Identifying barriers to chronic disease reporting in Chicago Public Schools: a mixed-methods approach

Abstract

BackgroundChronic disease among school-aged children is a public health concern, particularly for asthma and food allergy. In Chicago Public Schools (CPS), rates of asthma and food allergy among students are underreported. The aim of this study was to determine the barriers to chronic disease reporting as experienced by CPS parents and school nurses.MethodsA mixed-methods approach included focus groups and key informant interviews with parents and school nurses, and a cross-sectional survey was completed by parents. Qualitative data analysis was performed and survey data were analyzed to determine the significant demographic and knowledge variables associated with successfully completing the reporting process.ResultsThe three main barriers identified were 1) a lack of parental process knowledge; 2) limited communication from schools; and 3) insufficient availability of school nurses. Parents were significantly more likely to successfully complete the reporting process if they knew about special accommodations for chronic diseases, understood the need for physician verification, and/or knew the school nurse.ConclusionsThese findings suggest that increasing parental knowledge of the reporting process will allow schools to better identify and manage their students’ chronic conditions. A parent-focused intervention informed by these results has been completed.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1250) contains supplementary material, which is available to authorized users.

Parent perspectives on school food allergy policy

“…It is possible that many parents were not affected by such policies (e.g., children brought their own food to school or did not participate in after-school activities). However, clear and timely communication and a collaborative approach between the student’s school and family may provide an opportunity to help parents be more aware about policies that are in place and therefore feel that school is a safer environment for their food allergic child [ 30 ].…”

Exploring School Nurse Interventions and Health and Education Outcomes: An Integrative Review

“…School nurses engaged in chronic disease management including group asthma education (Mickel, Shanovich, Evans, & Jackson, 2017), individual education on epinephrine pens and ensuring students carried unexpired pens (Spina, McIntyre, & Pulcini, 2012), and management of students' asthma, diabetes, and anaphylaxis emergencies (Allen, Henselman, Laird, Quinones, & Reutzel, 2012). Eight studies explored school nurse experiences with chronic disease reporting (Rivkina et al, 2014), providing disease management for students with weight-related health issues (Powell, Engelke, & Neil, 2017;Quelly, 2013;Steele et al, 2011), and students diagnosed with asthma (Garwick, (Terry, Patel, Cohen, Scherzer, & Kline, 2016), and food allergies (Morris, Baker, Belot, & Edwards, 2011). School nurses communicated collaboratively with parents/guardians (n ¼ 9) to collect student health data (Bergren, 2016;Rivkina et al, 2014), obtain consent for ophthalmology consultation (Diao et al, 2016), provide human papillomavirus (HPV) and meningococcal vaccine information (Rhodes, Draper, Woolman, & Cox, 2017), explain immunization compliance (Swallow & Roberts, 2016), and discuss adolescent dating violence incidents (Khubchandani, Telljohann, Price, Dake, & Hendershot, 2013), asthma treatments (Krenitsky-Korn, 2011), and weight management (Lee & Kubik, 2015;Stalter, Kaylor, Steinke, & Barker, 2011).…”

“…Eight studies explored school nurse experiences with chronic disease reporting (Rivkina et al, 2014), providing disease management for students with weight-related health issues (Powell, Engelke, & Neil, 2017;Quelly, 2013;Steele et al, 2011), and students diagnosed with asthma (Garwick, (Terry, Patel, Cohen, Scherzer, & Kline, 2016), and food allergies (Morris, Baker, Belot, & Edwards, 2011). School nurses communicated collaboratively with parents/guardians (n ¼ 9) to collect student health data (Bergren, 2016;Rivkina et al, 2014), obtain consent for ophthalmology consultation (Diao et al, 2016), provide human papillomavirus (HPV) and meningococcal vaccine information (Rhodes, Draper, Woolman, & Cox, 2017), explain immunization compliance (Swallow & Roberts, 2016), and discuss adolescent dating violence incidents (Khubchandani, Telljohann, Price, Dake, & Hendershot, 2013), asthma treatments (Krenitsky-Korn, 2011), and weight management (Lee & Kubik, 2015;Stalter, Kaylor, Steinke, & Barker, 2011). School nurses communicated with school staff (n ¼ 3) to collect student health data (Bergren, 2016), to discuss asthma diagnosis and treatments (Krenitsky-Korn, 2011), and to develop a plan for students with symptoms of female athlete triad syndrome (Kroshus, Fischer, & Nichols, 2015).…”

“…In four studies, school nurses implemented case management plans with individualized goals and measured health outcomes of children diagnosed with chronic illnesses: decreased asthma-related symptoms and number of urgent care visits (Carpenter et al, 2013), parent and teacher perceptions of child's asthma/diabetes self-management, improved asthma/diabetes-related quality of life (Engelke et al, 2014;Peery et al, 2012), and ability to attain case management goals (Engelke et al, 2014(Engelke et al, , 2011. Two studies investigated the prevalence of student care plans for food allergies and asthma emergencies (Pulcini et al, 2011;Rivkina et al, 2014). Lazdowsky et al (2016) explored the types of school nurse actions and student/family perceptions of the direct care school nurses provided for management of headaches.…”

Preventing Asthma Emergencies in Schools

“…3 However, underreporting, a lack of asthma management plans, 4 and limited access to reliever medications complicate school-based asthma management. [5][6][7] The rate of asthma-related pediatric emergency department visits in Illinois in 2014 was 92 per 10 000, 8 which was much greater than the Healthy People 2020 goal of 49.6 per 10 000. 9 For non-Hispanic African American children, this figure was 265 per 10 000, which is 5.5 times higher than for non-Hispanic white children.…”