Dear CHIFA colleagues,
This paper emphasises the value of health education and self-care for children. This is especially important for children with chronic conditions such as asthma. The quotes from the children below illustrate some misconceptions.
CITATION: Ramdzan SN, Khoo EM, Liew SM, et al. How young children learn independent asthma self-management: a qualitative study in Malaysia. Archives of Disease in Childhood 2020;105:819-824.
https://adc.bmj.com/content/105/9/819
ABSTRACT
Objective: We aimed to explore the views of Malaysian children with asthma and their parents to enhance understanding of early influences on development of self-management skills.
Design: This is a qualitative study conducted among children with asthma and their parents. We used purposive sampling and conducted focus groups and interviews using a semi-structured topic guide in the participants’ preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo and analysed using a grounded theory approach.
Settings: We identified children aged 7–12 years with parent-reported, physician-diagnosed asthma from seven suburban primary schools in Malaysia. Focus groups and interviews were conducted either at schools or a health centre.
Results: Ninety-nine participants (46 caregivers, 53 children) contributed to 24 focus groups and 6 individual interviews. Children mirrored their parents’ management of asthma but, in parallel, learnt and gained confidence to independently self-manage asthma from their own experiences and self-experimentation. Increasing independence was more apparent in children aged 10 years and above. Cultural norms and beliefs influenced children’s independence to self-manage asthma either directly or indirectly through their social network. External influences, for example, support from school and healthcare, also played a role in the transition.
Conclusion: Children learnt the skills to self-manage asthma as early as 7 years old with growing independence from the age of 10 years. Healthcare professionals should use child-centred approach and involve schools to facilitate asthma self-management and support a smooth transition to independent self-management.
SELECTED QUOTES
“They (parents) say not to eat mutton. It causes runny nose and causes (which leads to) asthma. When there is dust, or house cleaning they suggest me to wear mask (so I don’t get runny nose).” (NR3, FGD3_ICh, 11-year-old Indian boy)
“So, they get runny nose and cough very frequent and it eventually will cause them to have asthma. I tried changing the milk powders for them, but still they’ll get runny nose. They get very bad runny nose and later on it led to asthma.” (PK4, FGD4_IC, Indian, mother of NR3)
“Doctors do not allow us to do vigorous exercise and advised mom not to give us to drink those icy things.” (P1_FGD2_CCh, 12-year-old Chinese boy)
“Cannot drink ice water, cannot take anything ‘cold’, cannot eat orange.” (SC2_ICh, 9-year-old lndian boy, child of A9)
“My mother usually does not allow us to eat ice cream... Afraid that we will have an asthma attack."
“For me, my doctor told me that I got asthma when I went to clinic. And then they told me not to drink ice water, not to play in the rain or play in cold water.” (S8, FGD8_ICh, 10-year-old Indian boy)
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Best wishes, Neil
Let's build a future where children are no longer dying for lack of healthcare information - Join CHIFA (Child Healthcare Information For All): http://www.hifa.org/forums/chifa-child-health-and-rights
CHIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and assistant moderator of the CHIFA forum. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org
