Use of Text Messaging to Educate Family Caregivers of Children With Asthma

ABSTRACT

Purpose

Knowledge deficiencies among family caregivers of children with asthma impede optimal disease management. Current research has shown that texting caregivers is an effective method for delivering family‐centered health education. The aim of this quality improvement project was to implement a short message service (SMS)‐based intervention to educate family caregivers of children with asthma and evaluate its effect on caregiver knowledge and confidence in asthma management.

Design and Methods

This project employed a pre‐posttest design with questionnaires completed at the beginning and conclusion of the intervention. Nineteen caregivers received daily educational messages over a 3‐week period.

Results

The intervention resulted in a significant increase in the caregiver asthma knowledge (p = 0.037), but not their confidence (p = 0.604). Caregivers indicated high satisfaction with the length and content of the messages.

Conclusions

This project suggests that the SMS‐based education intervention holds potential to assist family caregivers in better managing their child's asthma.

Practice Implications

This quality improvement project seeks to fill the existing gap of inadequate family caregiver education, strengthen caregiver confidence in asthma management, and ultimately, enhance the care experience of asthmatic children. As chronically ill children have the best care experience when their parents are well‐informed about the disease and able to formulate solutions to manage emerging symptoms, family caregivers benefit as well. The educational messages enrich their asthma knowledge, enabling them to administer medicine promptly and appropriately when their child exhibits symptoms. Early medical attention minimizes the incidence of asthma attacks as well as the demand for emergency room visits, easing the burden on the healthcare providers. Therefore, using text messaging to educate family caregivers of children with asthma may positively affect child, parent, and provider outcomes.

1. Introduction

Asthma is a chronic inflammatory disease that causes repeated episodes of airway narrowing in the lungs, manifested by symptoms such as coughing, wheezing, breathlessness, and chest tightness (Lizzo et al. 2024). These symptoms vary widely in frequency and severity, but uncontrolled asthma and acute exacerbations can become life‐threatening emergencies (Lizzo et al. 2024). Globally, the prevalence of asthma symptoms among children is high. One in ten school‐aged children has experienced wheezing in the past year, with approximately half of these children exhibiting severe asthma symptoms (Asher et al. 2021). Asthma causes increased school absenteeism (Sullivan et al. 2018), disrupted sleep patterns (Plaza‐González et al. 2022), and limited physical activity (Holderness et al. 2017), all of which contribute to a decrease in children's quality of life (Plaza‐González et al. 2022). In addition, children with asthma are at risk for developing chronic obstructive pulmonary disease in adulthood (Ali 2022), which may further impair their quality of life.

Asthma is the most common chronic condition among children in the United States requiring emergency room visits or hospitalizations (Centers for Disease Control and Prevention, CDC 2022a). According to the fifth Asthma Surveillance Summary Report from the Centers for Disease Control and Prevention (Pate et al. 2021), around six million American children suffer from asthma, accounting for 8.1% of all children. There is a significant difference in the prevalence of pediatric asthma based on demographic characteristics. Pediatric asthma is more prevalent in boys than in girls, in older children (5–17 years) than in younger children (< 5 years), and in non‐Hispanic, Black children and those of Puerto Rican descent (Pate et al. 2021). Furthermore, children from low‐income families have a higher risk of being diagnosed with asthma, and the condition tends to be more severe and persistent (Pate et al. 2021; Plaza‐González et al. 2022).

As there is currently no cure for asthma, the primary focus of treatment is asthma management (National Heart, Blood, and Lung Institute 2022). Asthma management entails a range of actions, including self‐monitoring of symptoms, identification and avoidance of asthma triggers, and the proper use of medications (Foronda et al. 2022). Unfortunately, overall adherence to recommended asthma treatment in the pediatric patient population is less than 50% (Morton et al. (2014)). In 2019, asthma contributed to 790,478 emergency room visits and 64,525 hospitalizations (Centers for Disease Control and Prevention, CDC 2022b). The unplanned use of healthcare resources incurs an increased cost of $529 to inpatient hospital admissions and $105 to emergency room visits per person each year (Nurmagambetov et al. 2018).

The primary responsibility for asthma management in childhood rests with parents, with the goal of minimizing the burden of asthma on children and their families (Brown et al. 2010). However, the responsibilities for playing such a critical role in disease management can inevitably overwhelm parents and caregivers. A systematic review and meta‐analysis concluded that caregivers of children with asthma tend to have higher levels of anxiety and depressive symptoms than those of healthy children (Easter et al. 2015). Anxiety and depression among caregivers of asthmatic children are negatively predicted by family socioeconomic status (Zhou et al. 2014), inferring that low‐income caregivers are at increased risk for suffering from mental illness. Other psychosocial challenges faced by caregivers of children with asthma include diminished quality of life, sleep disturbances, family stress, inadequate education, cultural and health disparities, and miscommunication in healthcare (Foronda et al. 2020). Ultimately, there is a link between caregiver health and child health outcomes; thus, by supporting caregivers, child health may be improved (Foronda et al. 2020).

1.1. Asthma Knowledge Gap

Although caregivers are expected to provide the majority of at‐home asthma management, a lack of knowledge about pediatric asthma may hinder their ability to do so. In fact, various studies have identified that knowledge deficit is a barrier to disease management (Foronda et al. 2020; Foronda et al. 2021; Jordan et al. 2022; Parikh et al. 2018). Caregivers generally lack awareness regarding the chronic nature of asthma, the extent of activity limitations, and the importance of maintenance medication in asthma care (Parikh et al. 2018). In a qualitative, descriptive study by Foronda et al. (2020), healthcare providers reported that caregivers lacked knowledge about appropriate asthma management, as evidenced by a need for education on asthma pathophysiology, the difference between controller and rescue medications, the use of inhalers and spacers, the importance of an asthma action plan, how to avoid triggers, and when to seek emergency care.

Two other studies yielded comparable results. Jordan et al. (2022) found that caregivers' understanding of the asthma disease process and management strategies was insufficient, particularly with respect to medication administration and mechanism of action. In a mixed methods randomized controlled study, Foronda et al. (2020) revealed that about half of caregivers had a limited understanding of pediatric asthma. Caregivers expressed a wish to be more educated about asthma medications. One participant stated, “I want to spend more time on the maximum amount of medication [how many times Albuterol can be given]” (Foronda et al. 2021, 6). Additionally, both studies suggested that the majority of family caregivers did not have an asthma action plan available (Foronda et al. 2021; Jordan et al. 2022). As educating caregivers about asthma significantly reduced their depressive symptoms (Foronda et al. 2021), and consequently improved child health outcomes (Foronda et al. 2020), the use of evidence‐based solutions to support caregiver education is warranted.

1.2. Text Messaging

Current research has demonstrated that texting caregivers is a promising strategy for family‐centered health education (Coker, Mitchell, Lowry, et al. 2023; Farias et al. 2020; Teach et al. 2021; Tully et al. 2018). Although research on the use of text messaging to support caregivers is still in its early stage, text messaging holds the potential to assist caregivers of children with the following chronic conditions: asthma, overweight/obesity, hearing loss, autism spectrum disorder, sickle cell disease, medical complexity, Type 1 diabetes, and attention deficit hyperactivity disorder (ADHD) (Wang and Foronda 2022). Importantly, text messaging via short message service (SMS)‐enabled mobile devices is a timely, convenient, and cost‐effective approach to disseminating educational health information to caregivers (Schwebel and Larimer 2018). According to the Pew Research Center (2021), 97% of Americans own a cell phone with the ability to send and receive SMS messages.

One‐way texting is a form of text message delivery in which the sender does not anticipate or allow a response from the recipient (Pernell et al. 2017). The existing body of evidence indicates that sending one‐way text messages to help caregivers of children with chronic diseases is feasible and acceptable (Shah et al. 2021; Tully et al. 2018). In a study conducted by Tully et al. (2018), parents of children with Type 1 diabetes received one‐way SMS messages weekly for 3 months to reinforce the learning content of educational sessions. This intervention resulted in excellent recruitment and retention rates, with 77% of eligible parents enrolling in the program and 90% completing it (Tully et al. 2018). Meanwhile, parental satisfaction with the intervention was exceptionally high (Tully et al. 2018). In a quasi‐experimental study, Shah et al. (2021) sent one‐way text messages to parents in an effort to provide evidence‐based information to improve the outcomes of children with ADHD. Participant parents were receptive toward the intervention, as 89.7% read most of the text messages, and 96% believed that the message length was adequate (Shah et al. 2021).

In the context of pediatric asthma, three studies have highlighted the effectiveness of SMS‐based interventions on child health outcomes (Arenas et al. 2022; Coker, Mitchell, Lowry, et al. 2023; Teach et al. 2021). Arenas et al. (2022) developed an intervention, “Remote Asthma Link,” in which text messages were sent to parents so that they could remind their asthmatic children to take inhaled corticosteroids every day. The authors observed improvements in child outcomes from baseline to 6 months, including a reduction in maximum symptom days, emergency department visits, hospitalizations, and oral steroid courses (Arenas et al. 2022). Teach et al. (2021) implemented a comprehensive stress management intervention (coaching sessions combined with SMS messaging and group sessions) for parents of children with persistent asthma. At the 12‐month follow‐up visit, children of intervention parents had a significant increase in asthma symptom‐free days compared to the children of control parents (p = 0.04) (Teach et al. 2021). Further, a randomized trial, Text2Breathe, demonstrated that primary care utilization was 35% higher among intervention parents than among control parents over a 12‐month period (p = 0.03) (Coker, Mitchell, Lowry, et al. 2023).

2. Project Goal and Objectives

The overarching goal of this quality improvement project was to implement an SMS‐based intervention to educate family caregivers of children with asthma. There were three primary objectives that the project intended to fulfill. This project sought (1) to increase caregiver knowledge about asthma, (2) to strengthen caregiver confidence in managing childhood asthma, and (3) to evaluate the degree of caregiver satisfaction in relation to the SMS‐based program.

3. Materials and Methods

3.1. Design

This quality improvement project used a pretest‐posttest design. The Model for Improvement was selected as the methodological framework to guide the project (IHI 2022). In this model, a practice improvement team is asked to address three fundamental questions with the intent of helping the team set aims, establish measures, and select changes before applying the Plan‐Do‐Study‐Act (PDSA) cycle to test changes in the real work environment (IHI 2022). Changes that pass testing can eventually be implemented across the organization (IHI 2022). Surveys were administered to family caregivers to assess their knowledge of asthma and their confidence in asthma management at baseline and upon the completion of the SMS‐based program.

3.2. Ethical Considerations

Under the authority of the University of Miami Human Subjects Research Office, this practice improvement project was deemed to have met the criteria of nonhuman subjects research; thus, the project was not subject to review under 45 CFR 46.

3.3. Setting

This quality improvement project took place in two pediatric pulmonology clinics in the Southeastern region of the United States. Both clinics serve a racially and ethnically diverse population of children with asthma. A previous asthma study conducted at one of the facilities revealed the following demographics: 61% were Hispanic, 44% were Black, Haitian, or African American, 39% were White, 6% were Asian, and 11% were multiracial (Foronda et al. 2021). In this previous study, about 80% of the caregivers indicated they were in a low‐income bracket (Foronda et al. 2021). The other facility also provided care primarily to an underserved pediatric patient population; therefore, similar demographics were anticipated for the population of this project.

3.4. Participants

Family caregivers that were invited to participate have to (1) care for a child aged 4 to 14 years with a new or established diagnosis of asthma; (2) speak and read English or Spanish; and (3) have a cell phone capable of receiving SMS messages. As all participants were seeing a pediatric pulmonologist, they already had a written asthma action plan. Participating family caregivers were recruited using multiple approaches. First, health care providers informed eligible family caregivers about the project by distributing business cards advertising the program after their child's visit with the pulmonologist. If the family caregivers were interested in participating, they contacted the program coordinator via the phone number or email address listed on the business card. Second, eligible family caregivers were approached in waiting rooms by the project manager. They were provided with a project description and invited to participate. After the caregivers agreed to participate, their phone numbers and preferred language (English or Spanish) were documented. For children with asthma who met the age requirement but did not show up at the scheduled clinical appointment, the project manager texted the caregivers to inquire about participation.

Participants were enrolled into two cohorts. The first cohort (n = 11) comprised of participants who enrolled within the first 3 weeks to start receiving asthma educational text messages. The second cohort (n = 8) consisted of those who registered in the last week. The texting educational program lasted approximately 3 weeks.

3.5. The Program

Participating family caregivers were sent SMS messages addressing five areas that warranted education in the context of pediatric asthma (Foronda et al. 2020). These areas were derived from a program called the Asthma Academy, an intervention for caregivers of children with asthma (Foronda et al. 2021). The five areas were (1) understanding the pathophysiology of asthma; (2) identifying common asthma triggers; (3) distinguishing between rescue medications and control medications; (4) recognizing asthma medication devices; and (5) navigating the healthcare system (Foronda et al. 2021). Messages were delivered in either English or Spanish, depending on the preference of the participant (Table 1).

Table 1.

Asthma education text messages for family caregivers of children with asthma.

Asthma tips for your child	Text message contents
#1	Asthma is a chronic disease, meaning it can last years. Asthma cannot be cured, but can be managed to the point that the symptoms become minor. Learn more about what asthma is and how it affects the lungs: https://www.youtube.com/watch?v=Et_alsghel8
#2	Asthma symptoms result from inflammation (mucus & swelling) within the airways. When asthma symptoms become much worse than usual, it is called an asthma attack. Watch a 2‐min video to learn about asthma symptoms: https://www.youtube.com/watch?v=znHd7da_7z4
#3	“Rule of 2's” is a good way to know if your child's asthma is OUT of control. See your doctor if the child:
	Has trouble with asthma more than 2 days a week Needs to use a rescue inhaler more than 2 days a week Is waking up at night more than 2 nights per month Needs oral steroids more than 2 times a year
#4	Severe asthma attacks can be dangerous to life. Call 911 or go to the nearest emergency department right away if your child has any of the following symptoms:
	Rapid breathing or retractions (ribs pull in with each breath) Blue lips or fingernails Big belly movements to breathe Trouble walking or talking Unusually sleepy, trouble waking up
#5	Common asthma triggers include:
	Common cold and flu Cockroaches, pets, dust mites, mice, mold, and pollens Smoke Dry wind, cold air, or sudden changes in weather Exercise Children can join in ANY sport or activity as long as their asthma is under control. Talk to your doctor to see if a medication should be taken immediately before physical activities.
#6	RESCUE medications relax the airway muscles, and provide fast, short‐term symptom relief during an asthma attack. They should be taken at the first sign of symptoms (asthma attack) or right before exercise. Make sure your child always has a rescue inhaler on hand and uses it while still able to take a good breath.
#7	CONTROLLER medications prevent mucus and swelling. They are usually taken DAILY. Get new medications before the old ones run out. Learn about the difference between a rescue medication and a controller medication: https://www.youtube.com/watch?v=f87LJzigr0w
#8	After using an inhaler, ask your child to rinse their mouth with water and spit it out.
#9	CONTROLLER medications won't work right away, and you won't notice while they are working. It is important to use them every day, even if the child does not have symptoms. These medications do not cause big muscles or weight gain. They do not cause addiction or dependence.
#10	Oral corticosteroids relieve airway inflammation caused by a severe asthma attack. They are NOT quick‐relief medications. Long‐term use of oral corticosteroids can cause side effects throughout the body, so they are only used for 5–14 days.
#11	People with asthma are more likely to have serious flu complications. Call your doctor if your child gets flu‐like symptoms. Make sure your child gets an annual flu shot. Flu shot immunity kicks in about 2 weeks after vaccination.
#12	Did you know 80% of people do not know how to use an inhaler properly? There are 2 main types of inhalers: metered‐dose inhalers (MDIs), which require a spacer, and dry‐powder inhalers (DPIs), which do not require a spacer. Watch 2 short videos to learn how to use these inhalers. MDIs: https://iggyandtheinhalers.com/pages/how-to-use-an-inhaler DPIs: https://www.youtube.com/watch?v=bxC48vQEfZI
#13	Nebulizers turn liquid asthma medicine into a mist. Make sure your child is breathing in the mist until the mist stops (~5 min or so). Learn how to use a nebulizer: https://www.youtube.com/watch?v=9K3yL4vW6h0
#14	Always make sure a written asthma action plan is easy to find when needed. An asthma action plan can help families understand:
	When to adjust control medications How well treatment is working Signs of an asthma attack and what to do when one occurs When to call the doctor or ask for emergency help
#15	Children with asthma can get help from a doctor's office, an urgent care center or an emergency room. When your child has only MILD symptoms of an asthma attack, follow the yellow area of the asthma action plan: https://www.cdc.gov/asthma/action-plan/documents/asthma-action-plan-508.pdf

Caregivers of children with asthma received daily messages (Monday to Friday) for 3 weeks. Each night around 7:00 p.m., the project manager delivered an educational SMS message to all participants using Google Voice. In addition, a welcome message and a goodbye message with links to online surveys were sent to participants 3 days before the first educational message and 3 days after the last educational message, respectively. The welcome message concluded with a disclaimer reminding participants that the educational messages were unidirectional and advising them to consult their healthcare provider for any asthma‐related concerns.

3.6. Measures

All surveys were created and completed via Qualtrics survey software. Surveys consisted of an Asthma Knowledge Questionnaire (Rodríguez Martínez and Sossa 2005), a caregiver confidence questionnaire, and a participant satisfaction questionnaire—the latter two of which were developed by the project manager. Participants spent about 10 to 15 min to complete these surveys. Surveys were offered in English or Spanish, depending on participants' needs. The Spanish surveys were translated from the original English surveys and back‐translated to English for validation before implementation.

3.6.1. Asthma Knowledge Questionnaire

The Asthma Knowledge Questionnaire is a valuable instrument for determining baseline asthma knowledge among family caregivers of children with asthma and assessing the efficacy of educational interventions aimed at enhancing knowledge and awareness of the disease (Rodríguez Martínez and Sossa 2005). The instrument has 17 items and uses a 5‐point Likert scale (1 = strongly disagree to 5 = strongly agree) to evaluate caregiver asthma knowledge and awareness in three domains: myths and beliefs about asthma management, disease knowledge, and other asthma‐related factors such as physical activity and smoking (Rodríguez Martínez and Sossa 2005). Total item scores range from 17 to 85; the higher the score, the more knowledgeable the caregiver is about asthma (Rodríguez Martínez and Sossa 2005). This instrument has a good internal consistency (Cronbach's α = 0.73) and a desirable test‐retest reliability (Lin's correlation coefficients = 0.92) (Rodríguez Martínez and Sossa 2005). Although the instrument does not specify a correlation with knowledge scores and clinical outcomes, the instrument has demonstrated sensitivity including statistically significant differences on parental knowledge scores from pre to post educational intervention (Rodríguez Martínez and Sossa 2005).

3.6.2. Caregiver Confidence Questionnaire and Participant Satisfaction Questionnaire

A one‐item caregiver confidence questionnaire and a four‐item participant satisfaction questionnaire was designed by the lead author (C.W.) based off of the literature. Participants responded to each item on a 5‐point Likert scale, with 1 indicating “strongly disagree” and 5 indicating “strongly agree.” On the caregiver confidence questionnaire, the participants were asked to select their level of agreement with the statement, “I feel confident managing my child's asthma.” The participant satisfaction survey included the following items: (1) “I read the asthma education messages every day,” (2) “I think the length of information provided daily about asthma is adequate,” (3) “Overall, I am satisfied with the content of the text messages,” and (4) “I would like to receive more educational information about asthma via text message in the future.” This instrument was given to two doctoral prepared providers to establish face validity. The caregiver confidence questionnaire was distributed before and after the program, whereas the participant satisfaction questionnaire was only distributed after the program.

3.7. Data Analysis Plan

Data were collected via Qualtrics and analyzed using Jamovi, version 2.3.19. Paired samples t‐tests were conducted for pre‐post analysis of caregivers' asthma knowledge levels and confidence in asthma management. Descriptive statistics were generated to report caregiver satisfaction data. The results were considered statistically significant if the p‐value was less than 0.05.

4. Results

4.1. Description of the Participants

A total of 19 family caregivers of children with asthma participated in this project, with none expressing a desire to drop out of the program. Of them, six received text messages in Spanish, and 13 received text messages in English. Almost all participants reported being the child's mother (n = 15) or father (n = 3), with only one participant being a grandmother (n = 1). The asthmatic children that the participants cared for ranged in age from 5 to 13 years. Eight participants completed the pre‐and posttest Asthma Knowledge Questionnaire (Rodríguez Martínez and Sossa 2005), seven completed the pre‐and posttest caregiver confidence questionnaire, and 12 completed the posttest participant satisfaction questionnaire.

4.2. Asthma Knowledge

The intervention was found to have a significant effect on caregiver asthma knowledge, t (7) = −2.56, p = 0.037. Caregiver asthma knowledge after the intervention (M = 63.9, SE = 2.85) was significantly higher than that before the intervention (M = 56.8, SE = 2.30).

4.3. Caregiver Confidence

The mean of the pre‐test scores on caregiver confidence was 4.43. The mean of the posttest scores was 4.57. Although caregiver confidence increased from before the intervention to after the intervention, the improvement was not statistically significant t (6) = −0.548, p = 0.604.

4.4. Participant Satisfaction

The participant satisfaction survey revealed that 91.7% (n = 11) of caregivers read the asthma education messages on a daily basis (somewhat agree = 16.7%, strongly agree = 75.0%). The remaining one was neutral toward daily text message reading (neither agree nor disagree = 8.3%). All caregivers who responded (n = 12) were satisfied with both the length and content of the messages. Ten (83.3%) strongly agreed that the messages were adequate in length and content, while two (16.7%) agreed. In terms of future willingness to receive asthma‐related information via text message, eight caregivers (66.7%) strongly agreed and four (33.3%) neither agreed nor disagreed.

5. Discussion

The results of this quality improvement project suggest that the SMS‐based education intervention holds potential as an educational supplement for family caregivers of children with asthma. Caregiver knowledge of asthma significantly increased with the implementation of the text intervention. Though it was not statistically significant, caregiver confidence in asthma management trended upward demonstrating a slight increase. This lack of significance may have resulted because of several events. First, the mean pretest score on caregiver confidence was relatively high, giving little room to improve from pre to posttest score. Because most participants had been managing their child's asthma for months to years, many were quite confident already in their ability to do so. Second, it may not be sufficient to assess caregiver confidence using a one‐item questionnaire. Third, the participant sample size may not have been large enough to detect significance.

Data from the participant satisfaction questionnaire revealed that the SMS‐based educational intervention was highly acceptable among family caregivers of children with asthma. Responses showed that all caregivers were pleased with the information provided by the messages, of which more than 90% went through the messages daily. This finding resonates with a prior study supporting the acceptability of texting fathers of children on the autism spectrum (May et al. 2021). May et al. (2021) reported that 95.8% of participants enjoyed receiving the messages, and 93% expressed willingness to recommend the program to other fathers. This satisfaction of text‐based educational programs may have implications for the future of family caregiver education.

5.1. Challenges and Recommendations

Given the small number of participants (N = 19), a large amount did not fully complete the pre and post questionnaires. Only eight of 19 caregivers completed the knowledge assessment, only seven of 19 caregivers completed the confidence questionnaire, and only 12 of 19 completed the posttest participant satisfaction questionnaire. While it is suspected that the caregivers were busy with their child or children and may not have had time or realized the importance of completing the questionnaires, the reason behind this low participation rate remains unknown. It must be acknowledged that caregivers who did not complete the satisfaction questionnaire may not have been satisfied. Similarly, it is possible that caregivers did not complete the knowledge assessment if they did not know the answers or the confidence questionnaire if they were not feeling confident. Because participants were texted the surveys, they had the choice of whether or not they wanted to complete this voluntary request for their feedback from the comfort of their homes. Perhaps a more successful approach would be to call the caregivers and complete the surveys on their behalf or ask them to respond to the questionnaires in‐person at their next visit.

As with any quality improvement pilot project, certain challenges came across during the implementation of this project. The program only provided participants with asthma education text messages in English and Spanish; therefore, Creole‐speaking caregivers were excluded. Creole should be considered for future replication of this project to make it more linguistically and culturally‐tailored to the local community. In addition, the majority of asthmatic patients seen at these two clinics were from low‐income families, and their show‐up rates were slightly low due to transportation issues or other factors. This project could be explored for future implementation in the emergency room, where the most vulnerable and high‐risk pediatric populations can be reached.

5.2. Limitations

This quality improvement project has several limitations. The short duration (about 1 month) of the recruitment period limited the number of participants obtained. A power analysis was not conducted to determine adequate sample size due to the pilot nature of the project. Another limitation, the large number of participants that did not complete both the pre and post surveys limits interpretation of the findings. The decision to go with a feasible and convenient approach for the caregivers—that of texting the links to the questionnaires—may not have been the most effective approach for data collection. Further, as the caregiver confidence questionnaire and participant satisfaction questionnaire were developed by the project manager, the validity and reliability of these instruments were not tested through a rigorous methodology. However, this approach was deemed appropriate for program evaluation due to the nature of quality improvement as opposed to a formal research approach.

6. Conclusions

6.1. How Might This Information Affect Nursing Practice?

Asthma is a common chronic condition that negatively impacts the health and well‐being of millions of children, as well as family caregivers who are primarily responsible for disease management. Currently, strong evidence indicates that knowledge deficiencies widely exist among family caregivers, resulting in suboptimal pediatric asthma management. Although small, this quality improvement project demonstrated the effectiveness of text messaging in raising asthma knowledge among caregivers. Nurses may wish to champion similar text‐based educational initiatives to improve family caregiver education efforts.

This quality improvement project seeks to fill the existing gap of inadequate family caregiver education, strengthen caregiver confidence in asthma management, and ultimately, enhance the care experience of asthmatic children. According to Homa et al. (2015), chronically ill children have the best care experience when their parents are well‐informed about the disease and able to formulate solutions to manage emerging symptoms. Family caregivers benefit as well. The educational messages enrich their asthma knowledge, enabling them to administer medicine promptly and appropriately when their child exhibits symptoms. Early medical attention minimizes the incidence of asthma attacks as well as the demand for emergency room visits, easing the burden on the healthcare providers. Therefore, using text messaging to educate family caregivers of children with asthma may positively affect child, parent, and provider outcomes.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.