A Qualitative Study of Parental Use of the Written Asthma Action Plan for Their Children in Primary Care in Singapore

Abstract

A symptom-based written asthma action plan (WAAP) was introduced to both adult and pediatric patients as part of the evidence-based local clinical practice guidelines to educate patients in asthma self-management in Singapore in 1998. This article aimed to explore the issues pertaining to the parental use of the WAAP for their children with asthma. A qualitative method using focus group discussions was used to gather qualitative data from parents of children with asthma who are on review at primary care clinics in Singapore. Qualitative data analysis based on grounded theory was carried out to identify emergent themes. Parents expressed difficulty in differentiating asthma-related symptoms from early symptoms of an upper-respiratory tract infection. Because of the failure to recognize cough as an asthma-related symptom, they focused more on symptomatic treatment of cough. They often relied on their own assessment of their children’s asthma status and sought medical consultation soon after onset of the children’s symptoms, rather than adjusting their inhaled medication. This deviated from the WAAP given by their physician. Their threshold to consult a doctor was thus variable, reflecting their confidence in self-management of their children’s asthma condition. Factors that hinder the implementation of the WAAP for children included difficulty in symptom recognition, parental focus on symptomatic treatment, and confidence issues in using the tool.