ArticleHospital pediatrics2025
Caregiver-Perceived Determinants of Asthma Morbidity in Early Childhood: A Qualitative Study.
Article in Hospital pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSocial determinants of health are linked to asthma health inequities starting in early childhood. We sought to contextualize this quantitative evidence by characterizing caregiver-perceived determinants of asthma morbidity among young children.
methodsCaregivers of children aged less than 5 years hospitalized with asthma participated in semi-structured interviews. The Asthma and Allergy Foundation of America (AAFA) health disparities framework incorporates 10 determinants that informed interview guide development, spanning upstream (racism/discrimination, policies/governance, culture, economic stability, education) to downstream (physical environment, social environment, health care services, individual behaviors, genes/biology). Asthma providers were interviewed for triangulation. Interviews were analyzed using content analysis, and themes were organized by AAFA determinants.
results25 caregivers and 6 providers were interviewed. Children had a median age of 3 years (interquartile range, 2-4 years), were often male (n = 18; 72%), and frequently experienced adverse community-level social determinants of health (n = 14; 60%). Four themes were identified: (1) uncertainty if children aged less than 5 years with asthma symptoms have asthma; (2) downstream determinants including asthma knowledge and access to asthma care, caregivers' behaviors, children's environments, and family history of asthma/atopy are relevant to children's asthma morbidity; (3) upstream, structural determinants are often considered irrelevant to children's asthma morbidity; and (4) asthma impacts families' socioeconomic potential and quality of life.
conclusionCaregivers perceived downstream determinants (health care, environment, individual behaviors) as key contributors to young children's asthma morbidity and raised the uncertainty with diagnosing asthma in early childhood. Standardizing the diagnosis of asthma and improving access to guideline-based asthma care may be one family-centered approach to optimizing asthma health equity in early childhood.
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