Análisis Estadísticos de los Datos

Cognitive development stages of a child’s thinking and reasoning ability become more complex as a child increases in age, but it is important to note that each child will develop at different rates and age is not always an indicator of their ability to make independent decisions regarding the management of their asthma. This theme presents Dean one of the youngest participants who demonstrated a high level of autonomy organisational skills and increased agency compared to other children who were older (such as Amanda above). Dean 7 and Susan (Mother)

Dean seven years of age lives with his mother, step-father and brother. His mother works part time. Dean enjoys playing out with his friends. He has a dog, a variety of fish and reptiles. He also has a diagnosis of eczema. Dean demonstrates agency in the management decisions of his asthma. He will administer the reliever and preventative inhaler. He is able to acknowledge asthma symptoms that require treatment and in the presence of symptoms he will restrict physical activity. Susan, Dean’s mother demonstrates a mostly permissive and only occasionally authoritarian parenting style, as she typically allows Dean the control over the majority of management decisions but dominates decisions in the presence of more

severe symptoms. His organisational skills facilitate his mother’s confidence in his ability to manage. The only decision that Dean ‘shifts’ the control back to his mother is when he experiences severe symptoms from additional illness when he gains reassurance from her support. She takes control of the decision if further health care advice is required, when the symptoms continue to deteriorate. Figure 7 presents the family decision map as a

continuum of examples of what decisions are made, when and who has control of the decision.

Figure 7: Dean 7 and Susan (mother) decision map

A B C D E F B C G H

Shifting process

Key Type of decision

A Decides whether cough is a symptom related to asthma

B Decides to administer reliever treatment

C Decides to administer preventer inhaler

D Decides to minimise risk of specific trigger

E Decides on mode of administration

F Decides when to resume activity

G Mother decides to prompt inhaler use

H Mother decides on the action and treatment of severe symptoms

The family decision map illustrates the high level of agency that Dean demonstrates within the asthma management decisions with a concentrated number of decisions controlled by Dean. He recognises his cough symptoms relate to asthma, the administration of reliever and preventative inhalers, reducing his risk of specific triggers and when to resume leisure activity following an acute asthma episode.

Shared decision-making Dean controls decisions Susan (mother) controls decisions

‘I have my preventer in my room, which is the one I take each morning and night’ Dean 7

‘Pets don’t make my asthma worse and cold weather doesn’t either. My asthma starts up when I am doing sports then I know to go and get my inhaler’ Dean 7 ‘I use the one in my room. If I am coughing really bad I might just take two puffs’ Dean 7

‘I still enjoy running around I would carry on doing it but not as fast’ Dean 7 ‘I would make that decision myself to use my inhaler at school but my mum might help at home’ Dean 7

‘He listens to his own body, he knows how he is feeling and doesn’t know it any other way. You have to teach these children what their limitations are. As he gets older I am with him less and less…another life skill he has to manage because of the condition he has)’ Susan, mother ofDean 7

‘He will always say I am having it (inhaler) and he will just go and get it. If his asthma does start he will have his inhaler. He doesn’t avoid anything that may trigger his asthma’ Susan, mother of Dean 7

‘He takes his medication straight through the inhaler although we get conflicting advice’ Susan, mother of Dean 7

Susan, Dean’s mother generally allows Dean to self-manage his asthma but was strong in her view, showing an authoritarian parenting style that as soon as his symptoms become worse she will dominate the decision-making and take back the responsibility from Dean regardless of his decision preferences.

‘We would involve Dean unless we thought this was something more. It would be my decision if we were going to the hospital. It is my decision if he has time off school due to his asthma. Obviously if it is a really bad attack I would take over regardless of what he wanted’ Susan, mother of Dean 7

‘I only let my mum know if it is really bad.’ Dean 7

‘When I had whooping cough and I wanted to play out, I asked my mum if I could play out.’ Dean 7

When discussing this with Dean he was very happy to share the decision-making with his mother and it didn’t impact on his autonomy, agency or self-confidence. He indicated how he appreciated his mother prompting him as he knew himself sometimes he forgot to take his inhalers and she was also better at spotting him starting to wheeze.

‘Can’t feel myself wheezing but mum might see me like puffing she will say do you want your inhaler and I will say yes’ Dean 7

‘I like sharing decisions with mum otherwise I might forget to take it (inhaler).’ Dean 7 ‘Maybe I have said do you need it (inhaler) and he will say no. I will just leave it and monitor him and nothing happens’ Susan, mother of Dean 7

Dean is encouraged to be autonomous to make sure when he is not with his parents he can make appropriate decisions regarding his asthma management. So the control of decisions, for the majority of the time, rest with him, he demonstrates higher cognitive development and child agency but either allows the control to fluctuate or relinquishes control when his mother chooses to take over, only in presence of severe illness.

‘He sleeps at my parent’s house and we just pack everything for him and he would just sort it out’ Susan, mother of Dean 7

Dean demonstrates agency with the majority of his asthma management decisions and is highly organised which contributes to his mother’s confidence in his ability to self-manage effectively. Cognitive developmental psychology provides valuable information about a child’s cognitive abilities, which can be applied to understand the child’s level of

participation within the shared decision-making for their asthma management. Earlier in the thesis Piaget’s cognitive developmental stages indicated that a child’s thinking and reasoning ability become more complex as their chronological age increases. Within this study the youngest child is one of the most confident and independent children with respect to the self-management of his asthma (comparable to Nathaniel who was 11) and other older children within the study. This highlights that the rate of cognitive development for each child is very different and may be influenced more by society and contextual influences. In the case of Dean his learnt organisational skills which enhance his ability to manage

in his ability facilitated his increased self-efficacy. What was important to note was that sharing decisions did not hinder autonomy or child agency but provided reassurance and support.

6.3 Shared decisions used to build self-confidence and develop child agency