The Implementation Evaluation Of A Pediatric Asthma Family Health Management And Counseling To Children And Their Parents In China

Background Pediatric asthma has significantly increased in China in recent years,with especially high prevalence among children living in cities.The diagnosis and treatment of pediatric asthma are problematic despite health management effects to improve symptom control.With the increase in the prevalence of pediatric asthma in China,Chinese health care professionals confront the challenge of pediatric asthma specialists in other countries.Research indicates that health education programs positively impact the health management of pediatric asthma.Research indicates that asthma education is essential for parents of children with asthma.Children are dependent on their parents for their health management.The increase in urgent care utilization in the child with asthma suggested a need for further study of asthma family management research to improve asthma control in children and their families.In this study,a family-based asthma education program is implemented to explore a way to improve asthma control and quality of life of children with asthma in China.The feasibility and benefits of this program need to be evaluated.Objectives The overall research purpose is to determine the feasibility and benefits of family-based asthma education for pre-school children aged 3-5 years old with asthma and their family caregivers based on the Consolidated Framework for Implementation Research(CFIR)framework evaluating feasibility and family management style framework for benefits will guide the research.Methods This study contents three-stages.(1)The first stage is a need assessment preference to determine the information resources,preferences,and needs,and self-management challenges of parents caring for a child with asthma in China.A mixed-method,crosssectional,descriptive design was used.Parents of a child with asthma aged 3-13 years receiving care in an outpatient respiratory clinic in Wuhan,China,completed a three-part,pragmatic,self-report survey.Descriptive and non-parametric statistics were used to analyze quantitative data.Qualitative data were analyzed using an adapted version of Colaizzi’s phenomenological method.(2)The second stage is a qualitative study focus on the parents’experience of caring for a child with asthma.A qualitative study approach was used for this study.Sixteen parents with a child diagnosed with asthma were interviewed in a Children’s asthma outpatient clinic in central China using purposive sampling.Experiences of parents were obtained through semi-structured,in-depth interviews obtained.Interviews were transcribed verbatim and analyzed using a content analysis method.(3)Moreover,the third stage is quasi-experiment research using a single group pretest-posttest design.Participants will be recruited in an outpatient department of the Children’s hospital.Baseline data will be collected when a child and their family being recruited into this program to describe asthmarelated knowledge,the social-demographic information for both family and child,family management behaviors,asthma control,and quality of life among the participants.A familylevel intervention was then applied to provide education to increase knowledge related to asthma management,skills needed to manage asthma,and family management experience.After the intervention is applied,post-intervention data will be obtained.The instruments used will be the General information questionnaire,the adapted Knowledge of Asthma Survey(KAS),Test for Respiratory and Asthma Control in Kids Family(TRACK),Family Management Style Measure,and PedsQL Asthma module 3.0.The intervention’s overall feasibility,fidelity,and satisfaction were evaluated by feedback checklist and research records.Descriptive analysis will be used to establish participants’ sociodemographic characteristics and summarize the evaluation of feasibility,fidelity,and satisfaction;a series of t-tests will be used to compare the outcome differences between pretest and post-test to evaluate the primary benefits of the intervention among participants.Results(1)Parents(N=71)indicated they needed more knowledge to manage their child’s asthma sought information from internet sources available to them in China,including WeChat and QQ.However,most parents preferred receiving information during an in-person consultation with trained asthma specialists,such as physicians and nurses.Challenges in caring for a child with asthma revolved around learning about and understanding asthmarelated information;formulating beliefs about asthma as a chronic condition;experiencing distressing thoughts,feelings,and emotions;forming supportive networks that included family,school,and healthcare systems;and meeting their child’s psychological and emotional needs.(2)Four main themes emerged from data analysis of the second study:the parents suffering from the torturous diagnosis;Learning asthma-related knowledge trying to control their child’s asthma,having a delicate relationship with health care providers,and confronting difficulties in family life to caring child and control asthma.(3)Based on the first and second study results,the program for family-based intervention was adopted and revised.Then implemented among 3-5 years old children who were diagnosed with asthma and their parents.The feasibility,fidelity,and satisfaction of both facilitators within the clinic and study participants were good.Except for the consideration of time limitation for face-to-face communication in the clinic.The benefit of the intervention was analyzed with t-test and the results shown statistical significance of improving on child’s asthma control level(t=2.759,p=0.012),quality of life in asthma aspect(t=-3.051,p=0.005),treatment aspect(t=-.2.278,p=0.032)and communication aspect(t=-4.373,p<0.000),and the family management style also changed in the aspects of Child’s daily life(t=-.9.001,p<0.000),Family life difficulty(t=2.756,p=0.011),Parental Mutuality(t=-3.899,p=0.001),and View of condition impact(t=5.088,p<0.000).Conclusion Parents prefer receiving asthma information from trained healthcare professionals during in-person consultation over accessing the internet and social media resources.Health policy in China should be extended the time required for initial in-person interactions between parents and healthcare professionals before directing parents to reliable internet sites and social media.Parents and healthcare professionals must have enough time to obtain some level of understanding of the nature of asthma,setting treatment goals,and agreeing on the role of medications and self-management practices.Despite the great shortage of pediatric health care resources and the great workload in general children’s hospitals,the improvement of training on pediatric asthma diagnosis and treatment guidelines is essential in mainland China;The alternative method of communication between parents and health care providers is the internet-based communication is recommended.Thus the intervention adopted based-on comprehensive assessment of the target population had good feasibility in implementation and had a potentially positive effect on clinical outcomes of child and family management styles among parents.A further large clinical trial scale is needed to determine the effectiveness and cost-benefits of this family-based health education and counseling program among Chinese parents and their children with asthma.