Pletta Karen H, Kerr Bradley R, Eickhoff Jens C, Allen Gail S, Jain Sanjeev R, Moreno Megan A
Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States.
Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States.
JMIR Pediatr Parent. 2020 Nov 9;3(2):e21863. doi: 10.2196/21863.
Asthma Action Plans (AAPs) are recommended for pediatric patients to help improve asthma control. Studies have shown variable results for unscheduled doctor and emergency room visits. AAPs may have an impact on parental self-efficacy for asthma management as well as on other daily living factors that are valuable for patients and families, such as the number of missed school days and parental workdays, and on school and caregiver management.
The purpose of this study is to understand parent perceptions of AAPs. The goals of this analysis were threefold, including examining (1) the association between pediatric AAPs and parental self-efficacy, (2) parent perceptions of the helpfulness of an AAP for daily living factors, and (3) associations with the type of provider who gave the AAP (a primary care provider or an asthma specialist).
A national cross-sectional online survey was completed in October 2018 by parents of children with asthma aged 0-17 years. Survey questions included the presence or absence of a pediatric AAP, the Bursch Parental Self-efficacy for Asthma scale, parental perceptions of the AAP's helpfulness with regard to daily living factors ranked on a 5-point Likert scale, and the provider type who gave the AAP. Survey responses were summarized in terms of percentages or means and standard deviations. A 2-sample t test and analysis of covariance were used to compare self-efficacy for asthma and parental-perception-of-helpfulness scores between subjects with an AAP versus subjects without an AAP. All reported P values were 2-sided.
A total of 704 parents with a child with asthma completed the survey. The parents had a mean age of 37.5 years (SD 10.9), and 82% (577/704) were women and 18% (127/704) were men. Most (564/704, 80%) parents had an AAP for their child; 65% (367/564) were written, 51% (286/564) were online, and 84% (474/564) were available at school. The Bursch Self-efficacy scale was significantly higher for parents with an AAP (mean 57.7, SD 8.6) versus no AAP (mean 55.1, SD 9.9; P<.001). Parents reported that they agreed/strongly agreed that an AAP was helpful for daily living factors, including managing asthma (446/544, 82%), decreased parental missed workdays (367/544, 68%), decreased child missed-school days (396/542, 73%), and for when a child is at school (422/541 78%), with other caregivers (434/543, 80%), doing normal activities (421/540 78%), and leading a normal life (437/540 81%). Parents agreed/strongly agreed that an AAP was helpful from all provider types: a pediatric provider (583/704, 82.8%), a family practice provider (556/704, 79%), and an asthma specialist (594/704, 84.4%). There was no significant difference (P=.53) between the type of provider who gave the AAP.
Parents who had pediatric AAPs for their children reported increased parental self-efficacy compared to those who did not have AAPs. Parents found AAPs helpful for decreasing missed time from work and school, and for asthma management when at home, school, and with other caregivers. Significant AAP helpfulness was seen regardless of the provider who gave the AAP, the parent's education, and income level. Findings support the usefulness of pediatric AAPs for families and the development of easily sharable electronic AAPs for children.
建议为儿科患者制定哮喘行动计划（AAP），以帮助改善哮喘控制。研究表明，在计划外的医生就诊和急诊室就诊方面，结果存在差异。AAP可能会对父母在哮喘管理方面的自我效能感产生影响，也会对患者及其家庭的其他日常生活因素产生影响，如缺课天数和父母工作日天数，以及对学校和照顾者的管理。
本研究的目的是了解父母对AAP的看法。该分析的目标有三个，包括研究（1）儿科AAP与父母自我效能感之间的关联，（2）父母对AAP对日常生活因素的帮助作用的看法，以及（3）与提供AAP的医疗服务提供者类型（初级保健提供者或哮喘专科医生）之间的关联。
2018年10月，对0至17岁哮喘儿童的父母进行了一项全国性横断面在线调查。调查问题包括是否有儿科AAP、哮喘的布尔施父母自我效能量表、父母对AAP在日常生活因素方面帮助作用的看法（按5级李克特量表评分），以及提供AAP的医疗服务提供者类型。调查回复以百分比或均值及标准差进行总结。采用双样本t检验和协方差分析来比较有AAP的受试者与没有AAP的受试者在哮喘自我效能感和父母帮助作用感知得分方面的差异。所有报告的P值均为双侧。
共有704名有哮喘儿童的父母完成了调查。父母的平均年龄为37.5岁（标准差10.9），其中82%（577/704）为女性，18%（127/704）为男性。大多数（564/704，80%）父母为孩子制定了AAP；65%（367/564）是书面的，51%（286/564）是在线的，84%（474/564）可在学校获取。有AAP的父母的布尔施自我效能量表得分（均值57.7，标准差8.6）显著高于没有AAP的父母（均值55.1，标准差9.9；P<.001）。父母报告称，他们同意/强烈同意AAP对日常生活因素有帮助，包括管理哮喘（446/544，82%）、减少父母工作日缺勤（367/544，68%）、减少孩子缺课天数（396/542，73%），以及在孩子在学校时（422/541，78%）、与其他照顾者在一起时（434/543，80%）、进行正常活动时（421/540，78%）和过正常生活时（437/540，81%）。父母同意/强烈同意来自所有医疗服务提供者类型的AAP都有帮助：儿科医疗服务提供者（583/704，82.8%）、家庭医疗服务提供者（556/704，79%）和哮喘专科医生（594/704，84.4%）。提供AAP的医疗服务提供者类型之间没有显著差异（P=.53）。
与没有为孩子制定儿科AAP的父母相比，为孩子制定了儿科AAP的父母报告称父母自我效能感有所提高。父母发现AAP有助于减少工作和学校的缺勤时间，以及在孩子在家、在学校和与其他照顾者在一起时进行哮喘管理。无论提供AAP的医疗服务提供者是谁、父母的教育程度和收入水平如何，AAP都具有显著的帮助作用。研究结果支持儿科AAP对家庭的有用性，以及为儿童开发易于共享的电子AAP。
