How parents, particularly mothers, transfer responsibilities for asthma management (preventive and symptomatic care) to their school-age children may be different from how health professionals define self-care development. This study explored the process of change from parent-directed care to child-directed care to help health care providers develop appropriate anticipatory guidance.

Nursing school faculty used grounded theory methods to develop and conduct interviews with families attending one of two asthma care facilities (a suburban specialty practice or an urban outpatient clinic.)  Private interviews were completed with 14 children (mean age 9.8 years, range 8 to 13) and, separately, with a parent or grandparent of each.

The findings led to development of a model of stages of transferring asthma care. The central concept was termed “Controlling the Situation” which included both managing the asthma but also the impact of asthma on the family. The interviews provided content themes or stages on a continuum beginning with an Out of Control stage at diagnosis, but moving onto parents’ Gaining Control of asthma. Then, an Autopilot stage emerged in which asthma care was considered integrated into family routines.

In time, a stage of Empowerment was evident as the parent shared responsibilities, e.g., for avoiding or treating in anticipation of exposure, managing symptoms, routine medications, and communicating with the health care provider. This stage was influenced by parents’ assessment of the child’s maturity and sense of responsibility as well as decisions to let the child experience consequences of forgetfulness or non-adherence.  The final stage labeled Letting Go was when the child would be independently managing his/her asthma.

The model indicates that the process of increasing self-care capacity is developmental for both parent and child.  Health professionals need to recognize and incorporate family’s views about what being in control of asthma means.  Anticipatory guidance should address appropriate transfer of responsibility to the child and teach parents about cues indicating readiness, problem solving when the child is away from parental supervision and reasonable supervision as the child handles more tasks, e.g., maintenance medication.

(Buford T. J Pedi Nurs 2004;19(1);3-12)

Comment: Emotional factors and the family’s beliefs about what is asthma “management” are important considerations in the individual health care plan to develop self-care capacity.       --J.O.