Pediatric Asthma Management: Navigating Child, Family, Healthcare, and Community Factors

Pediatric asthma is the most common chronic disease in childhood and disproportionately impacts Black/African American and low-income children. Pediatric asthma management involves regular clinical follow-up, medication adherence, trigger management, and asthma education. This dissertation focuses on the outpatient / primary care management of asthma among Medicaid-insured children ages seven-to-twelve in South Carolina. Chapters 1 & 2 provide an introduction and background to pediatric asthma and pediatric asthma management. The Pediatric Self-Management Model is introduced and discussed to identify modifiable and non-modifiable factors that influence the processes and behaviors of pediatric asthma management. Chapter 3 follows by introducing the methodology for each of the following studies. Chapter 4 (Study 1) investigates the relationship between asthma-related outpatient clinic visits, management factors, and acute asthma emergency department visits for pediatric patients ages 7-12 in a statewide Medicaid population in South Carolina. A Poisson regression model was used to show the complex relationship between outpatient visits and emergency department visits among three cohorts between 2015-2018 in a Medicaid claims dataset. This study demonstrates that children with at least one, but less than six asthma-related outpatient visits may be at reduced risk of emergency department visits, though more research is needed. Additionally, it supports prior review that shows higher asthma medication ratios were associated with less risk of emergency department visits and past emergency department visits were associated with increased risk. Chapter 5 (Study 2) examines how parents/guardians are impacted by and act on child, family, healthcare, and community factors that contribute to their child’s asthma self-management. Twelve female parents/guardians of Black/African American children with moderate persistent asthma and Medicaid insurance were interviewed. Inductive and deductive qualitative analysis identified that child management self-efficacy, parent/guardian health literacy, parent and child negative experiences related to asthma diagnosis and management, asthma management tools, and social support from multiple sources impact child self-management. Chapter 6 (Study 3) combines the parent/guardian interviews from Study 2 with five clinical providers and six community support service provider interviews to compare clinical and management experiences and perspectives on asthma self-management behaviors for pediatric asthma. Interviews were coded through an inductive and deductive thematic analysis to highlight how responsibility, systems-level healthcare factors, community support services, and connection with clinical providers influence pediatric asthma self-management behaviors. Lastly, Chapter 7 discusses all three studies together to highlight the contributions and strengths of the research. Conclusions and future directions for research are also discussed