Student perspectives on asthma management in schools: a mixed-methods study examining experiences, facilitators, and barriers to care

Abstract

Objective: Children spend nearly a third of their day at school, making it a critical point of intervention for those with asthma. This study aimed to illuminate minority students’ experiences with asthma at school and perceptions of facilitators and barriers to care. Methods: A mixed-methods study was conducted with elementary students with asthma. Participants completed a 24-question survey, drawing exercise to depict experiences caring for their asthma at school, and focus group discussion. Drawings were analyzed for narrative and pictorial themes. Discussions were audio-recorded, transcribed, and independently coded for themes. Results: Fifteen children with asthma (8–11 years) participated from two Chicago schools with predominately African-American populations. Most students (79%) indicated they had control of asthma at school, while 85% identified asthma as a problem when exercising. Half (53%) received help with asthma care at school. Drawings depicted cooperative management with adults or peers and the central role of inhalers as part of everyday asthma care in school. Finally, focus groups produced six key themes within the domains of facilitators: 1) support of others, 2) self-efficacy; 3) perception of being normal; and barriers: 4) lack of support from others; 5) difficulty accessing inhaler; 6) perception of being different. Conclusions: This study suggests asthma care plays an important role in students’ school experiences. Stigma around inhaler use, lack of concern by school staff, and limited access to medications remain as barriers to school-based asthma management. Although facilitators, such as support from teachers and peers, do exist, future interventions must address existing barriers.

Keywords:

• Children
• drawings
• human-centered design
• self-management
• youth

Acknowledgements

The authors would like to acknowledge the students and parents involved in this study for their willingness to participate. We would also like to thank the staff at the two schools involved in this study for helping coordinate the sessions, particularly Syrennia Hanshaw and Susan Taylor.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

All phases of this study were supported by The University of Chicago Medicine Institute for Translational Medicine Community Benefit Grant. The REDCap project at the University of Chicago is hosted and managed by the Center for Research Informatics and funded by the Biological Sciences Division and by the Institute of Translational Medicine, CTSA grant number UL1 TR000430 from the National Institutes of Health. J.N. was supported by the National Heart Lung and Blood Institute under Award Number R25HL096383-08. A.V. was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR000431. V.G.P. was supported by the National Heart Lung and Blood Institute under Award Number K23 HL118151. The remaining authors received no funding.