الفهرس 
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Abstract
Bronchial asthma is an airway chronic inflammatory disorder characterized by bronchial hyperreactivity, excessive production of mucus, and obstruction of the airway. Managing bronchial asthma is based on symptom control and adherence to the therapeutic regimen. Thus, pediatric nurses should encourage mothers’ adherence to the therapeutic regimens for their children and provide them with personal asthma action plans about disease and treatment. The aim of this study is to explore the relationship between mothers’ adherence to the therapeutic regimen of their children with bronchial asthma and the recurrence of attacks. The study was conducted in the Pediatric Outpatient Clinics of Specialized Smouha Hospital. A convenient sample of 200 mothers attending the previously mentioned setting with their children who fulfill the following criteria, were comprised of the study subjects: • Age ranged from 7 -11 years .
• Children diagnosed with bronchial asthma 6 months before data collection. • Free from any other chronic diseases. Three tools were used for data collection. Tool one Socio-Demographic characteristic of Children with Bronchial Asthma, their mothers, fathers, and children’s medical history sheets. Tool two Mothers’ Adherence to Therapeutic Regimen of Their Children with Bronchial Asthma Structured Interview Schedule. It included eight main items that involved the administration of prescribed medication, nutrition, triggers factors, chest physiotherapy, vaccination, sleeping pattern, sports, and follow-up visit every month. Mothers had good adhered when total score 75% and more and partially adhered 60 < 75% scores. Whereas, they had not adhered when their scores were less than 60%. Moreover, tool three Childhood Asthma Control Test (c-ACT) and the occurrence of recurrent attacks, it is a self-administered tool. It included two responses over the past 4 weeks. The scale was composed of seven questions on it (4 for the child- and 3 for the caregiver). The child-reported questions, rated on a 4-point Likert scale, included daytime and activity limitation, nocturnal awakenings, and self-perceptions of asthma; the caregiver-reported questions, rated on a 6-point Likert scale, included asking about the child’s daytime and nocturnal symptoms. A total score was calculated from the responses, and it ranged from 0 to 27. Children had controlled asthma when their scores were 20-27, partially controlled asthma with 13-19 scores, and uncontrolled asthma when their score were 0-12. The main results of the present study were as follows: Part I: (A) Socio-demographic characteristics of mothers • More than one third of mothers aged from 30 years to less than 35 years (38%) with mean age ± SD. 34.72 ± 6.100. • Half of mothers had a secondary educational level (50.5%). • The majority of mothers were not working and married (85.0%& 91.5% respectively). • More than two thirds of mothers had a medium socioeconomic level (67.0%). • Nearly three quarters of mothers were living in urban areas (73.0%).
• Regarding the history of bronchial asthma one fifth of mothers have a history of bronchial asthma (21.0%) and only two fifth of them get follow-up regularly (40.5%). Part I: (B) Socio-Demographic characteristics of Children and Medical History • More than one third of children aged from 7 years to less than 8 years (37.0%) with mean age ± SD. 8.640 ± 1.566. • Nearly two thirds of children were male (64.0%). • Majority of children had a primary educational level (94.5%). • Two thirds of children were delivered by cesarean section (67.0%). • One third of children diagnosed with bronchial asthma for more than 1year (34.0%). • One quarter of children had previously been hospitalized (26.5%). • Frequency of bronchial asthma attacks occurred in winter season for two thirds of children (66.5%) and all of children were treated with inhaler (100%). • In addition, the weight of one third of children was 25kg to less than 35kg with mean ± SD. 29.55 ± 11.31 and more than half of them had a family history of bronchial asthma (54.0%). Part II: Mothers’ Adherence to Therapeutic Regimen of Their Children with Bronchial Asthma. A. Related to the prescribed treatment: • Mothers were good adherent to their children’s medication encouragement and link the time of giving medication with daily habits (66.0% & 62.0% respectively). • More than three quarters of mothers were good adherent to the correct dose and administration (78.0%). • More than half of mothers were good adherent to the prescribed time of medication (58.5%). • Three quarters of mothers didn’t adhere to use an alarm clock with prescribed treatment time (75.0%). • Less than half of mothers were not adherent to compensation for the missed dose and afford to buy medication (49.0% &38.0% respectively). • The majority of mothers were partially adherent for using their children’s inhalers correctly (80.0%). B. Related to therapeutic nutrition: • Less than half of mothers were good adherent to give their children food rich in proteins (47.0%). • More than half of mothers were good adherent regarding given their children food rich in carbohydrates and vitamins (63.5% &54.5% respectively). • Sixty percent of mothers were not adherent to give their children foods rich in unsaturated fats and vegetable oils.
C. Related to trigger factors avoidance: • Mothers were good adherent to avoid their children’s exposure to medication that worsens asthma, pets in the house, allergies to food, smoking sources, and house dust (93.0%, 86.0%, 83.0%, 77.0% & 72.0% respectively). D. Related to chest physiotherapy: • Nearly three quarters of mothers were not adherent to apply the steps of chest physiotherapy (72.0%). E. Related to vaccination: • The majority of mothers were good adherent to give all mandatory vaccination to their children (95.0%). • 72.0% of mothers were not adherent to give seasonal flu vaccination to their children yearly. F. Related to sleeping pattern: • More than half of mothers were good adherent to maintain quiet bedrooms with dim light (53.5%). • The majority of mothers were good adherent to avoid giving their children stimulants as chocolate before sleep time (93.0%). • Less than half of mothers were not adherent to set a specific time to get up and go to bed and establish a routine before sleep time (41.0%& 34.0% respectively). G. Related to exercise/ sport activity: • Mothers were not adherent to put asthma inhalers in their children’s bags, give medication to their children before physical activity, allow exercise in closed halls, children exercise in a moderate climates, and encourage their children to regular exercise (91.5%, 88.0%, 76.5%, 75.5% & 73.5% respectively). H. Related to follow-up: • Equal percent of mothers were good adherent to visit the doctors regularly and referred to them if any deterioration occurred in their children’s health (79.0% and 79.0% respectively). • The majority of mothers were good adherent to perform required medical examinations to their children (81.0%). • Less than half of mothers were partially adherent to follow the therapeutic nutrition for their children (45.5%). Part III: Childhood Asthma Control Test (c-ACT) and the Occurrence of Recurrent Attacks A. Children’s response: • More than half of children responded with good about asthma today (57.0%). • More than one third of children responded that it’s a problem with asthma when they run, exercise, or play sports (39.0%).
• Cough was present most of the time (39.5%). • 35.0% of children responded that they wakeup sometimes during the night due to asthma. B. Mothers’ response: • One third of mothers reported that daytime asthma syndrome occurred from 4-10 days (33.5%). • 36.0% of mothers responded that wheezing didn’t occur for their children in the last 4 weeks. • More than half of mothers responded that their children didn’t wake up during the night due to asthma (51.5%). Part IV: Correlation between Levels of Mothers’ Adherence to Therapeutic Regimen of Bronchial Asthma and Their Socio-Demographic characteristics • There are statistically significant differences were observed between the mothers’ occupation, use of the computer, family socioeconomic levels, place of residence, and level of mothers’ adherence to the therapeutic regimen (X2=9.736 (P=0.008*), X2=26.396 (P=0.000*), X2=21.718 (P=0.005*) & X2=11.649 (P=0.003*) respectively). Part V: Correlation between Levels of Mothers’ Adherence to Therapeutic Regimen of Bronchial Asthma and The Children’s Socio-Demographic characteristics • There are statistically significant differences were found between the children’s birth order, type of delivery, diagnosis of bronchial asthma, and level of mothers’ adherence to the therapeutic regimen (X2=16.613 (P=0.011*), X2=9.026 (P=0.011*) & X2=22.716 (P=0.004*) respectively). Part VI: Correlation between children’s Levels of Recurrence of Bronchial Asthma attacks and Their Socio-Demographic characteristics as well as medical history. • A statistically significant difference was found between the children’s age, type of delivery, previous hospitalization, family history, and level of recurrence of bronchial asthma (X2=18.512 (P=0.018*), X2=14.969 (P=0.001*), X2=23.783(P=0.000*) & X2=11.429 (P=0.003*) respectively). Part VII: Correlation between children’s Levels of Recurrence of Bronchial Asthma and The Adherence to Therapeutic Regimen • There was a statistically significant difference between the controlled recurrence of bronchial asthma and the adherence to the therapeutic regimen (P=0.048*). • More than half of good adhered mothers to therapeutic regimens their children had controlled recurrence asthma (61.1%). • On the other hand, it was noticed that 19.6% of mothers have not adhered to therapeutic regimens their children had uncontrolled recurrence of asthma. • While 51.8% of partially adhered mothers with therapeutic regimens their children had partially controlled recurrence asthma.