Asthma in Middle Schools: What Students Have to Say about Their Asthma
Ayala, Guadalupe X., Miller, Delesha, Zagami, Edwina, Riddle, Connie, Willis, Stephanie, King, Donna, Journal of School Health
The transition to adolescence involves stronger peer affiliation, changes in self-identity, a larger social network, more settings in which activities take place (work, school, peer homes), and a greater likelihood of engaging in risk behaviors that exacerbate asthma symptoms. (1-2) Asthma may inhibit activities as a result of social isolation or restrictions imposed by health care providers or parents, affecting how well the adolescent copes with the illness. (3-6) From a social ecological perspective, chronic illness management is influenced by intrapersonal (self-efficacy, outcome expectations, cultural beliefs), interpersonal (parent-child relationship, doctor-patient relationship), and societal factors (income, education, access to care). (7-8) Successful adherence may be particularly problematic among young adolescents due to their short-term outlook and a developing ability to engage in abstract problem solving. Children may be more adherent with parental involvement, although this may be mediated by the type of involvement (more adherence among adolescents if parents foster independence).9 As a result, the National Institutes of Health recommends that providers, parents, and adolescents work collaboratively to develop an asthma management plan, thereby fostering greater care autonomy. (10-11)
This study gathered information from middle school students on factors that influence asthma management. We sought to identify developmental differences between sixth, seventh, and eighth graders and changes in management with the transition into middle school. Over 3 months, students from 2 middle schools participated in focus groups to inform the development of an intervention.
Setting and Partnerships
This study was conceived over several meetings with members of the Orange County (OC) Asthma Coalition in North Carolina. The coalition includes school nurses, physicians, health department personnel, tobacco control specialists, and public health researchers. This study represents the formative research phase of an intervention to improve asthma management among middle school students. All study protocols were approved by the OC School Board and the Institutional Review Board (IRB) at the University of North Carolina at Chapel Hill.
Recruitment of Schools and Participants
Two middle schools were selected by the coalition members based on the diversity of the student population (30% nonwhite, 12% on free and reduced lunch program), asthma prevalence rates (approximately 10%), and strong school nurse interest. These schools serve a suburban student population.
Several factors influenced selection of our student recruitment process: (1) we did not have access to school records to identify students with asthma and (2) we received permission from the IRB to obtain passive informed consent from parents. This led us to conduct a multistage recruitment process using passive and active methods. (12) To provide parents the opportunity to decline their child's participation, in early spring 2004, the school nurse mailed a study information letter to parents of students with asthma as reported on school health records (n = 124). Twenty-six parents (21%) declined their child's participation, and 5 of these indicated that their child no longer had asthma. No information is available on these families given the lack of access to school records.
Two weeks later, 2 research assistants went to the school during the student's lunch hour and distributed study information fliers. Interested students with asthma were instructed to write their contact information on a sign-up sheet (n = 66). The school nurse then verified the asthma diagnosis using the school health records, and a research assistant verified that the parent had not refused their child's participation. All 66 students who signed up for the focus groups were verified as having asthma based on the school health records, and only 1 interested student had a parent who declined his participation. …