178 A Pilot Study of Caregiver's Recall of Their Child's Skin Test Results and Environmental Remediation Education

BACKGROUND: Allergic asthma is common in urban minorities and evidence suggests that environmental remediation is an effective management strategy. However, remediation requires complex interventions. The purpose of this pilot study, therefore, was to examine caregiver's recall of their child's skin test results and the accuracy of planned remediation ∼4 months after testing. METHODS: A Q-sort was used to determine caregiver's knowledge of the appropriate remediation for their child's allergic status. Using this method, caregivers sorted cards into piles: important for my child's asthma, not important or unsure. Each of the 52 cards represented one intervention for a common indoor allergen. Three of the 52 cards were specific to cat allergen, 3 for dog, 10 for mold and 23 for dustmite. Unlike typical Q-sorts, these cards used pictures and low-literary language. Caregivers were then instructed to place each card on a continuum of highest to lowest priority. At the conclusion of the Q-sort, caregivers received feedback on the accuracy of their prioritization in the context of their child's skin test results. Acceptability of this technique was assessed using qualitative interviews. RESULTS: Five African American women (mean age 33.6; 80% receiving public assistance) caring for 5 children (4 males; mean age 7.8) were enrolled. Caregivers recalled 4.6 positive results per child; only 4.2 positive results per child were noted. However, no caregiver recall of skin test results was concordant with actual results. Caregiver's accuracy in identifying trigger reduction strategies specific to their child's skin test results ranged from 33 to 100% for cat, 40 to 70% for molds, 70 to 87% for dust mites, and 100% for the 1 dog allergic child. No standard battery was performed; rather each test was specific to the child's history. Qualitative interviews showed Q-sort to be an acceptable way to learn about remediation. CONCLUSIONS: Caregivers do not accurately recall skin test results and this may, in part, impede their ability to implement appropriate interventions. A low literacy game-style approach is a novel strategy to provide complex teaching that warrants further investigation.