Perspectives and Needs of Caregivers in Protecting Their Child With Asthma From Wildfire Smoke

OBJECTIVES: To determine the caregiver-reported barriers, communication needs, and potential interventions to reduce wildfire smoke (WFS) risk for children with asthma. STUDY DESIGN: English- and Spanish-speaking caregivers of children 4-13 years old with asthma were recruited from pediatric pulmonology clinics in Western Washington. Demographics and WFS-related practices were assessed via one survey and one interview, using interpreters when needed. Inductive and deductive thematic analysis was conducted using the Capability, Opportunity, and Motivation for Behavior and Source-Message-Channel-Receiver frameworks. RESULTS: Twenty-three caregivers participated. Interviews were conducted in English (n = 19, 83%) or Spanish (n = 4, 17%). Participant statewide social vulnerability index by 2022 census tract ranged from 0.026 to 0.997. Qualitative analysis revealed several themes including (1) significant anxiety about WFS, (2) uncertainty about reliability of the air quality index and when to take specific protective actions, (3) complex decision-making regarding staying indoors, and (4) financial barriers to implementing recommendations. Caregivers preferred receiving personalized messages about WFS from trusted health sources. We mapped the identified barriers to potential strategies to facilitate caregivers' ability to enact WFS recommendations. CONCLUSIONS: Caregivers experience a variety of barriers to WFS safety. The intervention strategies we identified represent opportunities for action and areas for future research aimed at improving health outcomes for children with asthma at risk for WFS exposure.