The current study examined the presence of alternate caregivers
(i.e., caregivers living outside of the home who spend
at least 6 hr per week caring for the child) in the daily lives
of RI Latino, Island PR, and NLW children with asthma
and the extent to which alternate caregivers participate in
asthma management. Across the sample, approximately
Table II. Mean Caregiver Confidence in Alternate Caregiver’s Asthma Management
Confidence that alternate caregiver will do the following Island PRa RI PRb RI DRc RI NLWd F p p
2 Post hoc comparisons
Notice child experiencing breathing problems 4.45 (.96) 4.73 (.47) 3.79 (1.27) 4.29 (.91) 2.97 .034 .06 a>c; a¼b¼d
Care for child’s breathing problems 4.66 (.83) 4.64 (.67) 4.28 (.96) 4.64 (.75) .89 .447 .02 a¼b¼c¼d
Give child medications correctly 4.89 (.38) 4.86 (.38) 4.45 (.69) 4.70 (.48) 4.82 .003 .11 a>c; a¼b¼d
Note. Each question is rated on a 5-point scale with higher scores indicating greater caregiver confidence. All analyses are conducted controlling for child’s asthma severity
and poverty threshold status. Bonferroni adjustments were made for post hoc comparisons.
Figure 1. Medication adherence across Island PR and RI PR, DR, and
NLW families and alternate caregiver status.
648 Fedele et al.
Downloaded from http://jpepsy.oxfordjournals.org/ by guest on September 24, 2016
one in four families reported having an alternate caregiver
who was involved in their child’s asthma care.
Grandmothers were most commonly identified as alternate
caregivers. For families with an identified alternate caregiver,
the majority of primary caregivers reported that alternate
caregivers were involved in children’s asthma
medication management (e.g., medication administration),
and that they were confident in alternate caregivers’ ability
to manage child asthma. However, primary caregivers indicated
that alternate caregivers may not be aware of all of the
child’s asthma-related symptoms related to asthma exacerbations
or know all of the child’s asthma triggers. These
findings add to the family asthma management literature
(Kaugars et al., 2004; McQuaid et al., 2005) by providing
empirical support for expanding existing asthma management
practices that primarily target primary caregivers. The
current study reveals the widespread reliance on alternate
caregiver support in providing child asthma care. Thus,
alternate caregivers should be considered valuable contributors
within a child’s asthma treatment plan.
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,Role of Alternate Caregivers in Pediatric Asthma Management