Related Experiment Video
Updated: Sep 14, 2025
Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
Caregiver-Perceived Determinants of Asthma Morbidity in Early Childhood: A Qualitative Study
Jordan Tyris1,2, Kavita Parikh1,2
1Children's National Hospital, Washington, District of Columbia.
Insights
Caregivers link young children's asthma to immediate factors like healthcare and environment, not broad social issues. Early diagnosis and better asthma care access are key for health equity.
Area of Science:
- Pediatric Asthma Research
- Social Determinants of Health
- Health Equity
Background:
- Social determinants of health significantly impact asthma-related health inequities from early childhood.
- This study aimed to understand caregiver perspectives on factors contributing to asthma morbidity in young children.
Purpose of the Study:
- To characterize caregiver-perceived determinants of asthma morbidity in children under five.
- To contextualize quantitative data on social determinants of health with qualitative caregiver insights.
Main Methods:
- Semi-structured interviews were conducted with 25 caregivers of children under five hospitalized with asthma.
- The Asthma and Allergy Foundation of America (AAFA) health disparities framework guided interview questions.
- Content analysis was used to analyze interview themes, organized by AAFA determinants, with triangulation from 6 asthma providers.
Main Results:
- Caregivers identified downstream determinants (healthcare access, environment, behaviors) as primary contributors to childhood asthma morbidity.
- A significant theme was the uncertainty in diagnosing asthma in children under five.
- Upstream, structural determinants were less frequently perceived as relevant by caregivers, though asthma impacted family quality of life.
Conclusions:
- Caregivers prioritize accessible healthcare, environment, and behaviors in managing childhood asthma.
- Addressing diagnostic uncertainty and improving access to guideline-based care are crucial for asthma health equity in early childhood.
Background:
Social determinants of health are linked to asthma health inequities starting in early childhood. We sought to contextualize this quantitative evidence by characterizing caregiver-perceived determinants of asthma morbidity among young children.
Methods:
Caregivers of children aged less than 5 years hospitalized with asthma participated in semi-structured interviews. The Asthma and Allergy Foundation of America (AAFA) health disparities framework incorporates 10 determinants that informed interview guide development, spanning upstream (racism/discrimination, policies/governance, culture, economic stability, education) to downstream (physical environment, social environment, health care services, individual behaviors, genes/biology). Asthma providers were interviewed for triangulation. Interviews were analyzed using content analysis, and themes were organized by AAFA determinants.
Results:
25 caregivers and 6 providers were interviewed. Children had a median age of 3 years (interquartile range, 2-4 years), were often male (n = 18; 72%), and frequently experienced adverse community-level social determinants of health (n = 14; 60%). Four themes were identified: (1) uncertainty if children aged less than 5 years with asthma symptoms have asthma; (2) downstream determinants including asthma knowledge and access to asthma care, caregivers' behaviors, children's environments, and family history of asthma/atopy are relevant to children's asthma morbidity; (3) upstream, structural determinants are often considered irrelevant to children's asthma morbidity; and (4) asthma impacts families' socioeconomic potential and quality of life.
Conclusion:
Caregivers perceived downstream determinants (health care, environment, individual behaviors) as key contributors to young children's asthma morbidity and raised the uncertainty with diagnosing asthma in early childhood. Standardizing the diagnosis of asthma and improving access to guideline-based asthma care may be one family-centered approach to optimizing asthma health equity in early childhood.
Related Concept Videos
01:29Asthma-I: Introduction
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:30Asthma-IV: Nursing Management
First, in...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes: