1.) Was this a qualitative or quantitative study? 2.) What was the sample size for the study? 3.) What percent of the sample had children who were at least school age? 4.) What percent of the sample had children who were five years old or younger? 5.) What type of sampling method was used and why? 6.) Was the probability or non-probability sampling and what is the difference in these two sampling methods? 7.) Look at the variables in table 2. What level of measurement are they? 8.) What is the difference between sampling error and sampling bias? Which one is very concerning to researchers?

Sorry the article is attached backwards.

ORIGINAL ARTICLE Parental Perceptions of Their Child's ABSTRACT Introduction: Adequate treatment for asthma depends on accurate as- sessment and intervention by the parent and child and timely com Asthma: Management munication with the provider. These actions by the parent may be af- fected by their understanding of asthma management and their con- and Medication Use cerns about medications being pre- scribed. This research reports parental experiences with their chil- dren with asthma, specifically their Kathleen Peterson-Sweeney, MS, CPNP, Ann beliefs, knowledge, and attitudes about asthma management, includ McMullen, MS, CPNP, H. Lorrie Yoos, PhD, CPNP, & ing medication use. Harriet Kitzman, PhD, RN Methods: Data reported are from a study investigating parental attitudes and beliefs affecting antiinflamma tory medication use in childhood asthma. These qualitative findings emerged from one-on-one semi- M. structured qualitative interviews Lorbidity and mortality resulting from childhood asthma continue with 18 parents of children 2 to 18 to rise at alarming rates despite an improved understanding of the basic years of age who were from diverse pathophysiology of asthma and the availability of increasingly effective racial and socioeconomic back- therapies. Perhaps more than any other illness, asthma necessitates an on- grounds and who represented the going partnership and communication between health care providers and spectrum of illness severity. the patient and family for optimal treatment to take place (Warman, 2000). Results: Eight main themes within For this partnership to work, patients/ families and health care providers the domain of asthma management need to have a common understanding of the nature of asthma, treatment and medication use were identified: goals, the role of medications, and self-management practices. "I know my child," "trial and error," Healthy People 2010 confidently states that "most of the problems caused "partnership," "need for education," by asthma could be averted if persons with asthma and their health care 'negotiating responsibility," "hassles with medication administration," providers managed the disease according to established guidelines" (Na- "preferences," and "the benefits tional Institutes of Health). The National Heart, Lung and Blood Institute outweigh the risks of side effects." (NHLBI) of the National Institutes of Health has established guidelines for Discussion: These themes empha the diagnosis and management of asthma (NHLBI, 1997). These guidelines size parents' need to partner with include goals for asthma management, as well as the following four key providers in their child's asthma management, as well as their need for ongoing asthma education. Par- ents also expressed concern about Kathleen Peterson-Sweeney is a Pediatric Nurse Practitioner and Associate Professor of Nursing, SUNY Col- adverse effects of antiinflammatory lege at Brockport, and a Doctoral Student at the University of Rochester School of Nursing, New York. medication but acknowledged the Ann McMullen is a Pediatric Nurse Practitioner in Pediatric Pulmonologistrong Children's Hospital and importance of controlling asthma Associate Professor of Clinical Nursing, University of Rochester School of Nursing, New York. symptoms. Based on these findings, H. Lorrie Yoos is a Pediatric Nurse Practitioner, Pediatric Primary Care Practice, Strong Children's Hospital, and Associate Professor of Nursing, University of Rochester School of Nursing, New York. systematic practice changes are rec- Harriet Kitzman is Associate Professor of Nursing, University of Rochester School of Nursing, New York. ommended that provide regular op- Supported by Grant No. RO3 HS10689 from the Agency for Healthcare Research and Quality. portunities for parent and child Reprint requests: Kathleen Peterson-Sweeney, MS, CPNP, Department of Nursing, 350 New Campus Dr, asthma education in a structured Brockport, NY 14420; e-mail: Kathleen_Peterson-Sweeney@urmc.rochester.edu. asthma wellness or "tune-up" visit. Copyright @ 2003 by the National Association of Pediatric Nurse Practitioners. Pediatrealth Care. (2003). 17, 0891-5245/2003/$30.00 + 0 118-125. doi: 10.1067/mph.2003.31 1 18 May/June 2003HI ORIGINAL ARTICLE Peterson-Sweeney et al HI ORIGINAL ARTICLE Peterson-Sweeney et al TABLE 1 Professional goals versus reality in asthma TABLE 2 Sociodemographic characteristics of sample BOX 1 Identified themes BOX 2 Prevalent themes in Accepted professional goals Current reality asthma management and Category Frequency % The semistructured interview ex- medication administration No persistent symptoms Almost 30% of asthma patients reported being awakened with breathing problems at least one a plored attitudes and beliefs within or sleep disruptions week (Asthma in America, 1998); 41% of participants in one study reported symptoms more than Age five identified themes: . I know my child two times a week (Halterman, Yoos, Sidora, Kitzman, & McMullen, 2001) Preschool (2-5 y) 39 The parent's understanding of the . Trial and error No missed school as a 49% of children with asthma missed school in the prior year because of asthma-related problems school age (6-12 y) 28 nature of asthma . Partnership result of asthma (Asthma in America, 1998); total of 10 million missed school days each year, depriving the child of Adolescent (13-18 y) How asthma affects the child and . Need for information academic achievement as well as social interaction (Lenney, 1997; Von Mutius, 2000) Socioeconomic status family . Negotiating responsibility Maintenance of normal 48% of patients with asthma say asthma limits their ability to participate in sports and recreation (Hollingshead, 1957: . Knowledge about asthma med- Hassles and worries activity levels (Asthma in America, 1998); 25% say asthma interferes with social activities (Asthma in America, occupation/education) ications . Preferences with medication ad- 1998) Upper 44 Attitudes and beliefs about ministration Normal or near-normal Only 35% of patients report having lung function tests in the past year; only 28% have peak flow Lower 56 asthma medications and adminis- Benefits outweigh the risks of side NO lung functions meters (Asthma in America, 1998); 49% of patients in one study had FEV, values less than 90% Missing 11 tration effects 25% had FEV, values less than 80% (Yoos, Kitzman, McMullen, Henderson, & Sidora, 2002) Race Partnership and communication No or minimal need for 32% of children with asthma went to the emergency department for asthma attacks in the prior year Minority (Black, 8 44 with the health care provider emergency department (Asthma in America, 1998); 55% of children had unscheduled emergency visits to a doctor's visit Hispanic) visits/hospitalizations (Asthma in America, 1998); children have approximately 3,028,000 doctor visits, 570,000 emer- White 10 56 terviews generally lasted between 1 gency department visits, and 164,000 hospitalizations per year (Asthma in America, 1998, Ameri- Sex METHODS and 11/2 hours; their duration was deter- can Academy of Allergy, Asthma & Immunology, 1999) Male 9 50 mined by when the topics were ex- Female a 50 Participants/Setting hausted. The interviewers were all ex- Severity Purposeful sampling of participants perienced nurses who had been Mild intermittent 28 drawn from clinical practice settings educated about asthma and trained in components for achieving control of ever, these study results clearly demon- If symptoms are not promptly and ac- Mild persistent 28 was used to ensure inclusion of children he principles and methodology for do asthma: (a) regular assessment and strated opportunities for improvement curately reported, guidelines for appro- Moderate persistent 33 with different levels of disease severity ing semistructured interviews. Eigh- monitoring of symptoms, (b) appropri- in specific areas such as the use of writ- priate asthma management cannot be Severe persistent 11 as well as sociodemographic diversity. teen interviews were conducted, tape- te pharmacologic therapy, (c) control ten treatment plans and scheduling followed. Unless we understand par- The sample consisted of 18 mothers of recorded, and then transcribed of triggers and patient education, and routine follow-up care. ents' and patients' concerns about med- children and adolescents. Enrollment (d) partnership with families (NHLBI, ications prescribed, we will be unable continued until saturation of new Approach to Data Analysis 1997). Nevertheless, despite more than to affect adherence. Svavarsdottir, McMubbin, and Kane themes was achieved. The study was The data were analyzed using a concep- a decade of Expert Panel reports and re- In the past decade, qualitative research 2000) reported on the relationships of approved by the Institutional Review tually clustered matrix to allow a sounding affirmation of the guidelines has provided health care providers with family and caregiving demands, sense Board. The interviews took place in the thumbnail profile of each informant and by the professional community, we Patients /families and descriptions of the everyday experiences of coherence, and family hardiness with participant's home following informed to provide an initial test of the relation have fallen short of reaching the goals of children with asthma and their fami- parents' well-being in research com- consent. Participants received an hono- ships between responses to the different of optimal asthma management (see health care providers need lies. Kieckhefer and Ratcliffe (2000) used pleted with 76 families of young chil- rarium of $30. The child's age, illness questions. These strategies for testing or Table 1). Research suggests why we ocus groups to obtain information about dren with asthma. The 4 most difficult severity, illness duration, gender, eth- confirming findings as suggested by have fallen short of such goals. Based to have a common the families' lived experience with tasks cited by mothers were providing nicity, and socioeconomic status were Miles and Huberman (1984) were used on data from 638 children from a cross- asthma and concluded that providers emotional support for the child, manag- obtained at intake. Illness severity was to minimize bias. Four independent sectional survey of kindergartners in 11 understanding of the should take into account parental fears ing discipline and behavior problems, classified with use of the NHLBI sys- raters read the transcripts line by line randomly selected elementary schools, and concerns as they develop asthma ac- developmental support for the child and tem, yielding four severity categories: and analyzed the content by clustering Grant et al. (1999) found a lack of nature of asthma, tion plans. Mansour, Lamphear, and De- handling asthma episodes, which in- mild intermittent, mild persistent, mod- and identifying themes. The overall do- asthma control and concluded that a Witt (2000) used focus groups to obtain cluded giving prescribed treatments erate persistent, and severe persistent mains identified were the diagnosis o possible reason for suboptimal treat- parental perspectives of barriers to and medicines and deciding if the child (NHLBI, 1997). Zip codes were used to asthma, knowledge about the nature of ment of asthma is not following the treatment goals, the role of asthma care in urban children. They needs to see the physician. classify families living in urban, subur- the disease and resulting symptoms, NHLBI guidelines. Diaz et al. (2000) identified parental concerns specific to In the research reported here, we ex- ban, small town, and rural geographic asthma management including med found that antiinflammatory medica- medications, and self- ong-term medication use as a barrier to pand the literature on parents' experi- locations. Table 2 reports the demo- ications, parent/provider relationship, tion for children with persistent or se- effective asthma management. Ryd- ence with children with asthma. Specif- graphic characteristics of the sample. treatment expectations, and impact on were asthma in East Harlem was under- management practices. strom, Englund, and Sandman (1999) con- ically, we investigated parental beliefs, the family. We report here on themes re- used, thus affecting asthma control. ducted unstructured interviews with 14 knowledge, and attitudes affecting an- Procedures lated to the domain of asthma manage- These authors also suggest that a possi- children using a phenomenologic-her- iinflammatory medication use in Study data were obtained through ment, including medication use. ble lack of physician adherence to meneutic method to illuminate what it is childhood asthma to add further to the semistructured, qualitative, face-to- NHLBI guidelines may be affecting this We are clearly failing in our efforts to like being a child with asthma. They de- insights in the existing literature spe- face interviews guided by a set of open- RESULTS lack of antiinflammatory use. Finkel- control asthma, and both patients / fam- scribed perceptions by the child as being cific to issues around medication use. ended questions designed to illicit par- Eight main themes related to asthma stein et al. (2000) found substantial un- ilies and health care providers have both participant in their management of We report findings that emerged from ents' understanding of the nature of management and medication use derstanding of the National Asthma been identified as contributing to this their own care and as an outsider in one-on-one semistructured qualitative asthma and the role of antiinflamma emerged from the interviews (Box 2). Education and Prevention Program failure. Adequate therapy for asthma everyday life. Horner (1997) conducted a interviews with parents of children tory medication in managing asthma, (NAEPP) guidelines in a survey of 671 depends on accurate and timely com- grounded theory study to describe the with asthma, in which we asked them as well as the experience of living with I Know My Child pediatricians and family physicians, munication and a partnership between fears and anxieties of mothers caring for about their experience of living with a a child with asthma (Box 1). Families The first theme was that of primary with little reluctance to use inhaled cor- families and health care providers their young children during illness epi- child with asthma and their attitudes also described their interactions with responsibility for asthma medication man ticosteroids in pediatric patients. How- (Fritz, McQuaid, Spirito, & Klein, 1996). sodes prior to a diagnosis of asthma. toward asthma medications health care providers. The in-depth in- agement. Universally, in the two-parent JOURNAL OF PEDIATRIC HEALTH CARE May/June 2003 119 120 Volume 17 Number 3 JOURNAL OF PEDIATRIC HEALTH CAREHI ORIGINAL ARTICLE Peterson-Sweeney et al HIORIGINAL ARTICLE Peterson-Sweeney et al families in this sample, the mother con- her (horseback riding lessons, cheer- at her, she's having a hard time suck- They reported initial explanations of Negotiating Responsibility parent was in control of the treatment rolled asthma management, including leading on a hot day)." ing it all in before she releases it. Her medications being given, but even these The mother took the primary role in ed- regimen. Developmentally, parents re- medication administration, health care "When the girls start displaying doctor would say, "I need to get some seasoned parents said that they could ucating children about asthma and ne- ported that older school-aged children provider visits, management and com- symptoms we kind of stepped up to x-rays," but her doctor was not on. benefit from review and reinforcement gotiating responsibility for asthma med- were able to take on more responsibility munication with school and day care, a more aggressive protocol of med- They thought she just had a bad cold Out of our sample, nearly half of the par- ication administration with the child. for their own care. The parents of older and other activities outside of the home. ications. If I feel after a couple of days and told me to just keep doing the ents reported minimal or no education Mothers of teenagers stated that their school-aged children and adolescents The mother clearly stated her need to that it is not taking effect, I usually nebs every 4 hours. We go for x-rays when their child was first diagnosed children understood the reasons for clearly struggled between wanting to en- structure a system of care. In most cases fax the pulmonologist a note. Then on Monday and she had pneumonia. with asthma. One parent stated that the medications; in fact, they also stated courage independence in their child's the father was not as involved in the we do it day by day; we increased That was frustrating to me. I was structure of the primary care office was that experiential learning for teenagers management of asthma and their own care of asthma for the child but was able meds on this day and if she's not get- very offended because I know my not conducive to asthma education helped them with adherence to daily need to ensure that medications were to fill in for the mother when needed. In ting any better I fax her the results child, I know what she can tolerate. therapy. One mother stated: given. Parents perceived that their one-parent families headed by the and she calls me back and she'll say, I know how she acts when she's se- "Even the structure of the follow- school-aged children needed reminders mother, the mother assigned the role of 'Let's try this."" vere. I would have never gone in up appointments isn't such that there "Since the episode last year she re- so that they could be spared the negative caretaker, as needed, to other family over the weekend if she wasn't se- is any mechanism for the education alizes that she does have it (asthma) consequences of not taking their med- members with whom she felt comfort- vere." to happen. You go to check to make and how severe it is. She is better ication. There was a clear power struggle able. The mother trained this caretaker Out "For an acute visit, I can't always sure everything is clear and the pred- about taking her medications now." identified in half of the relationships be- or chose a family member who was fa- miliar with asthma care. ut of our sample , see my doctor, and that's frustrating nisone worked. It was a 15-minute tween adolescents and their parents. not to be able to see your own doctor.' appointment and it sounds good and "For the first year of his life, de off you go!" "She's thirteen, and I say, "Do your The main part of asthma I do my- nearly half of the parents pending on if he couldn't see his own medicines" and I expect her to do self, because I think what I know pediatrician, one would start him on Another parent mentioned the inad- it, and she didn't-so the next thing we about asthma keeps her out of seri- reported minimal or no this medication, the next person equacy of teaching in the primary care know she's in this horrible flare-up." ous trouble. We go to her pediatrician stopped that and put him on another. office: school-aged children and "For right now, at 13, the biggest for her annual visit and I kind of let education when their child This went on until we saw the spe- challenge is making sure that he is him know what is going on. cialist." "It was the day after Christmas, taking his medicine. I'll say (in the It took a long time before she really and he (the doctor) was just seeing adolescents clearly morning) " You do what you have to stayed with my mother or sister. She was first diagnosed Parents expressed different views emergency patients. That day he pre- do and I'll get your medicine set up mainly stayed with my best friend. about being comfortable with the med- scribed an inhaler, and I knew noth struggled between wanting for you." When I come back, the Her daughter has asthma, so she with asthma. ication management plan initiated by ing about an inhaler, I didn't know medicine is still sitting there." feels comfortable with taking care of health care providers. Six of the 18 how to work them. I felt very frus- to encourage "You know, when I talk about Don- my daughter. stated that they agreed with their pri- trated in that I thought through the nie, it brings back, reminds me of a lot mary care physician's plan; 6 stated system I should have gotten more in- of things because I almost lost him 3 Trial and Error Partnership independence in their that they did not. Two families reported formation through his doctor's office times. And he doesn't understand Another consistent finding across the A targeted aim of the National Asthma that they found new physicians with or the pharmacy." yet, he doesn't understand. You sample was that once they were com- Education Program of the NHLBI is to whom they felt more comfortable. One child's management of know, every time I tell him, "Donnie fortable with asthma management, improve communication and partner- of the mothers stated, "Once we got rid Fourteen of the parents reported be- take your medication," he says, parents assumed the primary role of ship between provider and parent. In of the doctor who didn't listen to us and ing seen by a specialist office, with asthma and their own need "Mom, I know," and makes me wait. initiating or changing asthma therapy many instances, negotiation existed be- thought it was a temper tantrum, things many of them mentioning that they val- I try to be so patient with Donnie. I based on symptoms. Over time, parents tween the physician and parent. How- were better." The 14 families receiving ued the written and verbal education to ensure that medications come to him and say "Donnie, you've believed that they became more confi- ever, outside of established relation- care by a pediatric pulmonary specialty received in the specialist's office. Uni got to take your medication. Time for dent in this role through "trial and er- ships with the primary care physician office expressed confidence in the treat versally, learning occurred over time, were given. your medication." He says: "Mom, I ror." Parents thought that their health or specialist, one third of the parents ex- ment plans that resulted from these with parents identifying multiple re- know." But then I wait a couple more care providers encouraged them to use pressed distrust in professional man- specialty contacts sources, such as asthma-based Web minutes and I say "Donnie, when are trial and error, that is, to use their judge agement. Parents wanted to be ac- Need for Education sites, the library, an asthma network you gonna take it?" That's our prob- ment in evaluating symptoms and knowledged for their own assessments, and newsletter, family members who The mother of a very young child, lem we have." (Donnie was 16 years managing care. "Trial and error" in- knowledge, and evaluation of previous Another major theme identified was were nurses or who had asthma, and aged 2 years, related that her daughter old at the time of this interview.) creased parent confidence in treating therapies. the need for education about asthma the pharmacist. One particular mother began to understand that the medica- their child's symptoms. management and medications. Of the 8 was adamant in her suggestion to use tion helped her: One parent even articulated that she "He saw another doctor in the of- parents who remembered being taught the pharmacist for education: had no concerns about asthma medica- "It's kind of a sliding scale or ac- fice who said our son had an ear in- about asthma medications when their "She would go and get her ma- tion now, that her daughter was young tion plan style that we do. We would fection. My children don't usually child was first put on medication, half "I just feel that parents should stick chine out and every single time she and she was controlling the medications: go months without using albuterol ir get ear infections. He was coughing could not remember the action of these with one pharmacy, who knows my was right. So I think because she has our home life, and then we'd go on a and we knew he needed prednisone, specific medications. Even the four par- child, who knows her medicine. If had it her whole life, it's like telling "So I think when she becomes a trip to see her grandparents where but the doctor just gave us medicine ents who said they remembered what she is going to have side effects due me they were hungry. She would go teenager I would definitely be con- there are animals and she would end for an ear infection. We ended up in the medications were designed to do o this medicine the pharmacist will and get her machine and I have a cerned, but since I'm controlling it I up in the emergency room. Now we the emergency room." had significant gaps in information. tell me." stethoscope and my mom would guess I don't have any concerns." start her medications 3 to 5 days be- "When she had pneumonia my Furthermore, more than half of the 12 check. And every time she was right." fore we visit and things are much bet- doctor wasn't on call, and the office parents who had children with long- Four parents mentioned the nurse Hassles With Medication ter." was open on the weekend, and I was standing asthma (more than 3 years) ex practitioner as the person who taught Negotiation occurred between par- Administration "We have learned to premedicate upset because I know my child. She's pressed a lack of understanding or con them about medications and clarified ents and children as children reached Many parents described initial strug- when it's going to be a bad time for breathing at this rate and if you look fusion about how medications worked. information at subsequent visits. school aged years; prior to that time, the gles with their children who resisted JOURNAL OF PEDIATRIC HEALTH CARE May/June 2003 121 122 Volume 17 Number 3 JOURNAL OF PEDIATRIC HEALTH CAREHI ORIGINAL ARTICLE Peterson-Sweeney et al HI ORIGINAL ARTICLE Peterson-Sweeney et al taking medication. As children ad- cause he thinks that Zachary doesn't 18 mothers stated that they had con- good, but on the other hand, cer- practice change that included cues for problem solving and management of justed to the medication routine, co- keep it on there long enough to get cerns about the bronchodilator al- tainly if he could be medication free scheduling and for the content of the asthma and provides the family with operation followed. Parents also de- the full dose. But the nurse practi- buterol, using such words as "hyper," that would be good too. But I'm not visit would need to be instituted. Such security that the provider truly knows scribed ways of having their child tioner says that he gets the full dose." "tachy," "jumpy," and "shakes" to de- willing to let him be uncomfortable "tune-up" visits would allow providers and respects them. cooperate, such as setting up the nebu- Nearly half of the parents preferred scribe adverse effects experienced. One like he was before. To be medication to reinforce understanding about spe- For most of this sample, parents lizer, putting the mask on themselves, oral to the inhaled delivery of medica- mother reported that her infant "shook free is not the most important thing. cific aspects of care, for example, the ac- seemed relatively comfortable with in- sitting and reading books to the child, tion. Some of the reasons given were "I so bad he was evaluated for seizures." For his symptoms to be under control tion of medications, or the need to rinse haled steroid use and had more con- or gaining cooperation by having them can tell my child gets the whole thing," Our sample participants discussed is what I want." the mouth after using an inhaled cerns with oral steroid use. All families watch a favorite television show or "I know exactly what goes down," and many concerns about the oral antiin- steroid, in addition to the evaluation of identified hassles in medication admin- hold their favorite blanket. Other has- "I can see her swallow." flammatory medication prednisone. DISCUSSION AND istration, with the daily hassle of re- "Facial bloating" was a concern for 2 IMPLICATIONS FOR PRACTICE symptom relief and treatment success. sles mentioned were as follows: These findings also challenge providers membering to give medication a preva- It's a pain to remember to take med- mothers, and 6 expressed concerns over These interviews provide a rich source to utilize all available opportunities for lent theme. Appreciation of these ication twice a day." weight and weight gain. Three mothers of data about parents experiencing their patient and family education. At the concerns can inform interventions that It's hard to remember 3 times a day." Parents want health care mentioned hyperactivity as a concern, child's asthma. Parents acknowledged least when time is limited, handouts simplify treatment regimens and im- It's difficult to get up in the middle of and 5 mentioned that they had general that learning to care for their child's that describe the action and appropri- prove habit-forming behaviors in chil- the night if he needs his medication." concerns about their child taking an asthma was often experiential, that is, ate use of medications would be helpful dren. "He just goes on strike and says he's providers to respect and oral steroid. Of interest, 2 mothers "trial and error." However, they per- to reinforcing knowledge. It is less common for children to be not taking his medication." stated that they equated steroids with ceived that these experiences had given taking multiple medications to treat a When asked what was the hardest value their knowledge "body builders" and "football players." them a sound basis for management. variety of disorders than it is in adults. thing about having a child with asthma, Two mothers stated that although they They cried out, "Listen to me, I know However, parents expressed concerns 10 of the 13 parents who answered this question stated that remembering or about their child and how had concerns about the effects of oral my child." Parents want health care pro- that asthma medications interacted steroids, their children's "quality of viders to respect and value their knowl- Periodic asthma wellness with other medications their children giving or taking medications on a daily lungs" and "life and health" were more edge about their child and how they needed. Parents will be reassured if basis was the most difficult aspect of they manage asthma on a important. manage asthma on a day-to-day basis. asthma care. Clearly, medication ad- Minimal concerns were expressed Health care providers in general, but or "tune-up" visits would clinicians review a complete list of medications the child takes, including ministration was initially a major con- day-to-day basis. about inhaled steroids. One mother did particularly on-call providers in emer- cern, and over time, continued to be a not like the inhaled steroid when it was gency department and urgent care set- add to the family's/child's over-the-counter medications, and dis- cusses possible interactions. hassle for many families caring for their first prescribed, but was then able to ap- tings who do not have an existing rela- child with asthma. preciate the medication's benefit: "The tionship with the parent and child, knowledge and improve STUDY LIMITATIONS Although mentioned by only three One parent preferred inhaled deliv medicine goes right to the lungs." Of would be well advised to listen and ac- The investigators believed that the parents, a method of medication man- ery to oral medication because pills the 18 families, thrush developed in knowledge the parent's knowledge and outcomes, in addition to home was an excellent environment for agement offered spontaneously was gave her child a stomachache. Address- three children. One parent expressed experience with their child's asthma. completing the interview for parental the use of devices, charts, and systems ing the issue of steroids, four parents frustration over a power struggle with These narratives suggest that providers enhancing overall health. convenience and comfort; however, that organize medication administra- identified the positive improvement in a teenager to rinse his mouth after in- who incorporate information that par- conducting interviews in the home tion. The use of such systems was asthma management with inhaled haled steroid use; another stated that ents have given them will be more suc poses its own set of issues. One concern strongly associated with remembering steroids and preferred inhaled to oral she did not understand why her child cessful with parents in creating a mutu- during the interviews was the number to make sure medications were admin- steroids. Comments included the fol- had to rinse his mouth after inhaled ally formulated treatment plan. Primary care providers without time of interruptions that occurred as a re- istered with minimal missed doses. lowing. steroid use. Nevertheless, parents in this sample and resources to complete periodic sult of children, the telephone, or visi- One parent reported that she and her demonstrated significant gaps in asthma "tune-up" visits may want to tors in the home. These interruptions "The diary helps me stay orga- "I like the inhaler, because it's husband felt uncomfortable about their knowledge, even those whose children utilize specialist referrals for fine-tun- may have broken trains of thought and nized. I think it helps me because more direct to her lungs. It goes more child taking inhaled steroids until they had been diagnosed with asthma for a ing of asthma management and educa- completion of viewpoints being ex- when I go to the doctors and they ask directly to where it's needed. It's not received teaching material from the long period. Parents acknowledged tion on a more regular basis. Specialist pressed, thus limiting the completeness me questions, I can refer back." going throughout the body. To me specialist's office. Another mother ob- that they needed information from the offices are programmed with time for of the data. "My husband came up with the liquid medicine is a trial throughout served a significant improvement in be professional. A number of factors con- patient and family assessment and pa- In this phase of the study, only 18 notebook-when he came out of the the body until it gets to that area, but havior when her child's antiinflamma tribute to the need for education. Un- tient individualized education. Parents parents of children with asthma were hospital our son was on so many the inhaler goes right to the area." tory agent was changed from an oral to like diabetes or other chronic illnesses valued the relationships with the spe- interviewed; however, they were di- medications. And we needed to keep "Because of the inhaled steroids an inhaled preparation. Two mothers in where there is a definite point of diag- cialist office because they perceived verse in socioeconomic status, ethnicity, track." we haven't needed by mouth steroids our sample discussed their concerns nosis, the diagnosis of asthma often that these specialists in chronic illness and severity of child's asthma. It should in over a year." Preferences about their children's asthma medica evolves over time. Therefore, the edu- as well as asthma offered education and be noted that families in this study live "I wish we had started the inhaled tions interacting with the Ritalin that cation process regarding asthma may treatment that fostered healthier chil- in a metropolitan community in which Parents in this sample were asked steroids years ago." had been prescribed for Attention Def- not be systematic and comprehensive; dren and improved self-management 95% of all families have primary care about their preferences about medica- "Inhaled steroids is better than all icit Hyperactivity Disorder, although of information is often delivered in a skills in the family. "homes." Families in communities in tions. In the sample, 4 parents preferred that albuterol." note, neither had discussed this con- piecemeal fashion. Based on our find- These families perceived continuity which a large percentage of families do the nebulizer to the metered dose in- cern with their child's health care of care as important to their satisfaction not have a consistent primary care haler, stating that, with the nebulizer, The Benefits Outweigh the Risks ings of lack of knowledge and confu- provider. Many parents in our sample sion about medications, one might sug- with care. Parents often voiced the in- provider may have different concerns. they were sure that the child received of Side Effects said they did not like giving medica- gest that periodic asthma wellness or adequacy of care they received when Although these interviews were rich in the entire dose of medication. For ex- The children in this study had experi- tions but saw improvement with med- "tune-up" visits would add to the fam- treated by a provider who did not the multiple themes identified, the size ample, one parent said, ence with bronchodilators and with ication: ily's /child's knowledge and improve know the child and the family. Conti- of the sample limits the generalizability oral and inhaled antiinflammatories. outcomes, in addition to enhancing nuity of care enhances the provider's of findings to any subpopulation of "They taught us how to do the in- Parents had many concerns about both "On one hand I just feel let's leave overall health. To be effective across a ongoing knowledge about the child, families who deal with asthma. The haler. My husband is concerned be- classes of medications. One third of the him (on medication),' he has done so primary care practice, a systematic family, and parental capabilities in sample also was primarily from urban JOURNAL OF PEDIATRIC HEALTH CARE May/June 2003 123 124 Volume 17 Number 3 JOURNAL OF PEDIATRIC HEALTH CAREHI ORIGINAL ARTICLE Peterson-Sweeney et al and suburban homes and provider of- REFERENCES Kieckhefer, G., & Ratcliff, M. (2000). What parents fices. Rural families may have different American Academy of Allergy, Asthma, & Im- of children with asthma tell us. Journal of Pedi- experiences without provider or spe- munology. (1999). Pediatric practice: Promoting atric Health Care, 14, 122-126. cialty offices nearby. best practice. Milwaukee, WI: American Acad- Lenney, W. (1997). The burden of pediatric asthma. emy of Allergy, Asthma, and Immunology. Pediatric Pulmonologi SUMMARY Asthma in America Survey Slide Kit. (1998). Re- Mansour, M., Lanphear, B., & DeWitt, T. (2000). trieved from http://www.asrgmainamerica. 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Asthma Expert Panel 2 guidelines