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Al-Zayadneh E, Al-Darraji G, Momani A, Sa'ed RA, Abu Qutaish AF, Algallab N, Alzayadneh EM, Alrowwad KA, Alhalaki MM, Al-Iede M. Parental knowledge and attitudes toward asthma in Jordanian children with asthma, a multi-center cross-sectional study. J Asthma 2024; 61:501-510. [PMID: 38047590 DOI: 10.1080/02770903.2023.2289165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE We explored Jordanian caregivers' knowledge, attitudes, and practices (KAP) toward asthma in their children. METHODS This cross-sectional investigation was conducted on caregivers visiting the pediatrics clinic at the Jordan University Hospital and King Abdullah University Hospital between December 2021 and January 2023. KAP were measured using a literature-validated questionnaire. Differences in KAP scores across participants' characteristics were examined using the student-t test and ANOVA. RESULTS A total of 108 caregivers were included in the final analysis. Caregivers were aged 30 to 40 years (54.6%) and had at least secondary education (90.7%). The majority of participants displayed appropriate knowledge with respect to asthma's clinical course. Furthermore, the greater portion of caregivers were knowledgeable about preventing asthma attacks and treating their children during said attacks. Factors affecting knowledge of asthma included age of mothers (p < .05). On the other hand, attitude scores were affected by occupation, type of medication, and family history of asthma (all p < .05). Moreover, employee mothers, children well controlled on both Asthma Control Test and Global Initiative for Asthma scores, and having no pediatric intensive care unit admissions were associated with higher practice treatment scores (all p < .05). Overall practice score was weakly, yet positively correlated with knowledge scores (r = 0.195, p = .043). Similarly, negative attitudes were weakly correlated with higher knowledge scores (r = 0.199, p = .039). CONCLUSION While the knowledge and practice scores were satisfactory, the clinical status of children with asthma was unsatisfactory. Future studies should examine factors associated with caregiver insecurity and measure their extent of applying asthma prevention guidelines.
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Affiliation(s)
- Enas Al-Zayadneh
- Department of Pediatrics, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Ameera Momani
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | | | - Eba M Alzayadneh
- Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Montaha Al-Iede
- Department of Pediatrics, School of Medicine, The University of Jordan, Amman, Jordan
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Asthma Management in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:9-18. [PMID: 36334702 DOI: 10.1016/j.jaip.2022.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
Asthma is a common, complex heterogeneous disease often beginning in early life and is characterized by reversible airflow obstruction. The phenotypic differences that exist in children with asthma may impact underlying comorbid conditions and pharmacologic treatment choices. Prenatal factors for increased risk of asthma could include maternal diet and the maternal microbiome. Evidence also suggests that postnatal microbial exposures and colonization contribute to the risk of allergic diseases and asthma. After confirming the diagnosis, asthma management in children centers on 3 broad areas: pharmacologic treatment, treatment of underlying comorbidities, and education of the patient and caregivers on the importance of adherence and device technique. Moreover, social determinants of health significantly impact on symptom burden and treatment response.
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Zhai S, Chu F, Tan M, Chi NC, Ward T, Yuwen W. Digital health interventions to support family caregivers: An updated systematic review. Digit Health 2023; 9:20552076231171967. [PMID: 37223775 PMCID: PMC10201006 DOI: 10.1177/20552076231171967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023] Open
Abstract
Objective Chronic diseases are the leading causes of death and disability in the U.S., and disease management largely falls onto patients' family caregivers. The long-term burden and stress of caregiving negatively impact caregivers' well-being and ability to provide care. Digital health interventions have the potential to support caregivers. This article aims to provide an updated review of interventions using digital health tools to support family caregivers and the scope of the Human-Centered Design (HCD) approaches. Methods We conducted a systematic search on July 2019 and January 2021 in PubMed, CINAHL, Embase, Cochrane Library, PsycINFO, ERIC, and ACM Digital Library, limiting to 2014-2021 to identify family caregiver interventions assisted by modern technologies. The Mixed Methods Appraisal Tool and the Grading of Recommendations Assessment, Development and Evaluation were used to evaluate the articles. Data were abstracted and evaluated using Rayyan and Research Electronic Data Capture. Results We identified and reviewed 40 studies from 34 journals, 10 fields, and 19 countries. Findings included patients' conditions and relationships with family caregivers, how the technology is used to deliver the intervention, HCD methods, theoretical frameworks, components of the interventions, and family caregiver health outcomes. Conclusion This updated and expanded review revealed that digitally enhanced health interventions were robust at providing high-quality assistance and support to caregivers by improving caregiver psychological health, self-efficacy, caregiving skills, quality of life, social support, and problem-coping abilities. Health professionals need to include informal caregivers as an essential component when providing care to patients. Future research should include more marginalized caregivers from diverse backgrounds, improve the accessibility and usability of the technology tools, and tailor the intervention to be more culturally and linguistically sensitive.
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Affiliation(s)
- Shumenghui Zhai
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Frances Chu
- School of Nursing, University of Washington, Seattle, WA, USA
- Providence Health System, Swedish First Hill, Seattle, WA, USA
| | - Minghui Tan
- School of Nursing, Peking Union Medical University, Beijing, China
| | - Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Teresa Ward
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Weichao Yuwen
- School of Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA
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Lu MA, Eckmann T, Ruvalcaba E, McQuaid EL, Rand CS, Riekert KA, Eakin MN. Family management of asthma in Head Start preschool children. Ann Allergy Asthma Immunol 2022; 128:178-183. [PMID: 34774736 PMCID: PMC8810596 DOI: 10.1016/j.anai.2021.11.002] [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: 07/22/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Urban minority preschool children are disproportionately affected by asthma with increased asthma morbidity and mortality. It is important to understand how families manage asthma in preschool children to improve asthma control. OBJECTIVE To evaluate family asthma management and asthma outcomes among a low-income urban minority population of Head Start preschool children. METHODS The family asthma management system scale (FAMSS) evaluates how families manage a child's asthma. A total of 388 caregivers completed the FAMSS at baseline. Asthma outcomes were evaluated at baseline and prospectively at 6 months, including asthma control (based on the Test for Respiratory and Asthma Control in Kids), courses of oral corticosteroids (OCSs) required, and caregiver health-related quality of life (Pediatric Asthma Caregiver's Quality of Life Questionnaire [PACQLQ]). Multiple regression models evaluated the relationship between the FAMSS total score, FAMSS subscales, and asthma outcomes. RESULTS Higher FAMSS total scores were associated with fewer courses of OCSs required (b = -0.23, P < .01) and higher PACQLQ scores (b = 0.07, P < .05). At baseline, higher integration subscale scores (b = -0.19, P < .05) were associated with fewer courses of OCSs required, and higher family response scores were associates with higher PACQLQ scores (b = 0.06, P < .05). Nevertheless, higher collaboration scores were associated with lower PACQLQ at baseline (b = -0.06, P < .05) and 6 months (b = -0.07, P < .05). CONCLUSION Among this population of low-income minority preschool children, understanding how a family manages their child's asthma may help identify gaps for education to possibly improve caregiver asthma-related quality of life and reduce courses of OCSs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01519453 (https://clinicaltrials.gov/ct2/show/NCT01519453); protocol available from meakin1@jhmi.edu.
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Affiliation(s)
- Monica A Lu
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Eckmann
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island; Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Cynthia S Rand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Prather SL, Foronda CL, Kelley CN, Nadeau C, Prather K. Barriers and Facilitators of Asthma Management as Experienced by African American Caregivers of Children with Asthma: An Integrative Review. J Pediatr Nurs 2020; 55:40-74. [PMID: 32653828 DOI: 10.1016/j.pedn.2020.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION African American children with asthma demonstrate significant health disparities and poor health outcomes. Understanding the burdens faced by parents and caregivers of children with asthma may be helpful to develop future interventions to address this disparity. PURPOSE The purpose of this integrative review was to reveal the barriers and facilitators of child asthma management experienced by African American caregivers. METHOD Whittemore and Knafl's (2005) method of integrative review was used to review 40 articles. The integrative review involved appraising the quality of the literature, conducting a thematic analysis, and evaluating the barriers and facilitators of pediatric asthma management experienced by African American caregivers. RESULTS Barriers and facilitators were identified as themes. Barriers included caregiver burdens, and lack of home and neighborhood safety. Facilitators were family and community support, education and empowerment, and culturally competent healthcare providers. DISCUSSION To improve the care of African American children with asthma, nurses should work to engage, communicate, and foster trust with families. Nurses should assess and address the family caregivers' burdens while emphasizing support systems.
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Affiliation(s)
- Susan L Prather
- University of Miami, School of Nursing and Health Studies, FL, United States of America.
| | - Cynthia L Foronda
- University of Miami, School of Nursing and Health Studies, FL, United States of America.
| | - Courtney N Kelley
- University of Miami, School of Nursing and Health Studies, FL, United States of America.
| | - Catherine Nadeau
- University of Miami, School of Nursing and Health Studies, FL, United States of America.
| | - Khaila Prather
- Department of Public Health Sciences, University of Miami Miller School of Medicine, FL, United States of America.
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Lion KC, Zhou C, Ebel BE, Penfold RB, Mangione-Smith R. Identifying Modifiable Health Care Barriers to Improve Health Equity for Hospitalized Children. Hosp Pediatr 2020; 10:1-11. [PMID: 31801795 PMCID: PMC6931033 DOI: 10.1542/hpeds.2019-0096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children from socially disadvantaged families experience worse hospital outcomes compared with other children. We sought to identify modifiable barriers to care to target for intervention. METHODS We conducted a prospective cohort study of hospitalized children over 15 months. Caregivers completed a survey within 3 days of admission and 2 to 8 weeks after discharge to assess 10 reported barriers to care related to their interactions within the health care system (eg, not feeling like they have sufficient skills to navigate the system and experiencing marginalization). Associations between barriers and outcomes (30-day readmissions and length of stay) were assessed by using multivariable regression. Barriers associated with worse outcomes were then tested for associations with a cumulative social disadvantage score based on 5 family sociodemographic characteristics (eg, low income). RESULTS Of eligible families, 61% (n = 3651) completed the admission survey; of those, 48% (n = 1734) completed follow-up. Nine of 10 barriers were associated with at least 1 worse hospital outcome. Of those, 4 were also positively associated with cumulative social disadvantage: perceiving the system as a barrier (adjusted β = 1.66; 95% confidence interval [CI] 1.02 to 2.30), skill barriers (β = 3.82; 95% CI 3.22 to 4.43), cultural distance (β = 1.75; 95% CI 1.36 to 2.15), and marginalization (β = .71; 95% CI 0.30 to 1.11). Low income had the most consistently strong association with reported barriers. CONCLUSIONS System barriers, skill barriers, cultural distance, and marginalization were significantly associated with both worse hospital outcomes and social disadvantage, suggesting these are promising targets for intervention to decrease disparities for hospitalized children.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics and
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and
| | - Chuan Zhou
- Department of Pediatrics and
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and
| | - Beth E Ebel
- Department of Pediatrics and
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Rita Mangione-Smith
- Department of Pediatrics and
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and
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Pate CA, Qin X, Bailey CM, Zahran HS. Cost barriers to asthma care by health insurance type among children with asthma. J Asthma 2019; 57:1103-1109. [PMID: 31343379 DOI: 10.1080/02770903.2019.1640730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Children with asthma have ongoing health care needs and health insurance is a vital part of their health care access. Health care coverage may be associated with various cost barriers to asthma care. We examined cost barriers to receiving asthma care by health insurance type and coverage continuity among children with asthma using the 2012-2014 Child Asthma Call-back Survey (ACBS).Methods: The study sample included 3788 children under age 18 years with current asthma who had responses to the ACBS by adult proxy. Associations between cost barriers to asthma care and treatment were analyzed by demographic, health insurance coverage, and urban residence variables using multivariable logistic regression models.Results: Among insured children, more blacks reported a cost barrier to seeing a doctor (10.6% [5.9, 18.3]) compared with whites (2.9% [2.1, 4.0]) (p = 0.03). Adjusting for demographic factors (sex, age, and race), uninsured and having partial year coverage were associated with cost barrier to seeing a doctor (adjusted prevalence ratio aPR = 8.07 [4.78, 13.61] and aPR = 6.58 [3.78, 11.45], respectively) and affording medication (aPR = 8.35 [5.23, 13.34] and aPR = 4.93 [2.96, 8.19], respectively), compared with children who had full year coverage. Public insurance was associated with cost barrier to seeing a doctor (aPR = 4.43 [2.57, 7.62]), compared with private insurance.Conclusions: Having no health insurance, partial year coverage, and public insurance were associated with cost barriers to asthma care. Improving health insurance coverage may help strengthen access to and reduce cost barriers to asthma care.
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Affiliation(s)
- Cynthia A Pate
- 2M Research, LLC Contractor to Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xiaoting Qin
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cathy M Bailey
- Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hatice S Zahran
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
Health care disparities exist along the continuum of care for children admitted to the hospital; they start before admission, impact hospital course, and continue after discharge. During an acute illness, risk of admission, length of stay, hospital costs, communication during family-centered rounds, and risk of readmission have all been shown to vary by socioeconomic status, race, and ethnicity. Understanding factors beyond the acute illness that increase a child's risk of admission, increase hospital course complications, and lower discharge quality is imperative for the new generation of pediatric hospitalists focused on improving health for a population of children. In this article, we describe a framework to conceptualize socioeconomic, racial, and ethnic health disparities for the hospitalized child. Additionally, we offer actions pediatric hospitalists can take to address disparities within their practices.
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Affiliation(s)
- Shaunte McKay
- Department of Pediatrics, Duke University Hospital, Durhan, North Carolina
| | - Victoria Parente
- Department of Pediatrics, Duke University Hospital, Durhan, North Carolina
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