Using Concept Mapping with Parent and Youth Community Residents to Explore the Social and Environmental Influences on Children's Asthma

Background/Purpose: The burden of children’s asthma disproportionately impacts children living in economically underserved urban neighborhoods. While the causes of asthma are not fully understood, recent research indicates that the influence of social and environmental factors is essential to addressing racial and economic disparities. This paper illustrates findings from a community-based participatory research (CBPR) study which explored factors related to the triggers and care of asthma for youth living in a predominantly African-American, distressed urban neighborhood in Pittsburgh, PA.

Methods: This project involved a community and academic research team engaged with twenty one urban neighborhood youth and adult residents that were recruited through the existing community ties of the Homewood Children’s Village. Concept mapping, a mixed-methods participatory data collection method, was used to document, organize, prioritize, and compare perceptions of social and environmental factors impacting community youth with asthma. Participants were asked to attend three unique concept mapping sessions: a brainstorming session, a sorting/rating session, and one final discussion session to identify, organize and prioritize the findings.

Results: Results of our concept mapping sessions identified 88 unique social and environmental factors perceived to by youth and adults to trigger an asthma exacerbation.  Examples include indoor and outdoor irritants (e.g., cigarette smoke, pollution, dust), indoor and outdoor allergens (e.g., chemicals, pets, deodorants and detergents), and violence or emotions related to bad memories (e.g., having a family member killed, family member or friend shot, physical fights, shootings, stress, anxiety, panic, fear). Youth reported a higher ranking as compared to adults in school and other stress-related factors (e.g., testing, school responsibilities, and exciting events). The most important and common factors influencing asthma care included medical and other relievers (e.g., inhalers, medications, and hospital access), appliances (e.g., duct filters and purifiers), and asthma supports (e.g., school nurse, having friends with asthma).

Conclusions and Implications: This study goes beyond prior work by exploring and comparing the experiences of both youth and parents for a more comprehensive understanding of asthma from multiple perspectives. By using the knowledge and expertise of neighborhood residents to identify asthma triggers and methods of care, our study findings have significant implications for the design of interventions for children’s asthma in this distressed urban neighborhood, and inform how we think about developing and implementing tailored community-based health interventions more broadly. Based on these findings, the implications for the design of a community-wide asthma intervention are discussed.