the work," a phrase commonly used among healthcare workers in Malawi and Zambia describing the medical profession, to explore what this metaphor reveals about care.
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Affiliation(s)
- Emma Nelson Bunkley
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado, USA
| | - Comfort Asante
- Ndola Teaching Hospital, Ndola, Zambia
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Sarah Burack
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Lindsey Kaufman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Sam Miti
- Department of Pediatrics and Child Health, Arthur Davison Children's Hospital, Ndola, Zambia
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Jean Hunleth
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
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Waters EA, Pachur T, Pogge G, Hunleth J, Webster GD, Shepperd JA. Linking cognitive and affective heuristic cues to interpersonal risk perceptions and behavior. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:2610-2630. [PMID: 36781299 PMCID: PMC10423305 DOI: 10.1111/risa.14101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
People often use cognitive and affective heuristics when judging the likelihood of a health outcome and making health decisions. However, little research has examined how heuristics shape risk perceptions and behavior among people who make decisions on behalf of another person. We examined associations between heuristic cues and caregivers' perceptions of their child's asthma risk, the frequency of caregivers' asthma management behaviors, and child health outcomes. We used Ipsos KnowledgePanel to recruit 814 U.S. adult caregivers of children with asthma of the age <18 years. Participants completed a survey at baseline (T1) and 3 months later (T2). Caregivers who, at T1, reported greater negative affect about their child's asthma (affect heuristic cue), greater ease of imagining their child experiencing asthma symptoms (availability heuristic cue), and greater perceived similarity between their child and a child who has ever experienced asthma symptoms (representativeness heuristic cue) reported statistically significantly (p < 0.05) higher interpersonal perceived risk of their child having an exacerbation or uncontrolled asthma at T1. They also indicated at T2 that their child had poorer asthma control and more frequent exacerbations. Greater T1 negative affect was associated with more frequent T2 actions to reduce inflammation, manage triggers, and manage symptoms, and with poorer T2 child health outcomes. Heuristic cues are likely important for interpersonal-not just personal-risk perceptions. However, the interrelationship between caregivers' ratings of heuristic cues (in particular, negative affect) and risk judgments may signify a struggle with managing their child's asthma and need for extra support from health care providers or systems.
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Affiliation(s)
- Erika A. Waters
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | | | | | - Jean Hunleth
- Washington University in St. Louis, Saint Louis, Missouri, USA
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Waters EA, Pachur T, Pogge G, Hunleth J, Webster GD, Fedele DA, Shepperd JA. How are mental representations of asthma triggers and symptoms related to interpersonal risk perceptions? A psychometric investigation of caregivers of children with asthma. Psychol Health 2023:1-23. [PMID: 37545105 PMCID: PMC11073392 DOI: 10.1080/08870446.2023.2244522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Parents and guardians (hereafter caregivers) make decisions for their children's medical care. However, many caregivers of children with asthma struggle to understand their child's illness. We used the psychometric paradigm to investigate how caregivers conceptualize, or mentally represent, asthma triggers and symptoms and how these representations are linked to perceived asthma exacerbation risk. METHODS We asked 377 caregivers of children with asthma across the U.S. to rate 20 triggers or 20 symptoms along 15 characteristics. Caregivers also indicated their perceived risk of their child having an asthma exacerbation (hereafter interpersonal risk perceptions). Using principal components analysis, we extracted key dimensions underlying caregivers' ratings on the characteristics. Then we related the triggers' and symptoms' scores on the dimensions to caregivers' interpersonal risk perceptions. RESULTS Interpersonal risk perceptions were higher for triggers with high ratings for the dimensions severe and relevant, and negative affect-yet manageable, but not chronic-yet unpredictable. Risk perceptions were also higher for symptoms with high ratings for the dimensions severe and unpredictable, and relevant and common, but not self-blame or manageable despite unknown cause. CONCLUSION By identifying key dimensions underlying caregivers' mental representations of asthma triggers and symptoms, these findings can inform a new approach to asthma education.
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Affiliation(s)
- Erika A. Waters
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | | | | | - Jean Hunleth
- Washington University in St. Louis, Saint Louis, Missouri, USA
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Pogge G, Fedele DA, Waters EA, Maki J, Hunleth JM, Prabhakaran S, Bowen DJ, Shepperd JA. Exploring Caregiver Interest in and Preferences for Interventions for Children With Risk of Asthma Exacerbation: Web-Based Survey. JMIR Form Res 2023; 7:e46341. [PMID: 37531188 PMCID: PMC10433025 DOI: 10.2196/46341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Maintaining control of asthma symptoms is the cornerstone of asthma treatment guidelines in the United States. However, suboptimal asthma control and asthma exacerbations among young people are common and are associated with many negative outcomes. Interventions to improve asthma control are needed. For such interventions to be successful, it is necessary to understand the types of interventions that are appealing to caregivers of children with different levels of risk of exacerbation. OBJECTIVE This study aimed to evaluate whether caregivers of children with high (vs low) risk of asthma exacerbation show different levels of interest in and preferences for potential intervention programs and delivery methods. METHODS We contracted with Ipsos to administer a web-based survey to caregivers of children with asthma who were residing in the United States. Caregivers (N=394) reported their interest (1=not at all; 3=a lot) in 9 possible intervention programs and 8 possible intervention delivery methods. Caregivers also indicated their preferences by selecting the 3 intervention programs and 3 delivery methods that "most" interested them. Finally, caregivers completed 2 open-ended questions asking what other resources might be useful for managing their children's asthma. We classified children as having a high risk of exacerbation if they had an exacerbation in the past 3 months (n=116) and a low risk of exacerbation if otherwise (n=278). RESULTS Caregivers reported higher levels of interest in all intervention programs and delivery methods if they cared for a child with a high risk rather than a low risk of exacerbation. However, regardless of the child's risk status, caregivers expressed the highest levels of interest in programs to increase their child's self-management skills, to help pay for asthma care, and to work with the school to manage asthma. Caregivers expressed the highest levels of interest in delivery methods that maintained personal control over accessing information (websites, videos, printed materials, and smartphone apps). Caregivers' preferences were consistent with their interests; programs and delivery methods that were rated as high in interest were also selected as one of the 3 that "most" interested them. Although most caregivers did not provide additional suggestions for the open-ended questions, a few caregivers suggested intervention programs and delivery methods that we had not included (eg, education about avoiding triggers and medication reminders). CONCLUSIONS Similar interests and preferences among caregivers of children with high and low risk of exacerbation suggest a broad need for support in managing childhood asthma. Providers could help caregivers by directing them toward resources that make asthma care more affordable and by helping their children with asthma self-management. Interventions that accommodate caregivers' concerns about having personal control over access to asthma information are likely to be more successful than interventions that do not.
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Affiliation(s)
- Gabrielle Pogge
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - David A Fedele
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - Erika A Waters
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Julia Maki
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Jean M Hunleth
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | | | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, United States
| | - James A Shepperd
- Department of Psychology, University of Florida, Gainesville, FL, United States
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Spray J, Hunleth J. Breathing Together: Children Co-constructing Asthma Self-Management in the United States. Cult Med Psychiatry 2023; 47:301-328. [PMID: 35132504 PMCID: PMC8821853 DOI: 10.1007/s11013-022-09766-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/30/2022]
Abstract
Pediatric asthma management in the U.S. is primarily oriented around caregivers. As evident in policy, clinical literature and provider practices, this caregiver-centric approach assumes unidirectional transfer of practices and knowledge within particular relational configurations of physicians, caregivers, and children. Reflecting broader societal values and hierarchies, children are positioned as passive recipients of care, as apprentices for future citizenship, and as the responsibility of parents who will train them in the knowledge and labor of asthma management. These ideas, though sometimes contradictory, contribute to a systemic marginalization of children as participants in their health care, leaving a conceptual gap regarding children's inclusion in chronic illness management: what children's roles in their health care are or should be. We address this conceptual gap by asking, what does pediatric asthma management look like when we center children, rather than caregivers in our lens? We draw data from a study of asthma management in St. Louis, Missouri, and Gainesville, Florida, which included 41 caregivers, 24 children, and 12 health-care providers. By asking children to show us how they manage asthma, we find that children actively co-construct health practices within broader interdependencies of care and the structural constraints of childhoods.
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Affiliation(s)
- Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA.
- School of Population Health, Section of Social and Community Health, University of Auckland, Auckland, New Zealand.
| | - Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Shepperd JA, Webster GD, Pogge GC, Fedele D, Sreekala P, Hunleth J, Waters EA. Psychometric properties and predictive validity of the PP-ACT. J Asthma 2023; 60:174-184. [PMID: 35094619 PMCID: PMC9375783 DOI: 10.1080/02770903.2022.2036755] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Parent Proxy Asthma Control Test (PP-ACT) is a self-report measure of asthma control completed by caregivers on behalf of a child. We examined the psychometric properties and the reliability and predictive validity of the PP-ACT. METHODS We conducted two studies (one cross-sectional, one longitudinal over three months) that surveyed caregivers (N = 1622) of children with asthma. Caregivers completed the PP-ACT and a variety of other measures, including child health outcomes. RESULTS We found clear evidence that the five-item PP-ACT assesses two distinct constructs: Items 1-4 (which we call the PP-ACT4) assess symptoms, impairment, and use of a short acting beta-2 blocker (albuterol); Item 5 assesses caregivers' global subjective assessment of their child's asthma control. In addition, the two constructs function as unique predictors of asthma outcomes. Both the PP-ACT4 and Item 5 predicted unique variance in ED visits, the number of symptom-free days, and child quality of life. Only the PP-ACT4 predicted frequency of ICS use and only at Time 1 in Study 1. Conversely, Item 5 predicted exacerbation frequency whereas the PP-ACT4 did not. CONCLUSION Our findings suggest that researchers and clinicians should treat the PP-ACT4 and Item 5 as distinct indicators of asthma control because they differentially predict asthma outcomes and likely have distinct meanings to caregivers. Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2022.2036755 .
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Affiliation(s)
- James A Shepperd
- University of Florida, Psychology, Gainesville, 32611 United States
| | | | | | - David Fedele
- University of Florida College of Public Health and Health Professions, Clinical & Health Psychology, Gainesville, 32611 United States
| | | | - Jean Hunleth
- Washington University in Saint Louis School of Medicine, Surgery, Saint Louis, 63110-1010, United States
| | - Erika A. Waters
- Washington University in Saint Louis School of Medicine, Surgery, Saint Louis, 63110-1010, United States
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Ruiz S, Waters EA, Maki J, Fedele DA, Pogge G, Shepperd JA, Hunleth J. Towards emplaced understandings of risk: How caregivers of children with asthma identify and manage asthma-related risk across different places. Health Place 2022; 75:102787. [PMID: 35306275 PMCID: PMC10543977 DOI: 10.1016/j.healthplace.2022.102787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/05/2023]
Abstract
In the United States, pediatric asthma is distributed geographically across lines of racialized segregation. We draw on emplacement, or the theory that embodied experiences and the material world are mutually informed, to situate such geographic trends within the narratives of 41 caregivers of children with asthma. Results suggest that caregivers identified and managed asthma-related risk with regard to the relational and structural conditions of three categories of locations: (1) houses, (2) neighborhoods, and (3) schools and other childhood institutions. Within each type of location, caregivers used emplaced knowledge and emplaced caregiving tactics to respond to asthma-related risk. Based on our findings, we identify critical intervention topics that are consistent with families' everyday lived experiences of place.
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Affiliation(s)
- Sienna Ruiz
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States.
| | - Erika A Waters
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Julia Maki
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - David A Fedele
- Department of Clinical and Health Psychology, University of Florida, United States
| | - Gabrielle Pogge
- Department of Psychology, University of Florida, United States
| | | | - Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
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Spray J, Hunleth J, Ruiz S, Maki J, Fedele DA, Prabhakaran S, Fechtel H, Shepperd JA, Bowen DJ, Waters EA. How do embodied experiences of asthma influence caregiver conceptual models? Soc Sci Med 2022; 294:114706. [PMID: 35033796 PMCID: PMC10389678 DOI: 10.1016/j.socscimed.2022.114706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/05/2023]
Abstract
RATIONALE Many studies propose that patients', caregivers', and children's asthma management practices may diverge from biomedical recommendations because their understandings of asthma (i.e., conceptual models) are different from biomedical perspectives. However, little research in this area has examined conceptual models of asthma using embodiment theory, which suggests that caregivers' and children's experiences of the physical body shape their perspectives and consequent management strategies. OBJECTIVE We investigated how two embodied processes of symptom perception-detection and interpretation-may influence caregiver or patient conceptions of asthma. METHODS We interviewed 41 caregivers of children with asthma in Gainesville, Florida, and St. Louis, Missouri, and conducted ethnographic visits or virtual interviews with 19 children with asthma aged 6-16. RESULTS Four aspects of asthma's embodied experience shaped conceptual models via processes of detection and interpretation: 1) symptoms are experienced in the context of other bodily processes; 2) acute symptoms and exacerbations are more salient than their absence; 3) the embodied experience of asthma is one of integrated physiological and emotional processes; and 4) caregivers and children acquire embodied practices of perceiving symptoms that produce embodied knowledge. CONCLUSION Participant narratives suggest that embodied experiences of asthma shape caregivers' and children's understandings of asthma in ways that differ from the biomedical model. We argue that a focus on embodied experiences may provide important ground for mutual understanding and communication between providers and caregivers and/or patients.
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Affiliation(s)
- Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Sienna Ruiz
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - Julia Maki
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, United States
| | | | - Hannah Fechtel
- Department of Psychology, University of Florida, United States
| | | | - Deborah J Bowen
- School of Public Health, University of Washington, United States
| | - Erika A Waters
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, United States.
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