Parenting Stress and Child's Quality of Life on Parents' Expectation/Satisfaction and Medication Adherence with Asthmatic Child’s Therapy

Introduction: With about 300 million patients, projected to reach 400 million by 2025, asthma is responsible for about 250,000 premature deaths each year. The prevalence of asthma in the U.S. population has continued to grow. Asthma is a chronic disease that affects more children than adults in the U.S. Adhering to asthma medication is the cornerstone for asthmatic treatments. Asthmatic patients need to continue their treatments to prevent symptoms and the recurrence of asthmatic attacks, but maintaining adherence is challenging for parents with young asthmatic children. Failing to adhere to treatment may increase the risk of exacerbations and emergency room visits. The objective of this study is to examine the effect of parenting stress and the child's quality of life on parents’ expectation, parents’ satisfaction, and medication adherence by the child.

Methods: We conducted an observational cross-sectional exploratory study for the parents of asthmatic children who were under 12 years of age. Using convenience sampling methods, we collected data in asthma and pediatrics clinics in the Houston area. Parents of children with asthma who were visiting an allergy center were able to participate anonymously by completing an online survey about asthma using Qualtrics®. We adapted questions about parental intentions to adhere to asthma medication, parental satisfaction, parental confirmation, and parental expectations from Bhattacherjee (2004). The Parental Stress Scale by Berry et al. (1995), which we used to evaluate parental stress, consists of 18 items representing. For the child’s quality of life, we used The Pediatric Quality of Life Inventory TM Asthma Module Short Form (PedsQLTM Asthma Module Short Form). It is a self-administered questionnaire consisting of 22 questions with 3 domains. We also collected demographic data for parents and children as well as information about other factors that might affect the associations, such as health literacy, insurance, family support, number of medications, and the severity of the disease. We then conducted descriptive analyses and hierarchical linear regression and path analyses.

Results: A total of 262 surveys were completed. Respondents’ average age was 35.1 (±8.9), the majority were female (78.6%), around 66.4% were married, and 55.5% were employed full-time. The most common racial group was Whites (34.7%), followed by Hispanics (33.2%) and African-Americans (25.6%). In the Pearson correlation test, we found a significant correlation between parenting stress with medication adherence (r = - 0.21, p = 0.0005), parental satisfaction (r = -0.3, p = 0.0001), parental confirmation (r = - 0.33, p = 0.0001), parents’ perceived performance (r = -0.33, p = 0.0001), and parental expectations (r = -0.25, p = 0.0005). The child’s quality of life was significantly correlated only with parenting stress (r = -0.24, p = 0.0001). In the final model of the hierarchical linear regression, the results indicated a positive relationship between parenting stress and health literacy (β = 2.05, p < 0.0151), holding other variables constant. There was a negative association between parenting stress and the child’s quality of life (β = -0.162, p < 0.0151), as well as the relationship with the healthcare provider (β = -0.37382, p = 0.0096) after controlling for other variables. After conducting three path analyses, the model did not fit the data.

Conclusions: We found a significant correlation between parenting stress with medication adherence, parental satisfaction, and parental expectations in asthmatic children. However, the child’s quality of life, the only significant correlation was with parenting stress. After conducting hierarchical linear regression, we found that only parental expectations and the number of medications were associated with parental intention to adhere to asthma medications. Meeting parents’ expectations is crucial for controlling asthma. Physicians should know and manage their patients’ expectations, through education, for example, to increase the likelihood of adherence. Based on the hierarchical linear regression and the correlation test, we found that parenting stress indirectly affects parental intentions to adhere to asthma medication. Controlling parenting stress by controlling actors that can aggravate parenting stress is important because such stress might impact parental expectations and consequently might affect parental intention to adhere to asthma medications.