The Relationship between Asthma Illness Beliefs, Child Anxiety and Symptom Perception among Latino and African American Pediatric Asthma Patients

Abstract

Background: Research supports that caregiver illness representations and accuracy of symptom perception have direct effects on illness outcomes in pediatric asthma. There is little research, however, about child illness representations. This study therefore, examined child illness representations and the relationship with child anxiety and symptom perception variables among an ethnically diverse, adolescent population with asthma. We hypothesized that child anxiety would predict illness representations that aligned with lay model beliefs including beliefs that asthma is uncontrollable and unpredictable. We also hypothesized that child anxiety would predict over-perception of symptoms and that lay-model child illness representations would be associated with poorer symptom perception. Methods: This study was part of a larger longitudinal study and data analyzed were collected during the baseline and follow-up session prior to randomization to an intervention group. 108 caregiver-child dyads, who identified as Latino or African-American and self-reported a child with asthma, were recruited from outpatient clinics in the Bronx, N.Y. The Asthma Illness Representation Scale (AIRS) was used to assess caregiver and child illness representations. Multi-Dimensional Anxiety Scale (MASC-2) assessed child anxiety symptoms. AM2 devices were used to measure symptom perception over a 3-week time period. Pulmonary function was objectively measured by spirometry (percent predicted FEVI) at baseline, while asthma diagnosis and medications were confirmed by medical chart review. Results: The study sample included 108 caregiver-child dyads, who predominantly self-identified as Puerto Rican (37%) or African American (29.6%), with a mean child age of 13 (SD = 2.07 years). Results from hierarchical linear regressions indicated that higher child anxiety was associated with child (p < .01) and caregiver (p < .01) illness representations that aligned with lay model beliefs and beliefs that asthma symptoms are uncontrollable and unpredictable. Child anxiety explained 5.7% and 5.8% unique variance in child and caregiver illness representations, respectively. Caregiver and child illness representations were not associated with any symptom perception zones, after controlling for child and caregiver age. Child anxiety was not associated with any symptom perception zones, after controlling for child age. Discussion: This study was unique in that it examined child illness representations in the context of pediatric asthma. Child anxiety was shown to be associated with child and caregiver illness representations. These findings highlight potential risks for children who endorse heightened anxiety and the likelihood for illness beliefs to not align with medical facts and potentially interfere with positive health behaviors.