A study of the relationships among maternal caregiver family management behaviors, childhood asthma morbidity, and asthma control
Childhood asthma, the most common chronic childhood condition, is associated with high rates of asthma morbidity (emergency department visits, hospitalizations, and school days missed due to asthma). Inadequate asthma control accounts for $1.9 billion annual health expenditures. Numerous studies have identified the relationship of the family caregiver's perception regarding asthma management and the child's asthma outcomes; though few have examined family caregiver asthma management behaviors. Knafl and colleagues (2003) defined family management behaviors as accommodations that family members use to manage the condition on a daily basis. The primary aim of this study was to examine the relationship among family management behaviors, such as condition management ability and condition management effort; asthma morbidity; and asthma control from the perception of maternal caregivers.
A total of 101 maternal caregivers of school-aged children diagnosed with persistent asthma were recruited from a specialty asthma clinic. Data were obtained through maternal caregiver self-report and included demographics, asthma morbidity, asthma control (Asthma Control Questionnaire (ACQ), and family management behaviors (effort and ability subscales, Family Management Measure). Data were analyzed using correlations and regressions.
Data analysis (N =101) indicated 94% of maternal caregivers are mothers, while the majority currently work outside the home (57%). Children were 53% male, had an average age of 8.9 (range 5-12) and 66% were minority. 54% of the children had poor control as determined by the ACQ (using score of >1.5 to indicate poor control) and 62% had greater than one emergency department visit or hospitalization during the past year. Effort positively correlated with asthma control ( r = .426, p = .001) and school days missed (r = .259, p = .010) while ability negatively correlated with hospitalizations (r = - .206, p = .039). When controlling for minority, income, and work status, effort is predictive of school days missed (β = .920, p = .020) and asthma control (β = .253, p = .028) and ability is predictive of asthma control (β = -.238, p = .037).
Minority status, income, and work status correlated with emergency department visits, school days missed and asthma control; thus confirming what has been previously published in the literature. When caregivers perceived they were expending a lot of effort on their child's asthma management and were not confident in their ability to perform asthma management activities, the child's asthma outcomes were worse. This indicates the need to focus more interest on perceptions of maternal caregivers.
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