Influence of Caregivers' Health Beliefs and Experiences on Their Use of Environmental Control Practices in Homes of Pre-School Children with Asthma

Abstract

Current guidelines recommend environmental control practices (ECPs) as part of asthma management. We investigated the relationship of caregiver health beliefs and asthma experiences to ECP use in homes of children with asthma. Caregivers of children with asthma (ages 2 to 6 years) completed a survey about indoor environmental exposures, ECPs, physician ECP recommendations, caregiver health beliefs and experiences (outcome expectancy, self-efficacy, emotional bother) regarding ECPs, child's respiratory symptoms, and medication use. Allergic sensitization was determined by skin prick testing. Children (n = 150) were 58% male, 91% African American, 42% from households with annual income <$25,000, and 63% had persistent asthma symptoms. Caregivers who had higher outcome expectancy were more likely to report use of ECP than those with lower outcome expectancy (smoking avoidance (70 vs. 33%), roach control (61 vs. 44%), pet avoidance (42 vs. 24%), allergen-proof mattress/pillow encasings (6 vs. 0%), carpet removal (12 vs. 2%), and stuffed-animal removal (8 vs. 1%) (all p < 0.05)). Self-efficacy and emotional bother were not associated with use or failure to use most ECPs. Most caregivers (83%) reported that their child's physician had recommended smoking avoidance; however, less than half had recommended avoidance of specific allergens. Caregivers who reported that physicians recommended pet avoidance, allergen-proof mattress/pillow encasings, bed linens washing, or stuffed-animal removal were more likely to have high outcome expectancy for the ECP. This study demonstrates a strong link between physician recommendations, higher caregiver outcome expectancy, and greater reported use of ECPs. Given the role of the environment on childhood asthma, physicians should be encouraged to counsel caregivers about ECPs. (Pediatr Asthma Allergy Immunol 2006; 19[4]:231–242.)