Ecological barriers and social forces in childhood asthma management: examining routines of African American families living in the inner city.

OBJECTIVE: Asthma affects African American children at unprecedented rates. Researchers have examined the context in which African American families live and experience illness, and suggest that ecological barriers contribute to poor health. In this paper, the authors examine the social forces underlying these ecological barriers and what African American parents living in the inner city do to manage their children's asthma amidst these challenges. METHODS: African American parents of children aged 5 to 12 years diagnosed with persistent asthma living in the inner city were interviewed using a semistructured interview guide. Grounded theory analysis identified recurrent themes in the interview data. FINDINGS: Parents identified four adaptive routines they use to manage their children's asthma: ( 1 ) give young children with asthma responsibility for medication use; ( 2 ) monitor the availability of the school nurse; ( 3 ) manage air quality; and ( 4 ) frequently clean the home. These routines are described as adaptive because parents navigate ecological barriers and social forces within their daily context to manage their children's asthma. IMPLICATIONS: The authors argue that the first step in reducing the impact of ecological barriers is understanding African Americans' sociohistorical context.

A narrative of resistance: presentation of self when parenting children with asthma.

Using a social constructivist perspective and narrative analysis, the purpose of this paper is to illustrate how an understanding of self-presentation in interactions may inform health care interventions. We examine how a single African American mother, living in poverty, presents her sense of self in the context of obtaining and providing asthma care for her children. By analyzing four separate encounters--two interviews with the children's mother, the clinical encounter between the mother and her children's doctor, and an interview with the doctor, we gain an understanding of the mother's self-presentation and identity and the doctor's view of the mother. The analyses reveal the mother's consistent desire to protect her children in an unpredictable social world. By examining self-presentation, behavior that is typically construed as non-adherence is reframed as resilience, one mother's attempt to assert control. We argue that an understanding of identity production may enable practitioners and patients to create collaborative interventions. The analysis presented in this paper points to the need for a co-constructed intervention that allows for choice and control and honors the mother's sense of self.

Patterns of concordance and non-concordance with clinician recommendations and parents' explanatory models in children with asthma.

OBJECTIVE: Many children with asthma do not take medications as prescribed. We studied parents of children with asthma to define patterns of non-concordance between families' use of asthma controller medications and clinicians' recommendations, examine parents' explanatory models (EMs) of asthma, and describe relationships between patterns of non-concordance and EM. METHODS: Qualitative study using semi-structured interviews with parents of children with persistent asthma. Grounded theory analysis identified recurrent themes and relationships between reported medication use, EMs, and other factors. RESULTS: Twelve of the 37 parents reported non-concordance with providers' recommendations. Three types of non-concordance were identified: unintentional--parents believed they were following recommendations; unplanned--parents reported intending to give controller medications but could not; and intentional--parents stated giving medication was the wrong course of action. Analysis revealed two EMs of asthma: chronic--parents believed their child always has asthma; and intermittent--parents believed asthma was a problem their child sometimes developed. CONCLUSIONS: Concordance or non-concordance with recommended use of medications were related to EM's and family context and took on three different patterns associated with medication underuse. PRACTICE IMPLICATIONS: Efforts to reduce medication underuse in children with asthma may be optimized by identifying different types of non-concordance and tailoring interventions accordingly.