Current guidelines recommend environmental control practices (ECPs) as part of asthma
management. We investigated the relationship of caregiver health beliefs and asthma experiences
to ECP use in homes of children with asthma.
Caregivers of children with asthma (ages 2 to 6 years) completed a survey about indoor
environmental exposures, ECPs, physician ECP recommendations, caregiver health beliefs
and experiences (outcome expectancy, self-efficacy, emotional bother) regarding ECPs,
child's respiratory symptoms, and medication use. Allergic sensitization was determined by
skin prick testing.
Children (n = 150) were 58% male, 91% African American, 42% from households with annual
income <$25,000, and 63% had persistent asthma symptoms. Caregivers who had higher
outcome expectancy were more likely to report use of ECP than those with lower outcome expectancy
(smoking avoidance (70 vs. 33%), roach control (61 vs. 44%), pet avoidance (42 vs.
24%), allergen-proof mattress/pillow encasings (6 vs. 0%), carpet removal (12 vs. 2%), and
stuffed-animal removal (8 vs. 1%) (all p < 0.05)). Self-efficacy and emotional bother were not
associated with use or failure to use most ECPs. Most caregivers (83%) reported that their
child's physician had recommended smoking avoidance; however, less than half had recommended
avoidance of specific allergens. Caregivers who reported that physicians recommended
pet avoidance, allergen-proof mattress/pillow encasings, bed linens washing, or stuffed-animal
removal were more likely to have high outcome expectancy for the ECP.
This study demonstrates a strong link between physician recommendations, higher caregiver
outcome expectancy, and greater reported use of ECPs. Given the role of the environment on
childhood asthma, physicians should be encouraged to counsel caregivers about ECPs.
(Pediatr Asthma Allergy Immunol 2006; 19[4]:231–242.)
