This dissertation presents a new model of how children self-manage asthma with their parents. Traditional models of children's asthma self-management (CASM) rely on notions of adherence to medical regimens and consider parents to have primary responsibility for their children's health. However, children have primary control over the key CASM strategy: the self administered inhaler. This study investigated how children self-manage asthma, the tools they use and how they undertake shared responsibility for CASM with their parents. Employing sociological theories of children and childhood, a grounded theoretical, mixed method research design was employed to analyse data from multiple sources: primary qualitative data from interviews conducted with eight children (n = 8, age 7 -12 years) and their parents; interviews with two parents of infants; and secondary quantitative data from the 2001 NSW Child Health Survey (CHS01). Clear delineation was found between child and parent responsibilities. Responsibilities are responsive and adaptable according to the nature of the asthma event. There is consensus between children and parents as to what their responsibilities should be. Asthma is familiar, recognisable and usually easy to manage, particularly as childrens own actions are central to CASM. Thus, children considered asthma a predominantly 'ordinary' experience. 'Ordinary' tools include inhalers and non asthma-specific activities, such as resting. Parental responsibility focused on monitoring and reminding children of 'ordinary' CASM tasks. During frightening asthma events - such as night-time episodes and hospitalisation - children abdicated primary responsibility for CASM to their parents. 'Extraordinary' tools include nebulisers, oral medications and hospital. During 'extraordinary' asthma, the parental role is primary and includes responsibility for action and decision-making. While not considered 'ordinary', children nonetheless described frightening events in a way that accommodates asthma within schema for everyday life. Parents also described the '(extra) ordinariness' of asthma, but expressed greater anxiety for their children's future. This, plus the vigilance necessary for parents to monitor their child's condition, appeared to problematise asthma more for parents than for children. This was supported by results from parent-reported CHS01 analyses. This new model of CASM is discussed with respect to its implications for public health self management programs, guidelines and future research.
| Identifer | oai:union.ndltd.org:ADTP/279811 |
| Date | January 2010 |
| Creators | Tudball, Jacqueline Joy, Public Health & Community Medicine, Faculty of Medicine, UNSW |
| Publisher | Awarded By:University of New South Wales. Public Health & Community Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://unsworks.unsw.edu.au/copyright, http://unsworks.unsw.edu.au/copyright |
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