Research and commentary

Why it is important to engage children and young people in managing their asthma

Implications of studies into neonatal, child and adolescent health

Implications of studies into neonatal, child and adolescent health

Asthma
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Searle A, Jago R, Henderson J et al (2017) Children’s, parents' and health professionals’ views on the management of childhood asthma: a qualitative study. npj Primary Care Respiratory Medicine. 27, 1, 53. doi: 10.1038/s41533-017-0053-7

Aim

This study aimed to explore the perspectives of children, parents and health professionals on the management of childhood asthma.

Method

Qualitative face to face semi-structured interviews were conducted during 2015-16 in the south west of England to understand topics such as the experience of childhood asthma, symptoms and management .

Findings

Thirteen primary and secondary care health professionals, and nine parents and children aged 6-8 years, took part. Themes presented in this paper were common across all key stakeholder interviews. The themes are:

Child and parent awareness of symptoms

Although children demonstrated a good understanding and self-awareness of their asthma-related symptoms, parents found it difficult to distinguish these from breathlessness associated with exercise.

Health professionals thought that parents tended to over-protect their children, for example by limiting their activities, and this was a barrier to effective management.

According to GPs, children were ‘normalising’ their symptoms and therefore not seeking support or showing the same level of concern as their parents.

Management and child well-being

Frequent absence from school was commonly reported by parents and, from the children’s perspectives, this meant the continuity of learning was being affected.

Lack of parental knowledge about prophylactic therapy was seen by health professionals as the reason for non-adherence.

Parents’ reports aligned with this view in that they reported a lack of clarity regarding medication and its purpose.

Professional communication, education and consultation with families

Concordance of treatment was also affected by:

  • Limited time and lack of regular appointments to outline a full education programme
  • Children and parents had differing ideas of consistency of treatment 
  • Lack of effective communication with children and parents in consultations

Conclusion

Increased participation or engagement by children in consultations could help to optimise asthma management.

The study recommends that health professionals encourage child and parent management strategies in written asthma management plans.

Children and young people need to be engaged in asthma treatment

Despite clear guidelines and recommendations for the education of and inclusion of patients in the development of personalised asthma self-management plans (British Thoracic Society and Scottish Intercollegiate Guideline Network 2016, Royal College of Physicians 2014), national audits report continued and unacceptable asthma-associated morbidity and mortality in the UK (Royal College of Physicians 2014, Hagell et al 2017).

Although, as the authors acknowledge, the findings of this paper are limited in their application to higher income families and health services outside of south west England, they are similar to those of other studies into the subject conducted over the past 15 years.

Personalised asthma management plans based on the personal goals and treatment preferences of children and young people, and their parents, can improve the asthma-related quality of life for this population (Royal College of Physicians 2014).

As identified by Searle et al (2017), barriers to developing personalised asthma management plans can include short lengths of consultation, the infrequency of consultations, lack of parent and child knowledge and understanding, and poor communication between healthcare providers and patients.

These barriers to self-care support and knowledge development are not easily overcome in a pressured environments, particularly in primary care settings, when time and education programmes are needed to support the plans’ success.

Structured self-care support programmes could provide the recommended education and self-care skills development.

This research makes it clear that children and young people need to be engaged either in infrequent consultations or more structured educational programmes. For these interventions to succeed healthcare professionals require the understanding and skills to promote engagement and support.   

 


About the author

Linda Milnes is associate professor of children and young people’s nursing, School of Healthcare, University of Leeds. This article is written on behalf of the RCN’s Research in Child Health community

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