Family management of asthma triggers in the home: a grounded theory

Background
Family management of children and young people’s (CYP) asthma is complex and multi-faceted. Asthma triggers and indoor aeroallergen exposures contribute to reduced asthma control and risk of attacks. Maximising asthma control includes trigger and aeroallergen exposure reductions alongside health provider supported medicinal management and monitoring.
CYP with severe or uncontrolled asthma and co-existing allergic sensitisation would likely benefit from interventions to increase trigger and allergen avoidance uptake. Current evidence suggests that avoidance strategy uptake is often low, variable, or partial.
A systematic scoping review identified a paucity of literature explaining the current behaviours and behavioural influences on indoor aeroallergen avoidance uptake in the homes of CYP with asthma.
Aims
Develop an explanation of beliefs, processes, and behaviours involved in asthma trigger/allergen avoidance decision-making, in homes of CYP with sub-optimally controlled asthma and allergic sensitisation.
Design
A grounded theory approach was adopted for data collection, analyses, and theory development. In-depth qualitative interviews with CYP and mothers explored behaviours regarding avoidance uptake and influences in families of CYP with severe, uncontrolled asthma and allergic sensitivity to pets and house dust mite.
Findings
21 individuals participated (ten CYP aged 11-15 years and 11 mothers). Dyadic and individual interviews were conducted online and by telephone. During analysis, two categories were developed with interconnecting sub-categories, which were integrated into a theory explaining families learned about asthma triggers over time, through experience. Through learning, families developed acceptable levels of certainty about the role of allergens and triggers. This certainty affected uptake of remediation advice and was responsive to shifts in certainty occurring due to contextual changes: the core category being ‘responding to shifting certainties.’
Conclusion
The theory of responding to shifting certainties explains a range of asthma family-management behaviours. The fluidity of family decision-making suggests there are opportunities to intervene and facilitate greater remediation uptake.