Student perspectives on asthma management in schools: a mixed-methods study examining experiences, facilitators, and barriers to care

J Asthma. 2019 Dec;56(12):1294-1305. doi: 10.1080/02770903.2018.1534968. Epub 2018 Oct 30.


Objective: Children spend nearly a third of their day at school, making it a critical point of intervention for those with asthma. This study aimed to illuminate minority students' experiences with asthma at school and perceptions of facilitators and barriers to care. Methods: A mixed-methods study was conducted with elementary students with asthma. Participants completed a 24-question survey, drawing exercise to depict experiences caring for their asthma at school, and focus group discussion. Drawings were analyzed for narrative and pictorial themes. Discussions were audio-recorded, transcribed, and independently coded for themes. Results: Fifteen children with asthma (8-11 years) participated from two Chicago schools with predominately African-American populations. Most students (79%) indicated they had control of asthma at school, while 85% identified asthma as a problem when exercising. Half (53%) received help with asthma care at school. Drawings depicted cooperative management with adults or peers and the central role of inhalers as part of everyday asthma care in school. Finally, focus groups produced six key themes within the domains of facilitators: 1) support of others, 2) self-efficacy; 3) perception of being normal; and barriers: 4) lack of support from others; 5) difficulty accessing inhaler; 6) perception of being different. Conclusions: This study suggests asthma care plays an important role in students' school experiences. Stigma around inhaler use, lack of concern by school staff, and limited access to medications remain as barriers to school-based asthma management. Although facilitators, such as support from teachers and peers, do exist, future interventions must address existing barriers.

Keywords: Children; drawings; human-centered design; self-management; youth.

MeSH terms

  • Adolescent
  • Asthma / diagnosis
  • Asthma / epidemiology
  • Asthma / therapy*
  • Chicago
  • Child
  • Cross-Sectional Studies
  • Disease Management
  • Female
  • Humans
  • Male
  • Minority Groups / statistics & numerical data*
  • Needs Assessment
  • Poverty
  • Quality of Life*
  • Risk Assessment
  • School Health Services / organization & administration*
  • Schools
  • Socioeconomic Factors
  • Students / statistics & numerical data*
  • Surveys and Questionnaires*
  • Urban Population