How Families Manage the Home Environment for Young People With Asthma and Allergic Sensitisation: A Qualitative Study

TL;DR

This study explores how families manage allergen exposure at home for young people with asthma and allergies, focusing on decision-making processes.

Contribution

The study introduces a grounded theory explaining how families iteratively adjust their allergen remediation decisions based on perceived outcomes and communication.

Findings

Families adjust allergen remediation decisions based on their certainty about asthma management outcomes.

Understanding asthma severity and allergen exposure is challenging for families without ongoing clinician communication.

A theory explains reactive decision-making and opportunities for promoting preventative behavior change.

Abstract

Children and young people (CYP) with severe, sub‐optimally controlled asthma and co‐existing allergic senitization to indoor aeroallergens, such as pet dander and house dust mite (HDM), would likely benefit from reduced allergen exposure. Multiple allergen remediation interventions exist and are often suggested to families in secondary care asthma clinics in the United Kingdom. Evidence suggests remediation uptake is low or partial but there is sparse evidence to explain why. This study aims to explain how families in this situation make decisions about home‐based allergen remediations.

In‐depth qualitative interviews with CYP and mothers were analyzed, and a grounded theory approach was used to develop a theory to explain decision‐making processes and behaviors.

Ten CYP aged 11−15 years and 11 mothers were interviewed. The core finding was that families iteratively respond to changes in how certain they are in their asthma management decisions and actions. For allergen remediation uptake, this certainty varied depending on seeing an outcome‐exposure relationship, understanding asthma severity, variability, and asthma control at the time of remediation decision‐making. Understanding the mechanistic role of allergen exposures in asthma was challenging for families, and ongoing bi‐directional communication with clinicians was essential in supporting long‐term decision‐making.

The theory explains the often elongated, reactive process of allergen remediation decision making and implementation. It also explains other elements of family management of asthma, and their interconnections. Families' iterative responsiveness suggests opportunities to intervene and promote earlier, preventative behavior change.

Figures