Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;59(12):2461-2474.
doi: 10.1080/02770903.2021.2018704. Epub 2021 Dec 28.

A multilevel perspective on goals, barriers, and facilitators of school-based asthma management

Jennifer R Mammen  1 , Colleen M McGovern  2 , Judith D Schoonmaker  1 , Ashley Philibert  1 , Emma C Schlegel  3 , Kimberly Arcoleo  1
Affiliations

A multilevel perspective on goals, barriers, and facilitators of school-based asthma management

Jennifer R Mammen et al. J Asthma. 2022 Dec.

Abstract

Background: School based asthma care is being increasingly used to combat uncontrolled pediatric asthma.

Objective: The purpose of these secondary analyses was to explore multi-level perspectives regarding school-based asthma medical management for inner city, school-aged children with poor asthma control.

Methods: Sixty-six participants from two large U.S. urban school districts and key stakeholders participated in 1:1 interviews and focus groups. Participants were selected from across the asthma care community (children/caregivers, school personnel, nurses, pharmacists, healthcare providers, and administrators/insurers). Qualitative and descriptive techniques were used to analyze data.

Results: Goals: Children/caregivers prioritized living a normal active life with few asthma worries. Other stakeholders prioritized reducing student's asthma related emergency room visits and lost learning time. Facilitators: Continuity of care, strong relationships between care community members, and incentivizers were commonly suggested facilitators. School-based asthma management was viewed as a strong facilitator, particularly in the presence of a full-time school nurse. Barriers: Four themes were identified. (1) Greater systems and policy support for asthma management is needed in general, and at school in particular. (2) Overburdened families and systems often operate in crisis-mode, and asthma management is often not a priority until crisis is reached. (3) Discordance and distrust between members of the asthma care community can hinder shared asthma management. (4) Better communication is needed at all levels to improve care.

Conclusion: Moving away from a crisis-based approach to asthma management for high-risk children will require increased systemic support for proactive asthma care and optimized communication within the asthma care community.

Supplemental data for this article is available online at https://dx.doi.org/10.1080/02770903.2021.2018704.

Keywords: Asthma; barriers; children; school-based care; self-management.

PubMed Disclaimer

Conflict of interest statement

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Figures

Figure 1.
Figure 1.
Main themes across all interviews and supporting coding schema (synthesis map).
See this image and copyright information in PMC

References

    1. Lifetime Asthma Prevalence Percents by Age, United States: National Health Interview Survey, 2018. Available from https://www.cdc.gov/asthma/nhis/2018/table2-1.htm [accessed November 2020].
    1. Unconcontrolled asthma among children 2012–2014 Available from https://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthma-children.htm [accessed November 2020].
    1. Netz M, Fedele DA, Sweenie R, Baker D, Light M, McQuaid EL. Asthma management responsibility, control, and quality of life among emerging adolescents. J Pediatr Psychol 2020;45(1):40–49. - PubMed
    1. Frey SM, Jones MR, Goldstein N, Riekert K, Fagnano M, Halterman JS. Knowledge of inhaled therapy and responsibility for asthma management among young teens with uncontrolled persistent asthma. Acad Pediatr 2018;18(3):317–323. - PMC - PubMed
    1. Pinnock H, Epiphaniou E, Pearce G, Parke H, Greenhalgh T, Sheikh A, Griffiths CJ, Taylor SJC. Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies. BMC Med 2015;13:127. - PMC - PubMed

Publication types