Native Hawaiian Caregivers' Cultural Perspectives of Pediatric Asthma Management

Asthma remains the leading cause of chronic respiratory illness among Native Hawaiian children 0 to 17 years in Hawai'i. The National Asthma Education and Prevention Program (NAEPP) established asthma management guidelines which includes medical assessment and monitoring, education in partnership with the caregiver, control of environmental triggers, and medication adherence (National Asthma Education Prevention Program [NAEPP], 2007). However, these guidelines do not consider the worldview, health beliefs, and cultural practices of caregiver, child, and family. The purpose of this study was to describe how Native Hawaiian caregivers manage pediatric asthma, to understand which strategies are considered cultural practices, and to identify other cultural practices used to manage asthma. Eighteen interviews with self-identified Native Hawaiian caregivers of school-aged children between the age of 5 and 12 with a diagnosis of mild-persistent, moderate-persistent, or severe-persistent asthma were conducted. Interviews used a talk story approach to understand how the child's asthma was managed and to identify cultural practices the caregivers were aware of and used to manage pediatric asthma. Interviews were audio recorded and transcribed. A thematic form of inductive content analysis was used to analyze the data. Each transcript was independently reviewed and coded. The codes were then categorized and themes and subthemes emerged. Multiple coders validated the identified themes. Two overarching themes and six subthemes emerged from the analysis. The themes included asthma and its causes, physical activity, and management strategies. Native Hawaiian caregivers in this study believed that asthma was caused by heredity and environmental exposure. Asthma management strategies included using alternative therapies, responding to asthma symptoms, and preventing asthma symptoms. Awareness of cultural practices was readily discussed by caregivers. However, cultural practices such as la'au lapa'au (herbal medicine) and lomilomi (traditional massage) were seldom, if ever, used. Caregivers reported that they lacked the knowledge of and how to properly use such cultural practices as a treatment for asthma. Future research should explore the role and influence cultural beliefs have on health practices and the role and influence of the community one lives as it relates to asthma management.