Knowledge and practices among parents of asthmatic children: a quasi-experimental study conducted at tertiary care center of Western India

INTRODUCTION

Childhood is the most precious gift from God. A child is carefree, happy and is untouched by the worries of everyday life but all are not so lucky because for many children playing in grass is a distant dream as even this small game can threaten their life by causing devastating respiratory disorder, which is known as bronchial asthma.¹

Asthma is a chronic inflammatory disorder of the airways. Inflammation of airways causes recurrent episodes of wheezing, breathlessness, chest tightness and cough, especially at night or in the early morning.² 3-35% of people in the world (300 million individuals) suffer from asthma and 100 million more patients may be added to this statistic until 2025.^3,4 Aggarwal et al has reported asthma prevalence to be 2.38% in Indian population based on a survey conducted in Delhi, Chandigarh, Kanpur and Banglore.⁵ According to WHO report 2016, asthma is the most common chronic disease of childhood, the primary cause of school absences and the third leading cause of hospitalization in children younger than the age of 15 years.⁶

Asthma is a non-curable but preventable disease.⁷ Treating children with asthma is not only limited to medication therapy and resistance against allergens, but education also plays a vital role. In this regard, Rekha et al reported increase in knowledge of mothers with asthmatic children after a structured teaching program.⁸ An RCT conducted on 50 parents shows significant improvement in the knowledge with the help of multimedia program on asthma.⁹ According to Clark et al knowledge of asthma provides the foundation for parents and children to make decisions in response to changing conditions such as climate changes, allergen levels and activity levels.¹⁰ Hence, the role of training is important to teach children and their parents how to control the disease.

The incidence of asthma is increasing among children and poor knowledge and practices of parents contributes to increase in morbidity and mortality due to it. This study aimed to identify the areas in which knowledge and practices of parents are lacking related to asthma and then empowering them with the help of an information booklet. Improved knowledge and better practices may help parents to better understand condition of their children. It may also help in bridging the existing gap between recommended and actual practices.

METHODS

A quasi-experimental, pre-test post-test control group study was conducted on parents of children with asthma. The required sample size was calculated from effect size (d=0.94) obtained from pilot study for test power of 80% at 5% level of significance which came to be 21 but researcher decided to take 30 subjects in each group. Pilot study was used for sample analyses because no similar study was found during reviewing the literature. Non-probability purposive sampling technique was used to select the subjects. The inclusion criteria included parents who were available in pediatric OPD, who can read and understand Hindi or English, who were having asthmatic child between 6 years to 12 years, diagnosed for more than 1 month and called for follow up within 3-5 weeks and parents of children on inhaled corticosteroids. Exclusion criteria included parents of children with any congenital abnormality or any history of chronic, heart, vascular or kidney disease.

The instruments used in this study included sociodemographic data sheet containing 10 questions about child and parent (gender, age, parent education, parent occupation, any family member in health related setting, monthly income, place of living and duration of diagnosis). Knowledge questionnaire included 30 multiple choice questions related to asthma, triggers, sign and symptoms, prevention, treatment and myths. One mark was given to right answer and zero mark to wrong answer. There was no negative marking. Knowledge level were categorized as poor (score <10), fair (11-20) and good (21-30). Reliability was assessed using KR 20 and was found to be 0.82. Practices filter questionnaires consisted of 21 dichotomous questions. The questionnaire was divided into domains such as environment, pharmacology, exercise, follow-up, emotional, asthma attack and inhaled corticosteroid related management. One mark was given to right answer and zero mark was given to wrong answer. The questions further included options to clarify actual practices carried out by subjects. There was no negative marking. Practice level was categorized as poor (score <7), fair (score 8-14) and good (score 14-21). The instruments was validated by 9 experts including paediatricians, child pulmonary health specialist and child health nurse specialists.

The study was conducted in three stages

The stage before intervention

After obtaining ethical clearance from the institute ethical committee of AIIMS, Jodhpur, subjects who were fulfilling the inclusion criteria were selected from the pediatric OPD of AIIMS, Jodhpur by purposive sampling technique. Out of 60 subjects, first 30 were allocated to the control group and next 30 to the experimental group. After getting acquainted with the subjects, the researcher introduced herself and stated the objectives of the study, its importance and how the research was going to be done, then informed written consent was obtained ensuring confidentiality of information and pre-test was obtained from both the groups.

The stage of intervention

In this study an information booklet was used to achieve the objectives of this study. An information booklet on asthma was developed after reviewing literatures, books and booklets and pamphlets available from various international asthma societies. The booklet included information about asthma, its triggers, sign and symptoms, prevention, asthma attack, diagnosis, medication, proper use of inhaler, breathing exercises and some facts about asthma.

The booklet was validated and approved from the experts. After obtaining the approval booklet was given to subjects of experimental group after getting pre-test data from them. A short briefing about the topics covered in the booklet was also given to them. Subjects of control group received no special treatment.

The stage after intervention

When the subjects came for the follow up after 3-5 weeks, post-test data was collected. Information booklet on asthma was also given to subjects of control group after obtaining post-test data from them. Data were statistically analysed using SPSS version 16. Descriptive statistics include frequency, percentage, mean and standard deviation. Inferential statistical methods include unpaired t test to measure the effectiveness of the information booklet and Chi square to check the association of knowledge with demographic variables.

RESULTS

Table 1 describes the sociodemographic characteristics of the 60 subjects at the baseline survey. Most of the subjects had male asthmatic child in both the groups. There were 30 subjects in each group and result shows two groups had statistically comparable baseline characteristics.

Table 2 describes pre-test and post-test knowledge in experimental and control group. The result shows that mean pre-test and post-test knowledge scores of subjects were almost similar in control group (14.3±3.86 versus 14.2±3.58). However, in experimental group post-test knowledge scores has improved as compared to pre-test (24.9±2.85 versus 13.2±4.85). Most of the subjects76.7% in control group had fair knowledge in pre-test. This remains same in post-test of control group. In experimental group, majority of subjects 63.3% had fair knowledge in pre-test whereas, 76.7% had adequate knowledge in post-test.

Table 3 show that there is significant improvement in knowledge of subjects in experimental group (t=11.449, p<0.05). Hence, null hypothesis was rejected. This could be interpreted as information booklet on asthma was effective in improving the knowledge of subjects in experimental group.

Table 4 shows association of knowledge with selected demographic variables using Chi-square. The findings clearly reveal that there was significant association between level of knowledge and education of parent, occupation and monthly income of family (p<0.05). Thus, the null hypothesis was rejected.

ns-non significant, *significant, level of significance <0.05.

*significant, level of significant at p<0.05 (df=58) (independent t test).

level of significance p<0.05, ns-non significant, *significant.

*significant, level of significant at p<0.05 (df=58) (independent t test).

level of significance p<0.05, ns-non significant.

Table 5 shows pre-test and post-test practices in experimental and control group. The result shows that mean pre-test and post-test practice scores dip in control group (13.03±2.6 versus 12.7±2.76). However, in experimental group post-test practice scores has improved as compared to pre-test (17.6±1.84 versus 12.7±2.76). Most of the subjects 76.7% in control group had fair practice score in pre-test. This remains same in post-test of control group. In experimental group, majority of subjects 66.7% had fair practice score in pre-test whereas 96.7% had good practice in post-test.

Table 6 show that there is significant improvement in practices of subjects in experimental group (t=-8.079, p<0.05). Hence, null hypothesis was rejected. This could be interpreted as information booklet on asthma was effective in improving practices of subjects in experimental group.

Table 7 shows association of practice with selected demographic variables using Chi-square. The findings clearly reveal that there was no significant association of practices with any socio-demographic variable.

Table 8 describes frequency and percentage distribution of pre-test practices in experimental and control group. This table elaborates the wrong practices actually carried out by subjects. Though most of the subjects in both the groups were following right practices but still there was a section of group who were following wrong practices. Most of the subjects refrain from covering nose and mouth of child while going out in traffic. Kada is considered as most common home remedy to treat asthma. Some subjects stop medication as symptoms of child subside. Most of the subjects do not teach the child to carry his/her emergency medication because they are already giving it before child leaves home. More than 30% of subjects didn’t discuss medical condition of their child with teachers and don’t know about lean forward position during asthma attack. More than half of the subjects neither clean mouthpiece nor rinse the mouth of child after use of inhaled corticosteroids.

DISCUSSION

This study revealed that parents of asthmatic children had insufficient knowledge regarding asthma and its management. This also showed that parents gained knowledge after application of an information booklet in experimental group. There was a significant difference between the mean of parents’ knowledge before and after the intervention (p<0.05). Similar results were found in a research conducted by Zarei et al, that indicates knowledge score of parents increased significantly after training using a computer-based programme (p<0.05).¹¹ Another research conducted by Krishna et al showed parallel results which was done on children with asthma using multimedia education programs.¹² This intervention helped in increasing the knowledge of parents and children in order to control and prevent asthma attack. Similar results were found in a research conducted on 60 mothers of children suffering from asthma which revealed that structured teaching program was effective in improving the knowledge with t value of 6.56 and p<0.05.¹

A study conducted on 100 parents of asthmatic children showed 86% of parents didn’t knew about working of inhaled corticosteroids which is consistent with the results of our study.¹³ Present study indicates that parents of asthmatic children had fair practices related to asthma and its management. It was found that parents were not covering mouth and nose of their children neither giving them emergency medications to carry. In a study conducted by AlOtaibi et al showed that 52.4% parents gave herbal medicine to children during an asthma attack which was inconsistent with the results of our study which shows only around 20% of parents following this practice.¹⁴ The results of this study showed that initially in control group only 43.3% of knew about lean forward position during asthma attack which raised to 93.3% in experimental group.

This study revealed that there was significant association of knowledge with education and occupation of the parent and monthly income of family which was also seen in a study conducted by Prashanth.¹

Limitation

Only single setting was selected to conduct the study, hence the findings cannot be generalized.

CONCLUSION

The study concluded that most of the subjects in both the groups had inadequate knowledge related to asthma. Knowledge of subjects in experimental group had significantly improved after implementation of information booklet. Parents as the primary caregivers are the first ones who encounter with diseases in their children. Adequate knowledge and right practices will help in early identification and effective management of this disease condition. Physician and nurses should always pay attention to educate the parents of children suffering from asthma. In routine OPD physician and nurses are not able to give quality time to counsel the parents, an information booklet will help in bridging this gap and will further help in improvement of overall knowledge and practices of children.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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