The Principal and Nurse Perspective on Gaps in Asthma Care and Barriers to Physical Activity in New York City Schools: A Qualitative Study

Background. School officials and nurses play an important role in facilitating asthma management in schools. Little is known about their perspectives on in-school asthma management and barriers to physical activity (PA) at school. Aims. The goal of this study is to explore school officials’ and nurses’ perspectives on asthma care and barriers to PA in children with asthma attending New York City schools. Method. We conducted qualitative, semistructured interviews with 10 principals, 3 assistant principals, and 9 nurses in 10 Bronx, New York elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and coded for common themes. The thematic and content review was subsequently used to analyze interview data. Emerging themes were discussed and agreed on by both investigators. Results. Three main categories arose from the analysis: (1) procedures and policies around asthma management in school, (2) barriers to effective medication administration in school, and (3) barriers to PA in children with asthma. Discussion. Participants identified gaps to in-school asthma management and barriers to PA participation: ineffective ways of identifying students with asthma; lack of written procedures for asthma management; difficulty in meeting the administrative requirements to administer asthma medication; lack of knowledge and training on asthma management for the parents, students, and school staff; parental limitation of children’s PA; and schools not meeting the state physical education requirement. Conclusions. Our findings suggest the need for policy reform on asthma management and PA in urban schools and should be considered in the design of future interventions.