A multilevel perspective on goals, barriers, and facilitators of school-based asthma management

Abstract

Background

School based asthma care is being increasingly used to combat uncontrolled pediatric asthma.

Objective

The purpose of these secondary analyses was to explore multi-level perspectives regarding school-based asthma medical management for inner city, school-aged children with poor asthma control.

Methods

Sixty-six participants from two large U.S. urban school districts and key stakeholders participated in 1:1 interviews and focus groups. Participants were selected from across the asthma care community (children/caregivers, school personnel, nurses, pharmacists, healthcare providers, and administrators/insurers). Qualitative and descriptive techniques were used to analyze data.

Results

Goals: Children/caregivers prioritized living a normal active life with few asthma worries. Other stakeholders prioritized reducing student’s asthma related emergency room visits and lost learning time. Facilitators: Continuity of care, strong relationships between care community members, and incentivizers were commonly suggested facilitators. School-based asthma management was viewed as a strong facilitator, particularly in the presence of a full-time school nurse. Barriers: Four themes were identified. (1) Greater systems and policy support for asthma management is needed in general, and at school in particular. (2) Overburdened families and systems often operate in crisis-mode, and asthma management is often not a priority until crisis is reached. (3) Discordance and distrust between members of the asthma care community can hinder shared asthma management. (4) Better communication is needed at all levels to improve care.

Conclusion

Moving away from a crisis-based approach to asthma management for high-risk children will require increased systemic support for proactive asthma care and optimized communication within the asthma care community.

Supplemental data for this article is available online at https://dx.doi.org/10.1080/02770903.2021.2018704

Keywords:

• Asthma
• self-management
• children
• school-based care
• barriers

Acknowledgements

The researchers would like to thank the many individuals who contributed to this work. The content is based solely on the perspectives of the authors and do not necessarily represent the official views of the National Institutes of Health or other sponsors.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

None. E.C.S. and C.M.M. were supported by a Ruth L. Kirschstein National Research Service Award (T32NR014225), Ohio State University.

Quality in qualitative research statement

This study used COREQ criteria for reporting qualitative findings.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.