Study Reveals Barriers and Facilitators Faced by African American Caregivers of Children with Asthma

Asthma—a chronic disease—affects 10 million children in the United States. Out of all racial and ethnic groups, African American children experience the highest asthma prevalence. African American caregivers—who often live in uncertainty due to the unpredictable nature of asthma flare-ups—face a challenging responsibility in caring for a child with asthma.

A study—published in the November issue of the Journal of Pediatric Nursing and led by the University of Miami School of Nursing and Health Studies and the Miller School of Medicine—emphasizes that nurses are well-positioned to impact African American caregivers and children with asthma. It also emphasizes that it is imperative for nurses to be aware of the challenges faced by caregivers, as well as by the children, so that appropriate assessment, education, and referrals be provided. 

The study, therefore, reveals key information on the barriers and facilitators experienced by African American caregivers. Through an understanding of this information, nurses will be better able to predict challenges to support this population. 

“This integrative review was conducted to determine the state of science regarding African American caregivers of children with asthma,” said study first author Susan L. Prather, Ed.D., R.N., C.N.E., an assistant professor of clinical at the School of Nursing and Health Studies.

“The findings from the review further implicate social determinants of health and a need for a thorough community and environmental assessment as a valuable strategy for developing a plan of care for the child with asthma, caregiver, and family,” added study senior author Khaila Prather, B.S.P.H., who is a recent M.P.H. graduate from the Miller School of Medicine’s Department of Public Health Sciences.

Co-authors of the study also included Cynthia L. Foronda, Ph.D., R.N., CNE, CHSE, ANEF, associate professor of clinical at the School of Nursing and Health Studies, Courtney N. Kelley, MSN, ARNP, FNP-C, CCRN, and Catherine Nadeau, MSN, APRN-BC, FNP-BC, CCRN, assistant professor at the University of South Florida. 

Co-authors conducted a review of 40 articles that were assessed for their quality. After conducting a thematic analysis and evaluation of the barriers and facilitators of pediatric asthma management experienced by the caregivers, the study uncovered the specific barriers and facilitators faced by African American caregivers of children with asthma.

The barriers discovered included:

• Burdens experiences by caregivers, including poor quality of life, fear and stress, and low socioeconomic status
• Lack of home and neighborhood safety

“These barriers facing African American caregivers require societal attention to decrease the morbidity and mortality rates that African American children experience daily,” explained Dr. Prather.

The facilitations included:

• Family and community support
• Education and empowerment
• Culturally competent healthcare providers

“African American caregivers manage their child’s care based on the guidance and involvement of their family members, routines, faith, beliefs, and value systems. Hence, a comprehensive asthma management plan must incorporate these variables,” noted Khaila Prather.

To improve the care of African American children with asthma, the study suggests that health care professionals, such as nurses, be equipped with interventions that are focused on the needs of the patients. The study also emphasizes that a plan for social action should include community advocacy—encouraging social support systems, improved education, and securing resources.

The African American caregiver should be a partner in the development and implementation of asthma action plans for their child with asthma. The study also suggests the following:

• Improved culturally sensitive communication by providers to better engage and educate caregivers and their families
• Information management systems to help enhance communication and interaction with other systems, leading to a variety of innovative strategies that will help to improve health outcomes and empower caregivers with approaches to manage challenging plans of care
• Developing strategies and resources in academic settings, as well as establishing asthma centers to address this national health care disparity
• Elementary and middle schools can also better leverage a bridge to the gap in preventive care with in-house asthma care programs or partnerships with university-based health care systems

Dr. Foronda is the principal investigator of an overarching study called Asthma Academy—a School of Nursing and Health Studies research study designed to provide virtual education and telenursing support to low-income family caregivers of children with asthma, which is funded by the Josiah Macy Jr. Foundation.

The Asthma Academy is seeking participants for a study that will provide information to caregivers on how to better manage their child’s asthma with telehealth and education through their smartphone. 

“Understanding the barriers and facilitators faced by parents was a necessary first step to inform the subsequent interventional study. We are determined to improve the lives of struggling parents and children in our community by leveraging technology to fill this educational gap,” said Dr. Foronda.

“To be included in the study, participants must be able to have a smartphone with active service or computer with internet access, care for a child that is five to 12 years old, with newly diagnosed, poorly controlled, moderate, or intermittent asthma, and use Medicaid/Florida Kidcare for insurance,” said Khaila Prather.

For more information about this study, please contact the principal investigator of the study, Dr. Foronda, at (305) 284-1525 or through email at c.foronda@miami.edu.

Participation involves virtual training using a smartphone or computer. Participants are eligible for up to $100 in compensation.

Written by Amanda Torrres

Published on November 3, 2020