Multilevel Facilitators of Pediatric Asthma Outcomes: The Role of Caregiver Self-Efficacy

Objective: Caregivers' self-efficacy for managing their child's asthma appears to influence their success with managing their child's disease. We examined how caregiver self-efficacy operates in the context of multilevel social-environmental support factors to shape asthma outcomes. Method: Caregivers of children (<18 years old) with asthma completed surveys at baseline (T1) and 3 months later (T2). At T1, caregivers (n = 814) rated health care provider communication, family collaboration, community resources, socioeconomic status (SES), objective numeracy, caregiver global health, and caregiver self-efficacy for managing their child's asthma. At T1 and T2 (n = 401), caregivers rated their asthma management behaviors and their child's asthma-related morbidity and quality of life. We used structural equation models to test whether caregiver self-efficacy mediated the associations between support factors and outcomes. Results: For T1 caregiver asthma management behavior, we observed positive indirect effects through self-efficacy for community resources and caregiver global health, and an unexpected negative indirect effect for SES. For T2 caregiver asthma management behavior, we observed no indirect effects. For T1 child asthma-related morbidity, we found positive indirect effects through self-efficacy for community resources and caregiver global health, and a negative indirect effect for SES. For child asthma-related morbidity at T2, the indirect effects found at T1 remained significant. Conclusions: Social-environmental factors may be an underrecognized driver of caregiver self-efficacy and its consequent child asthma outcomes. Interventions focused on building resources at the community level and strategies that promote caregiver health could empower caregivers with greater self-efficacy and improve asthma outcomes.