title: Contrast of pediatric asthma management approaches in a multicultural and collectivistic population.
abstract: BACKGROUND
  Although asthma is the most prevalent chronic illness in childhood and affects approximately 9 million children, the management approaches used by practitioners may not be efficient from the perspective of families. Clinicians often maintain their usual customs of practice, and the context of the clinical encounter is defined in terms of an individual illness management. In collectivistic and multiethnic settings, the extended kin group or extended family shares responsibility for illness management. The goal of this study is to describe health care providers' strategies to manage children with asthma in a multicultural and collectivistic cultural context.
  
  
  METHODS
  Data were obtained through semistructured in-depth practitioner interviews. Western-trained and traditional practitioners participated.
  
  
  RESULTS
  Narrative analysis strategies produced two major themes: 1) fix the asthma and 2) making connections. Practitioners who perceived their responsibility to fix the asthma (make things physiologically normal) often ran into constraints with dealing with the extended family group. Other practitioners who used strategies of making connections often capitalized on the assistance of others to problem-solve the asthma management.
  
  
  CONCLUSIONS
  In terms of asthma management, the barriers most frequently reported by practitioners were related to the sociocultural and physical environment. There may be vast differences in asthma management approaches for populations from collectivistic cultural orientation.
authors.affiliation: Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii 96826, USA. atse@hawaii.edu
authors.forename: Alice M
authors.initials: AM
authors.lastname: Tse
authors.forename: Donna-Marie
authors.initials: DM
authors.lastname: Palakiko
authors.forename: Ronnie
authors.initials: R
authors.lastname: Texeira
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000208:ethnology* / Q000628:therapy*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018864:Cultural Diversity; D005260:Female; D006254:Hawaii / Q000208:ethnology; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D010821:Physicians, Family; D011369:Professional-Patient Relations