Caregiver Asthma Knowledge, Aptitude, and Practice in High Healthcare Utilizing Children: Effect of an Educational Intervention

Abstract

Factors underlying high healthcare utilization among Hispanic and African American (AA) children with asthma are not well known. We hypothesized that low parental knowledge and suboptimal practices are associated with high healthcare utlization and sought to elucidate these factors and identify ethnicity-specific differences. We also hypothesized that a targeted educational intervention will decrease emergency department (ED) visits and hospitalizations. A 57-item questionnaire investigating asthma knowledge, aptitude, and practice was administered during a hospitalization to 268 caregivers (158 Hispanic and 110 AA) of high healthcare utilizer children. Responses were compared between ethnicities. Participants were randomized into an education group and a control group to investigate the impact of an in-hospital educational intervention on future ED visits and hospitalizations. More than 80% of caregivers knew that asthma is associated with muscle constriction and mucus production. Overall, 66.7%-86.9% of caregivers found preventive steps including allergen avoidance, regular primary care physician (PCP) follow-up, and medication adherence helpful, but only 45.2% reported adherence to controller medications. Similarly, caregivers found management steps, including albuterol use, avoidance of ineffective medications, and need to contact PCP helpful but 33% Hispanic caregivers contacted their child's PCP at the time of the exacerbation leading the current hospitalization, compared with 17% AA caregivers (P = 0.006). Moreover, 40% and 30% Hispanic and 27% and 18% AA caregivers felt stressed and helpless, respectively, about their child's asthma. Despite high baseline levels of knowledge, there were fewer ED visits in the education group (1.56 -1.94) compared with the control group (2.05 -2.32) (P = 0.02) 2 years after the intervention. Although Hispanic and AA caregivers of children with high healthcare utilization were knowledgeable of asthma pathophysiology, and preventive and management steps, they reported being stressed and helpless and were unable to implement the steps at the time of an exacerbation, seeking care at the ED rather than contacting their PCP. The high health utilizers who underwent a targeted educational intervention had fewer ED visits 2 years following the intervention.

Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review

“…Parents, including parents of ethnic minorities [43] need guidance to interpret information, and translate it into knowledge in order to facilitate their judgment about the severity of their child's disease in order to support the child to act in accordance to need [19,44]. Another contributing factor to medical non-adherence is parental motivation and their belief in their child's asthma medication [4].…”

Health issues in Hispanic/Latino youth.

“…Reported depression and anxiety is high among caregivers of children with asthma (Silver, Warman, & Stein, 2005; Szabo, Mezei, Kovari, & Cserhati, 2010), and is associated with higher number of unscheduled health care visits (Spurrier NJ et al, 2003). While some of these factors are typical to residence in urban inner-city neighborhoods and do not differ between Hispanics/Latinos and African Americans (Rastogi D, Madhok N, & Kipperman S, 2013), others including language barrier (Mosnaim GS et al, 2007), influence the quality of care provided to Hispanic/Latino families. However, several intervention studies have demonstrated improvement in adherence with appropriate education and follow-up (Rastogi D et al, 2013; Spiegel J et al, 2006).…”

Efficacy of asthma education program on asthma control in children with uncontrolled asthma

“…Education has a primary role in asthma management and the role of education has been assesed in asthma control in previous studies [13][14][15][16][17][18] . Asthma education programs in these studies are different in their nature by means of population, intervention and duration.…”

“…Education of caregivers help their control of home environment and their childrens'asthma signs and symptoms 17 . Asthmatic children whose caregivers underwent a targeted education were found to have fewer emergency department visits 15 . But there is also a study in the literature that indicates educational intervention is not beneficial when targeted to only caregivers 14 .…”

“…Education programs are effective in asthma control because they change the behavior of the patients and caregivers on medication and help improvement of adherence, acute attack management and avoidance of triggers [15][16][17][23][24] .…”