In particular, alternate caregivers may play a central
role in Island PR families. Our findings suggest that 32%
of Island PR families received care from alternate caregivers,
which was twice as much as other groups including
RI PR families (15%) and were rated to be more knowledgeable
in asthma management compared with RI Latino
groups. Moreover, contrary to hypotheses, Island PR families
with an identified alternate caregiver were rated as
having higher levels of balanced integration and medication
adherence than those who did not identify an alternate
caregiver. These findings suggest that among Island PR
families, the inclusion of an alternate caregiver is related
to improved asthma management despite having additional
individuals serving a caregiving role. Island PR families are
likely to receive support from extended family members,many of whom reside in proximity (Garcia-Preto, 2005;
Landale & Oropesa, 2001). This support may be helpful
in balancing the daily demands of asthma management
within the larger family system and improving medication-
taking behaviors. Incorporating alternate caregiver involvement
and support may be beneficial in targeting
asthma management disparities that have been noted
among Island PR families (Canino et al., 2006).