Childhood asthma in the primary school environment

Abstract

Background. There is a relatively high prevalence of school children with asthma in Malta, yet there is limited information about how these children are managed and supported while at school. Aims. The aim of this research was to gather data from relevant stakeholders using a mixed methods approach and, by doing so, provide a significant contribution to knowledge in this field. Methods. In the first phase of the study, a systematic review was performed to systematically review published literature to determine current asthma management practices by primary school teaching staff and any supporting legislation/ policies/ guidelines. In the second phase of the study, four key stakeholders, one from the Ministry for Education and Employment, two from the Ministry for Health and one from the Malta Union of Teachers (MUT) were interviewed to provide an aerial view of practices and polices relating to asthma in primary schools. In the third phase, a cross-sectional electronic survey investigating beliefs about medicines, knowledge of asthma, current practices, views and experiences relating to asthma was sent to all state primary heads of school and teachers in Malta. In the last phase, additional qualitative data was collected from teachers, parents of children with asthma and children with asthma through 3 separate focus group discussions. The Theoretical Domains Framework (TDF) was used as a basis for both the qualitative component and some aspects of the quantitative component of the research. Results. Findings of the systematic review mainly identified that: teachers were unable to deal with an asthma exacerbation, teachers lacked knowledge regarding exercise-induced asthma and there is poor communication with parents of children with asthma. The only documented asthma legislation was found in New York schools (USA) and three studies reported that they had no asthma management guidelines or policies in schools. The TDF domains which emerged most from the interviews were knowledge (knowledge of health policy communication, lack of awareness about asthma, approaches in dealing with students having asthma), beliefs about consequences (disadvantages and barriers in relation to policies), environmental context and resources (lack of support and resources), emotion (teachers' fear in supporting children with asthma) and goals (need for school asthma policies). Significant issues such as lack of knowledge regarding individual student health, inadequate preparation in dealing with students having asthma, low asthma knowledge scores (heads of school mean score of 4.8±3.8; teachers’ mean score of 5.5±3.3 out of a possible maximum of 14), and poor self-efficacy among teachers were identified from the responses of 19 heads of school and 167 teachers. Data collected also showed that teachers believe more in the benefit of medicines (mean=14.9) rather than their harm (mean=11.0) or overuse (mean=13.5). Heads of schools also believe more in the benefit (mean=15.3) than the harm (mean=9.0) or overuse (mean=11.8) of medicines. Data from focus groups with teachers, children with asthma and their parents were congruent with survey findings. Additionally, children demonstrated limited asthma knowledge and expressed their embarrassment in using the inhaler at school and in discussing their condition with the teacher. Communication barriers between the school and parents were also reported. Conclusion. Findings support the need for interventions to better support primary school children with asthma such as the establishment of effective communication between school staff and parents, staff training and standard procedures that are supported by policy. Protection by a law similar to 'good Samaritan' law should be offered to teachers thereby limiting the liability of the teaching staff when supporting students with medicines administration.