Asthma affects over 6.2 million children in the U.S., particularly children who are African American and children whose parents have limited incomes and formal education. Yet, interventions that attempt to reduce asthma exacerbation by educating caregivers of asthmatic children are time and resource intensive and largely have enjoyed only modest success. We propose pausing intervention implementation and dissemination efforts to gain a thorough understanding of the basic scientific nature of caregivers' proxy risk beliefs and how the beliefs interact with the social context to shape caregivers' risk-reducing actions. By doing so, we can address three barriers to creating effective childhood asthma exacerbation interventions: (1) limited understanding of how caregivers think about asthma and the heuristics (judgment shortcuts) and biases that color caregiver beliefs, (2) limited evidence about how caregiver risk beliefs interact with the social context to influence decision making, and (3) limited evidence about how caregiver risk beliefs translate into their risk reduction behaviors and their child's health. We propose filling these gaps in scientific knowledge by employing a mixed methods approach. We will conduct qualitative interviews of caregivers of children with asthma who reside in one of two underserved communities (N=40) and a quantitative survey of caregivers recruited from a panel comprised of a probability-based random sample of adults in the US (N=801). The unique features of this project are that it (a) combines multiple methods to understand caregiver beliefs, (b) examines beliefs at three stages of the asthma exacerbation continuum (triggers, symptoms, and symptom management), (c) explores how beliefs interact with the social context to influence decisions about engaging in behaviors that reduce exacerbation risk, (d) uses psychometric analytic methods to understand the cognitive structures underlying caregivers' risk beliefs, and (e) capitalizes on an interdisciplinary research team with experts in health, social, and cognitive psychology, anthropology, health behavior intervention development and implementation, pediatric pulmonology, and statistics. This project is significant because elucidating the structures, heuristics, biases, and social and contextual factors that drive caregivers' decisions for their child will illuminate strategies for directly intervening on the most proximal determinants of behavior. This targeted approach will inform the development of a highly effective caregiver-based intervention that is time- and resource-efficient while accommodating the social and contextual features that may constrain or facilitate caregivers' risk-reducing behavior. We will also make a significant scientific advance by extending basic risk perception research through considering both the caregiver-child relationship and the broader social context.

Public Health Relevance

Preventing asthma exacerbations, which affect over 6.2 million children in the U.S., requires understanding caregiver beliefs about asthma triggers, symptoms and symptom management strategies. Findings from this study will directly affect public health by laying the groundwork for future interventions for caregivers of children with asthma by describing (a) the basic psychological nature of caregivers' beliefs, and (b) how the beliefs interact with the broader social context to shape caregiver risk reduction behaviors.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Social Psychology, Personality and Interpersonal Processes Study Section (SPIP)
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Freemer, Michelle M
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Washington University
Schools of Medicine
Saint Louis
United States
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