Patient (child) characteristics
In total, 2485 valid questionnaires were collected, a response rate of 83.95%. There were 1660 (66.8%) male children and 825 (33.2%) female children. Their average age was 7.20 ± 3.09 years, and the average disease course was 2.81 ± 2.05 years. More than a third (37.6%) of the children had a history of food allergy, nearly half (48.5%) had a history of eczema, more than half (58.59%) had rhinitis and nearly a third (29.7%) had a family history of asthma.
Parent knowledge, attitudes and practices
In the 2485 valid questionnaires, the average combined KAP score was 17.11± 3.92, with level expression: the fourth level (< 18 points) 51.43% (1278/2485), the third level (18–20 points) 29.58% (735/2485), the second level (21–24 points) 16.86% (419/2485), and the highest level (> 24 points) 2.13% (53/2485).
Parent asthma-related knowledge
The knowledge component of the questionnaire contained 13 items. The average score was 5.69 ± 2.10 and 18.31% of parents scored ≥ 8. Many parents (63.98%) knew that asthma is a chronic allergen-induced airway inflammatory disease. Only 6.08% (151/2485) knew that “wheezing > 3 times, coughing > 4 weeks, > 6 respiratory infections in the last year and relief after using bronchodilator” could suggest asthma. Almost two thirds (63.58%) of parents knew that wheezing more than three times suggests asthma. By contrast, only 23.74% (590/2485) recognized that a chronic cough may indicate asthma. “Self-withdrawal, catching a cold, exposure to allergens, strong emotional changes and cold stimulation” were identified by 11.03% (274/2485) of parents as precipitants of asthma. “Repeated strenuous coughing, chest tightness with restricted breathing and dry cough after exercise or sleep” were identified by 20.97% (521/2485) of parents as suggestive of an asthma attack. Parents exhibited a low level of asthma-related knowledge, with a better understanding of the nature of asthma, but a lack of awareness of clinical manifestations of the disease and the indicators of acute attacks.
Parent attitudes and beliefs
The attitudes component of the questionnaire contained seven items. The average score was 5.23 ± 1.283 and most parents (89.58%) scored ≥ 4. A total of 83.30% (2070/2485) of parents knew that asthma is controllable with regular medication. Most (84.67%) believed that their child could participate in sports if their asthma was under control, and of these parents, 60.31% (1269/2104) believed that children with asthma could exercise as much as healthy children. However, 33.60% (835/2485) of parents would allow their children to participate in minor sports only. In items related to adherence with inhaled corticosteroids, 67.32% (1673/2485) of parents worried about negative effects on children’s growth, 40.56% (1008/2485) worried about drug dependence, and 23.98% (596/2485) were worried about potential harm to their child’s intelligence. Regarding access to asthma knowledge, 80.63% (2003/2485) of parents preferred to communicate with physicians.
The practice component of the questionnaire contained 10 items. The average score was 6.19 ± 1.57, and more than half of the parents (67.89%) scored ≥ 6. Regarding examination, two-thirds (68.25%) of children had undergone allergen tests, of which 76.24% (1293/1696) had undergone skin prick tests and 66.96% (1664/2485) had undergone pulmonary function tests. However, only 25.03% (622/2485) had used a peak flow meter to monitor their daily condition, and only 7.00% (174/2485) had used the children’s Asthma Control Test questionnaire. Regarding monitoring, 73.88% (1836/2485) of parents of children with well-controlled asthma regularly took their child to see a physician, among which 67.05% (1231/1836) visited every 1–3 months. Most parents avoid their child being exposed to tobacco smoke (94.78%) and plush toys (88.17%). Many (81.53%) parents of children with controlled asthma insisted on their child adhering to their medication regimen, of which 78.33% (1587/2026) adhered to the correct use of inhaled corticosteroids/compounds and 31.44% (637/2026) to oral leukotriene receptor modulators. In 1456 children with comorbid allergic rhinitis, 34.68% (505/1456) adhered to the correct use of nasal steroids. In addition, 18.87% (469/2485) of parents also used antibiotics as supplementary therapy, regardless of whether their child exhibited symptoms associated with infection.
Influence of parent knowledge and attitudes on practices
Table shows that parent asthma-related knowledge (dichotomized by cut-off score of 8) was associated with eight aspects of pulmonary function testing, regular physician visits, asthma monitoring with a peak flow meter and the C-CAT questionnaire, avoidance of asthma triggers (including smoke and plush toys), using an inhaled β2 receptor agonist and adherence to medication regimen. There were no associations between parent knowledge and allergen testing or using antibiotics.
Influence of parent asthma-related knowledge on practices
Table shows that parent asthma-related attitudes (dichotomized by a cut-off score of 4) were significantly associated with allergen testing, pulmonary function testing, regular physician visits, monitoring with a peak flow meter and the C-CAT questionnaire, smoke avoidance, using an inhaled β2 receptor agonist and better adherence to medication regimen. Better practices were associated with positive parent attitudes.
Influence of parent asthma-related attitudes on practices
Factors associated with parent KAP questionnaire scores
A logistic regression analysis was used to determine the effects of multiple factors on parent KAP score. The dependent variable was KAP questionnaire score (dichotomized by cut-off score of 18). The independent variables are parent education, monthly family income, course of asthma in children, food allergy history, eczema history, coexist with allergic rhinitis, family history of asthma, regular return visits for asthma control, frequency of review. Table shows that food allergy, rhinitis, regular physician visits, frequency of physician visits and parent education had positive associations with KAP scores.
Factors associated with parent KAP scores