To benefit the health of children with asthma, caregivers should possess more than just a basic understanding of asthma facts, suggest the results of a study of inner-city children. According to the study, the ideal caregiver also needs strong problem-solving abilities -- involving resourcefulness, flexibility, and creativity -- to surmount the daily challenges of asthma management.

�These findings provide additional information about a growing health problem affecting children in the inner city,� said lead author Shari L. Wade, PhD, of the Department of Pediatric Rehabilitation at the Children�s Hospital Medical Center, Cincinnati, Ohio.

Asthma is increasing among youth in general and among inner-city youth in particular. Between 1980 and 1993, the childhood asthma hospitalization rate rose by 28 percent, according to information from the Centers for Disease Control and Prevention cited by the authors.

Wade and colleagues interviewed the caregivers of 1,376 asthmatic children who were originally recruited for the National Cooperative Inner-City Asthma Study.

To measure problem-solving ability, the researchers asked caretakers to describe optimal responses for various asthma scenarios. The researchers also assessed caregivers� expectations or confidence in their ability to help with asthma management. Finally, the researchers measured the caretakers� basic knowledge of asthma.

The benefit of both good problem-solving skills and positive expectations were modest, and caregiver knowledge about asthma appeared to have no effect on asthma symptoms.

Children of caretakers with superior problem-solving skills spent approximately eight fewer hours wheezing during a two-week period than those of caretakers without such skills, and positive caregiver expectations were also associated with better functioning ability, Wade and colleagues found.

In addition, the researchers found that many caregivers generated a combination of ineffective and effective solutions to the study scenarios. This finding suggests caregivers not only need to learn effective problem-solving strategies, but also to unlearn ineffective ones.

Despite the modest nature of their findings, Wade asserted good problem-solving skills and positive expectations have potential clinical importance. �Efforts to improve these aspects of asthma management may offer hope of reducing symptoms and improving functional status in a substantial number of children,� said Wade.

�Programs for caregivers that simply provide facts about asthma are not adequate; programs must target the attitudes and practical skills that determine day-to-day asthma management,� she said.

�Simply altering knowledge about an illness may not produce long-term change if the intervention fails to build practical problem-solving skills and positive personal expectations regarding one�s ability to use these skills effectively,� Wade concluded.

This research was supported in part by grants from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health.

The Journal of Developmental and Behavioral Pediatrics is published bimonthly by the Society for Developmental and Behavioral Pediatrics. For information about the journal, contact Mary Sharkey at 212-595-7717.

Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, [email protected], 202-387-2829.