Evaluation of levels of literacy in health, knowledge in asthma and quality of life of parents associated with disease control in children and adolescents diagnosed with asthma from specialized centers
Aims: to evaluate the level of knowledge in asthma, health literacy and quality of life of caregivers of children and adolescents diagnosed with the disease, as well as the association with asthma control, treatment adherence and quality of life.
Methods: this cross-sectional study was conducted with caregivers and patients from two specialized referral centers in southern Brazil, between March 2018 and November 2018. Parents and caregivers of children and adolescents diagnosed with asthma, aged 18 years and older, participated in the study. The following questionnaires were applied: sociodemographic, Short Assessment of Health Literacy for Portuguese-Speaking Adults and Paediatric Asthma Caregiver’s Quality of Life Questionnaire. For statistical purposes, the t-test, chi-square and Binary Logistic Regression were used.
Results: a total of 125 caregivers were included, 89 (71.2%) mothers, with a mean age of 35.7±9.2 years, 65 (52%) with completed high school and 100 (80%) belonging to economy class C. Of the total, 74 (59.2%) inadequate levels of literacy in health and 117 (94.4%) inadequate levels of knowledge in asthma. Asthma was not controlled in 91 (72.8%) of the patients, being associated with a lower quality of life of them and their caregivers (p<0.001). Logistic Regression verified whether health literacy, asthma knowledge and caregivers’ quality of life were associated with asthma control of patients, and this model was significant [X2(4) = 22.083; p<0.001, R2Nagelkerke = 0.484]. The categorical variables used as reference were the ones with the highest frequency (uncontrolled asthma and inadequate knowledge). Health literacy (OR = 3,650; CI95% = 1.335 - 9.984) and quality of life (OR = 3.095; CI95% = 1.850 - 5.178) were also significant.
Conclusion: the analyzed population presented levels of literacy in health and knowledge in asthma unsatisfactory. Furthermore, the levels of disease control were low and may be associated with quality of life levels.
Global Initiative For Asthma. Global strategy for asthma management and prevention [Internet]. Fontana: Global Initiative For Asthma; 2018 [cited 2021 Apr 03]. 162 p. Available from: https://ginasthma.org/wp-content/uploads/2018/04/wms-GINA-2018-report-V1.3-002.pdf
Terzano C, Cremonesi G, Girbino G, Ingrassia E, Marsico S, Nicolini G, Allegra L. 1-year prospective real life monitoring of asthma control and quality of life in Italy. Respir Res. 2012;13(1):112-23. https://doi.org/10.1186/1465-9921-13-112.
Braman SS. The global burden of asthma. Chest. 2006;130(1 Suppl):4S-12S. https://doi.org/10.1378/chest.130.1_suppl.4S
Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009;64(6):476-83. http://dx.doi.org/10.1136/thx.2008.106609
Roncada C, Oliveira SG, Cidade SF, Sarria EE, Mattiello R, Ojeda BS, et al. Burden of asthma among inner-city children from Southern Brazil. J Asthma. 2016;53(5):498-504. https://doi.org/10.3109/02770903.2015.1108438
Eder W, Ege MJ, von Mutius E. The asthma epidemic. N Engl J Med. 2006;355(21):2226-35. https://doi.org/10.1056/NEJMra054308
Apter AJ, Wang X, Bogen DK, Rand CS, McElligott S, Polsky D, et al. Problem solving to improve adherence and asthma outcomes in urban adults with moderate or severe asthma: a randomized controlled trial. J Allergy Clin Immunol. 2011;128(3):516-523.e5. https://doi.org/10.1016/j.jaci.2011.05.010
Boulet LP, FitzGerald JM, Reddel HK. The revised 2014 GINA strategy report: opportunities for change. Curr Opin Pulm Med. 2015;21(1):1-7. https://doi.org/10.1097/MCP.0000000000000125
Roncada C, Bischoff LC, Bugança BM, Soldera K, Cardoso TA, Pitrez PM. Características psicométricas do Questionário Newcastle de Conhecimento em Asma (NAKQ) para pais de crianças com asma. Sci Med. 2017;27(2):ID25635. https://doi.org/10.15448/1980-6108.2017.2.25635
Roncada C, Cardoso TA, Bagunça BM, Bischoff LC, Soldera K, Pitrez PM. Levels of knowledge about asthma of parents of asthmatic children. Einstein (São Paulo). 2018;16(2):eAO4204. https://doi.org/10.1590/s1679-45082018ao4204
Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios Contínua 2016-2017. PNAD Contínua - Educação 2017 [Internet]. Brasília: IBGE. 2018 [cited 2019 Jun 25]. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101576_informativo.pdf
Instituto Paulo Montenegro. Ação social do IBOPE. Ação educativa. Indicador de alfabetismo funcional. INAF Brasil 2018 [Internet]. São Paulo: Instituto Paulo Montenegro. 2018 [cited 2019 Jun 26]. Available from: https://acaoeducativa.org.br/wp-content/uploads/2018/08/Inaf2018_Relat%C3%B3rio-Resultados-Preliminares_v08Ago2018.pdf
Ponte EV, Cruz AA, Athanazio R, Carvalho-Pinto R, Fernandes FL, Barreto ML, et al. Urbanization is associated with increased asthma morbidity and mortality in Brazil. Clin Respir J. 2018;12(2):410-17. https://doi.org/10.1111/crj.12530
Szefler SJ, Szefler SJ. Examining causes of the urban (inner city) asthma epidemic: Implementing new management strategies. Allergy Asthma Proc. 2016;37(1):4-8. https://doi.org/10.2500/aap.2016.37.3906
Brasil. Ministério da Saúde. Sistema Único de Saúde (SUS) [Internet]. Brasilia: SUS. 2019 [cited 2019 Jun 28]. Available from: http://www.saude.gov.br/sistema-unico-de-saude
Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios Contínua 2016-2017 [Internet]. Brasília: IBGE; 2018 [cited 2019 Jun 27]. Available from: https://www.ibge.gov.br/estatisticas/sociais/rendimento-despesa-e-consumo/9171-pesquisa-nacional-por-amostra-de-domicilios-continua-mensal.html?=&t=o-que-e
Associação Brasileira de Empresas de Pesquisa (ABEP). Critério de Classificação Econômica Brasil (CCEB) [Internet]. São Paulo: ABEP; 2014 [cited 2019 Jun 15]. Available from: http://www.abep.org/criterio-brasil
Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8(3):483-91. https://doi.org/10.1183/09031936.95.08030483
Global Strategy for Asthma Management and Prevention (GINA). Global Initiative For Asthma. Global strategy for asthma management and prevention. Fontana: Global Initiative For Asthma; 2015. Available from: https://ginasthma.org/wp-content/uploads/2016/01/GINA_Report_2015_Aug11-1.pdf
Cardoso TA, Ribeiro MC, Roncada C, Santos RRG, Pitrez PM. Development and validation of Knowledge in Pediatric Asthma questionnaire (Q-CAP) for brazilian population. Sci Med. 2020;30(1):e34765. https://doi.org/10.15448/1980-6108.2020.1.34765
Apolinario D, Braga Rde C, Magaldi RM, Busse AL, Campora F, Brucki S, Lee SY. Short assessment of health literacy for portuguese-speaking Adults. Rev Saude Publica. 2012;46(4):702-11. https://doi.org/10.1590/S0034-89102012005000047
Sarria EE, Rosa RCM, Fischer GB, Hirakata VN, Rocha NSd, Mattiello R. Field-test validation of the brazilian version of the Paediatric Asthma Quality of Life Questionnaire. J Bras Pneumol. 2010;36(4):417-24. https://doi.org/10.1590/S1806-37132010000400005
Oliveira-Filho AD, Barreto-Filho JA, Neves SJF, Lyra Junior DP. Association between the 8-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure control. Arq Bras Cardiol. 2012;99(1):649-58. https://doi.org/10.1590/s0066-782x2012005000053
DeMaris A. A tutorial in logistic regression. J Marriage Fam. 1995:57(4):956-68. https://doi.org/10.2307/353415
Pacheco LMD, Balem NM. Revisitando conceitos: alfabetismo/analfabetismo e respectivos neologismos. Rev Ciênc Hum Educ. 2002;3(3):133-50. https://doi.org/10.31512
Costa DD, Pitrez PM, Barroso NF, Roncada C. Asthma control in the quality of life levels of asthmatic patients’ caregivers: a systematic review with meta-analysis and meta-regression. J Pediatr (Rio J). 2018;95(4):401-09 https://doi.org/10.1016/j.jped.2018.10.010
Harrington KF, Zhang B, Magruder T, Bailey WC, Gerald LB. The impact of parent’s health literacy on pediatric asthma outcomes. Pediatr Allergy Immunol Pulmonol. 2015;28(1):20-6. https://doi.org/10.1089/ped.2014.0379
Centers for Disease Control (CDC). National Health Interview Survey (NHIS) data: 2008 lifetime and current asthma [Internet]. Atlanta: US Department of Health and Human Services, CDC; 2010 Feb 10 [cited 2019 Jun 07]. Available from: http://www.cdc.gov/asthma/nhis/08/data.htm.
Cardoso TA, Roncada C, Silva ERD, Pinto LA, Jones MH, Stein RT, et al. The impact of asthma in Brazil: a longitudinal analysis of data from a brazilian national database system. J Bras Pneumol. 2017;43(3):163-8. https://doi.org/10.1590/S1806-37562016000000352
Cabello M, Sancho Gutiérrez R, García Higuera L, Pérez Belmonte E, Cabero Pérez M. Knowledge that parents of asthmatic children have about medical treatment of asthma. Bol Pediatr. 2014;54(229):168-72. Available from: http://sccalp.org/uploads/bulletin_article/pdf_version/1376/BolPediatr2014_54_168_172.pdf
Marchioro J, Gazzotti MR, Nascimento OA, Montealegre F, Fish J, Jardim JR. Level of asthma control and its relationship with medication use in asthma patients in Brazil. J Bras Pneumol. 2014;40(5):487-94. https://doi.org/10.1590/s1806-37132014000500004
Roncada C, Oliveira SG, Cidade SF, Rafael JG, Ojeda BS, Santos BRL, et al. Asthma treatment in children and adolescents in an urban area in southern Brazil: popular myths and features. J Bras Pneumol. 2016;42(2):136-42. https://doi.org/10.1590/S1806-37562015000000166
Mendes MA, Sant’Anna CC, March MFBP. Stress in children and adolescents with asthma.
Journal of Human Growth and Development. 2013;23(1):80-6. https://doi.org/10.7322/jhgd.50395
Friedman D, Masek B, Barreto E, Baer L, Lapey A, Budge E, et al. Fathers and asthma Care: paternal involvement, beliefs, and management skills. J Pediatr Psychol. 2015;40(8):768-80. https://doi.org/10.1093/jpepsy/jsv035
Kouzegaran S, Samimi P, Ahanchian H, Khoshkhui M, Behmanesh F. Quality of life in children with asthma versus healthy children. Open Access Maced J Med Sci. 2018;6(8):1413-8. https://doi.org/10.3889/oamjms.2018.287
Goodwin RD, Robinson M, Sly PD, McKeague IW, Susser ES, Zubrick SR, et al. Severity and persistence of asthma and mental health: a birth cohort study. Psychol Med. 2013;43(6):1313-22. https://doi.org/10.1017/S0033291712001754
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