Doctoral Dissertations

Martha Keel

Date of Award

5-2003

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Human Ecology

Major Professor

Susan M. Smith,

Abstract

Asthma, the leading chronic disease of childhood, affects over five and one-half million children. Children, aged zero months to four years, have experienced the greatest increase in asthma prevalence, with a rise of 160 percent from the early 1980s to 1994. Tennessee's asthma prevalence rate for children is estimated at 7.4 percent. With proper management, a child with asthma can have normal or near-normal lung function. There are over 300,000 children enrolled in childcare centers in Tennessee. Childcare workers must learn proper asthma management to minimize the impacts of asthma on children. The purpose of this study was to evaluate the asthma knowledge, beliefs, experience, and self-efficacy of childcare center workers in selected urban and rural counties in Tennessee. The Health Belief Model was used as the theoretical foundation for this research. The Tennessee Childcare Asthma Survey was created to measure childcare worker perceptions by adapting an existing survey used to analyze parent's knowledge, beliefs, and self-efficacy of asthma. The instrument was reviewed by an expert panel and childcare workers, validated, and pilot tested for reliability. Childcare centers, licensed by the Tennessee Department of Human Services, were identified in selected urban and rural counties. The drop-off method was used to collect the data. Data were analyzed using t-tests, chi-square testing, cross tabulation residual analysis, multivariate tests, analysis of variance, Pearson's correlation, Spearman's Rho, z-tests, and measures of central tendency. The following major conclusions were drawn from this study: (1) center location was associated with childcare workers' self-reported knowledge of asthma signs and symptoms, asthma triggers, and self-reported beliefs about perceived asthma susceptibility, perceived severity of asthma, and perceived barriers to managing asthma; (2) childcare center profit status (for-profit or not-for-profit) was associated with childcare workers' self-reported asthma knowledge on three asthma triggers (mosquito bites, a cold or the flu, and poorly vented heaters); (3) age, race, level of education, and employment status of childcare workers were associated with childcare workers' self-reported knowledge of, beliefs about, and self-efficacy on managing asthma; and (4) childcare workers' self-reported experience was associated with childcare workers' self-reported knowledge of asthma, beliefs about asthma, and self-efficacy on caring for a child with asthma. Developing, implementing, and evaluating an "asthma management in childcare centers" educational program, based on the Health Belief Model, was recommended. Components of the program should include: asthma signs and symptoms, asthma triggers, asthma treatments, asthma medications, facts and myths about asthma, planning for emergencies, and communicating with parents. Childcare worker training should be offered in one-half day sessions on a Saturday or a three-hour session on a week night, using childcare workers experienced with asthma as peer educators, and establishing a mentoring program for childcare workers inexperienced with asthma. Further studies should be conducted to clarity differences found between various groups of childcare workers. Educational programs developed and implemented for childcare workers need to be thoroughly evaluated to measure their effectiveness on the childcare workers' ability to manage asthma in Tennessee childcare centers.

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