At-Home Asthma Education is Necessary for Low-Income and Minority Families

There is a need for ongoing child and family education to improve asthma control for low-income, minority children with asthma, reported researchers in Baltimore, Maryland with Johns Hopkins and the University of Maryland.

The qualitative study of low-income, minority children with poorly controlled asthma, between the ages of 7-12, determined that there were “significant knowledge gaps,” which suggested the need for more aggressive self-management education to fill in those gaps with accurate asthma control knowledge.

Melissa H. Bellin, PhD (pictured), the School of Social Work at the University of Maryland, and colleagues began their interdisciplinary study, funded by the National Institute of Nursing Research and the National Institutes of Health, recognizing that there was little knowledge available concerning “asthma home management from the perspective of poor, minority children.”

Bellin noted that previous studies confirmed the existence of significant health disparities in asthma control and treatment and that “children of minority groups — particularly those residing in urban poor environments – “are in a disproportionately higher risk group and have higher incidences of asthma morbidity and mortality and decreased asthma control in comparison to other asthma populations.”

The study theorized that the cause of increased morbidity and mortality and decreased control of asthma may stem from the fact that non-white, lower-income children with asthma are less likely to have asthma management plans, and may not be receiving sufficient asthma home management education to control asthma exacerbations.

The study was completed in cooperation with an ongoing 12-month randomized control trial from Johns Hopkins and the University of Maryland, which examined increased Short-Acting Beta-Antagonist, or “rescue inhaler,” use by inner-city children with persistent asthma and high emergency department intervention for asthma symptoms.

Members of the research team interviewed a total of 24 families from the previous study between July and October 2015. The population selected for inclusion in the qualitative study was low-income, inner city, African-American children between the ages of 7-12 with a diagnosis of persistent asthma.

Using a focus-group method, children were interviewed using a standardized script designed to “elicit reflections on living with asthma and to draw out child perspectives of the range of barriers and facilitators to asthma management at home and in the broader social context.” Interview questions centered on home stability, medication use, and second-hand smoke exposure and the children’s responses were analyzed for trends, themes, and subthemes to produce qualitative data for analysis.

Bellin and fellow researchers discovered that many of the children had frequent instability in housing — their families moved frequently or had regularly changed sleeping locations. According to Bellin, “Transitions in households created an extra burden in asthma management, because children and caregivers had to remember to bring medications and devices to each location.” Frequent changes in living situations revealed emotional impacts as well as asthma-related health impacts for children, particularly in the area of asthma medication administration.

Data also revealed that nearly two-thirds of the children interviewed (61.5%) were routinely exposed to second-hand smoke from family members or neighbors in multi-family apartment structures, or via frequent public exposure to smoke. Many interviewees also reported that their uncontrolled asthma had limited their recreational and social activities, placing a burden on the children’s psychological well-being, with many children reporting that health concerns prohibited them from playing, visiting relatives, or participating in sports.

Secondary themes that emerged from the interviews were the need for families to develop self-management strategies to deal with asthma triggers and exacerbations, medication storage and routine, and symptom management. Bellin remarked that there was evidence of misinformation about the need for routine, the nature of triggers, and the need for symptom management in children’s responses to many of the questions.

The team suggested that education was imperative in order for children in low-income minority families establish better asthma control and decrease the emotional and physical stress, particularly on:

· The benefits of housing stability

· Second-hand smoke dangers

· Proper asthma self-management skills

· Establishment of individualized self-management plans

Bellin and colleagues proposed that their study revealed real-life attitudes and practices in the home, and advanced the “understanding of the experience of asthma home management from the perspective of young, urban poor children.” The study results showed that the difficulties of asthma home management is particularly challenging for this group, and recommended the development of, and use of, multi-faceted education programs to help ease asthma burden in this high-risk population.

The article “Asthma Home Management in the Inner-City: What can the Children Teach us?” was published in the May-June 2017 issue of the Journal of Pediatric Health Care.

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