P0677 - Exploring Low-Income African American and Latinx Caregiver Perspectives on Asthma Control in their Children

Background:
Significant disparities exist in pediatric asthma outcomes, with African American and Hispanic children suffering from higher rates of uncontrolled asthma compared to white children. Racial/ethnic identity and cultural and socioeconomic factors often play a significant role in how caregivers navigate asthma control for their children.

Objectives:
The purpose of this study was to 1) Elicit the knowledge, perceptions and behaviors of Latinx and African American caregivers related to their children’s asthma; 2) Identify knowledge gaps, cultural norms, and other barriers to asthma management, and 3) Explore and refine messaging materials to help caregivers better recognize uncontrolled asthma and seek timely medical treatment.

Methods:
Study participants were recruited and screened to meet the following inclusion criteria: African American or Hispanic/Latinx race/ethnicity, household income at or below 185% of the federal poverty line, and having at least one child diagnosed with asthma with symptom frequency consistent with uncontrolled asthma according to national guidelines. Participants attended one of three focus groups (one was in Spanish) during which the moderator guided the groups to cover all three objectives. The transcripts were qualitatively analyzed using a thematic analysis approach.

Results:
Of the nineteen caregiver participants, 42% were male and 58% were female; 79% were Hispanic or Latinx and 21% were African American; 58% were publicly insured on Medicaid and 42% had private insurance. Caregivers were generally confident in their ability to manage their child’s asthma, but they had objective gaps in asthma knowledge. Many expressed frustration at the lack of information and guidance from their health care providers. Many were uncomfortable using controller medications on a daily basis, citing issues of provider trust and side effect concerns. They often preferred instead to limit their child’s activities as a way of managing symptoms, not recognizing that that in itself is an indication of poor asthma control. Caregivers generally worried about asthma exacerbations that require ER visits and hospitalizations more than the daily impairments caused by uncontrolled asthma. Importantly, most caregivers did not recognize uncontrolled asthma in their own child, even after viewing messaging materials informing them of symptom frequency criteria for uncontrolled asthma. Consequently, they did not see the messaging materials as particularly applicable to them.

Conclusion:
Understanding caregiver perspectives, especially within populations at risk for uncontrolled asthma, is essential for informing the development of interventions to optimize childhood asthma management, including public health messaging interventions that are aimed at reducing racial and ethnic asthma disparities. It is recommended that culturally tailored interventions address low trust in provider recommendations and caregiver concerns about the daily dosing of controller medications.