Exploring the reasons why children with asthma may have unscheduled medical contacts after their return to school in September – Qualitative Study

Problem

It has been proposed that the increase in the number of unscheduled medical contacts in September among school-aged children is caused by a viral challenge at the start of the school year. It is hypothesised that this challenge is compounded by a change in routine over the summer holiday impacting on adherence to medication. The study used a mixed methods approach to answer the research aim, which was to determine what was causing the increase in unscheduled medical contacts for school-aged children in September. The quantitative data has come from ‘PLEASANT’ (Preventing and Lessening Exacerbations of Asthma in School-age children Associated with a New Term) which was a cluster-randomised intervention study. The intervention was a simple letter sent by the child’s GP reminding them to take their medication over the summer holidays. The PLEASANT study then informed the development of the qualitative study. The aim of this qualitative study was to learn from children why there was an increase in unscheduled medical contacts and if this was related to adherence.

Approach

The interviews were completed before and after the summer holiday (July 2016 – Sept 2016) giving the children the opportunity to accurately recall changes in behaviour and to reflect on the impact of summer holidays. Conducting the interviews at two time intervals provided the opportunity to expand upon emergent themes.Children with asthma aged 5-16 were purposively sampled from local state and independent schools in Sheffield, England. In total, 13 boys and 25 girls aged 5-15 were interviewed. Semi-structured interviews, lasting no more than 30 minutes were conducted in the child’s school. The children were asked generic questions about their asthma, such as ‘what is it like having asthma?’ and ‘what makes your asthma better/worse?’. The questions and topics developed initially from the literature and evolved iteratively between interviews. With later interviews focusing more on exercise and returning back to school.Thematic analysis was conducted with the data managed using N-Vivo.

Findings

Four main themes emerged; ‘Trigger and Factors’, ‘Impact’, ‘Adherence and Medication’ and ‘Sport and Exercise’. From the results of the interview analyses, it is suggested that exercise could play a role in causing the September peak for a certain sub-population of children. These children could be at a higher risk of having an unscheduled medical contact in September.

Consequences

These findings could lead to a change in the original PLEASANT intervention, or a possible new intervention, which could be aimed at these higher risk children.