327 - Barriers and Facilitators to Administration of Medication to Children with Asthma at Schools: A Qualitative Lens from the Perspectives of Parents

Publication Number: 2316.327

Sarah Frischmann, UH Rainbow Center for Child Health & Policy, UH Rainbow Babies & Children’s Hospital, Cleveland Ohio, Cleveland, OH, United States; Marie Masotya, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Sarah D. Ronis, University Hospitals Rainbow Babies and Childrens Hospital, Cleveland Hts, OH, United States

Background: Asthma is among the most common chronic conditions of childhood, with schools playing a central role in asthma management given the amount of time children spend in those settings. Chronic school absenteeism among children with asthma is often interpreted as a marker of poor asthma control but may also reflect broader interpersonal and system-level challenges to asthma management, including access to medication. Understanding the barriers and facilitators is an important step in developing downstream school-based interventions.

Objective: To describe perceived barriers and facilitators to receipt of medication at school from the perspectives of the parents and caregivers of children with asthma.

Design/Methods: As part of a larger initiative to address chronic school absenteeism among children with asthma, semi-structured qualitative interviews were audiorecorded by telephone with 13 parents and caregivers (100% female) of children aged 6-12 years who had an Emergency Department, specialist or primary care encounter with a primary diagnosis of asthma within the prior 6 months. Using a directed content approach, deidentified transcripts were coded for barriers and facilitators and children receiving medications at school.

Results: Most participants reported an overarching experience that “In school, they’re not administering the medicine, so during the school year, [students are] having more asthma attacks throughout the day”. Concern about gaps in medication access in turn contribute to absenteeism, for example “When she is sick, I cannot send her to school because they won’t administer her medicine.” Barriers to children receiving medication at school centered on perception that school nurses and staff were ill-prepared to address the needs of children with asthma. Additional barriers were tied to daily life challenges associated with the intersectionality of managing a child with a chronic illness while also navigating social drivers of health, preventing timely filing of required paperwork such as the Asthma Action Plan. Facilitators encompass the opposite – nurses and staff who were perceived to be well-trained and adherent to clear school policies (table 1) were identified as crucial for medication administration.

Conclusion(s): Management of asthma in schools is highly linked to a complex relationship between school-based policies and compliance, social drivers of health, and effective communication and education

Table 1. Facilitators and barriers to children with asthma receiving medication while at school with illustrative quotes from parent/caregiver interviews
Table 1. Facilitators and barriers to children with asthma receiving medication while at school with illustrative quotes from parent interviews.pdf