Caregiver Empowerment of Children With Asthma: A Literature Review

ABSTRACT

Purpose

Asthma is a major chronic disease with a large disease burden worldwide. Caregivers of children with asthma can have decreased quality of life and stress. Empowerment has been studied in the caregiver population related to competence, self‐efficacy, and mental health. The aim of this paper is to examine studies related to empowerment in caregivers of children with asthma.

Design and Methods

A traditional, narrative literature review was conducted using MEDLINE, CINAHL, and APA PsycInfo Databases. Articles were reviewed related to empowerment in caregivers of children with asthma. Twenty‐two articles were retained to include in the review, as they met all inclusion and exclusion criteria.

Results

Articles were either related to caregiver empowerment interventions or the concept of empowerment. Themes related to empowerment interventions included asthma management and quality of life. Themes related to the concept of empowerment include facilitators for empowerment, consequences of empowerment, and the need for further development of empowerment methods.

Practice Implications

Empowerment is an important concept related to caregivers of children with asthma. There is a need for further studies to examine ways to measure empowerment in this population and to look at the relationships between caregiver empowerment and other key concepts related to asthma management.

1. Introduction

Asthma is a chronic health condition that affects both national and global populations and has a major impact on numerous populations. According to the World Health Organization, asthma is a major noncommunicable disease, and is the most common noncommunicable disease in children worldwide. Asthma is present in countries of all development levels. As of 2019, 262 million people had an asthma diagnosis (World Health Organization ²⁰²²). As of 2019, around 5.1 million children below the age of 18 were living with asthma, which is about 7% of the pediatric population. 44.3% of those with asthma reported having at least one asthma attack (Centers for Disease Control and Prevention ²⁰²⁰). In 2016, 49% of school‐aged children were absent for at least 1 day of school and 16.7% visited the emergency department or urgent care due to an asthma attack. Additionally, asthma was more prevalent in children of families living at incomes below 100% Federal Poverty Level than in children of families living with incomes at 250% or more Federal Poverty Level (Zahran et al. 2018).

While there is no cure for asthma, the burden of asthma can be reduced through disease management, including the use of medication. Appropriate disease management can lead to asthma control and high quality of life (World Health Organization ²⁰²²). Childhood asthma can be difficult to diagnose and cannot be cured. While it cannot be cured, if it goes uncontrolled, it can lead to permanent lung damage (American Academy of Allergy Asthma & Immunology ²⁰²⁰). Additionally, asthma contributes to the economic burden of disease. In 2013, the total direct cost of pediatric asthma care in the United States was 5.92 billion dollars. Annual costs have been reported to range from $3076 to $13,612 (Perry et al. 2019).

Pediatric asthma not only impacts the lives of children with asthma, it also has an impact on the caregivers of these individuals. A systematic review on pediatric asthma and caregiving burden found that both decreased quality of life and stress can be present in caregivers of children with asthma. Sources of stress include the “caregiving activities…financial burden, parental responsibilities, and personal distress” (Ekim and Ocakci 2016, p. 5). Higher caregiver stress is also associated with poorer asthma control (Sharp et al. 2009) and parental quality of life can be predictive of asthma control, with lower quality of life being associated with poor asthma control (Cano‐Garcinuño et al. ²⁰¹⁶). Management of the caregiver burden is an important step in the mitigation of the adverse impact of pediatric asthma.

Empowerment is a concept that has been studied for many years throughout many disciplines including social work, psychology, sociology, management, education, and religion (Bartunek and Spreitzer 2006). When relating empowerment to healthcare, it has been defined by the World Health Organization as “a process through which people gain greater control over decisions and actions affecting their health” (World Health Organization ¹⁹⁹⁸, p. 16). Empowerment can be a process that is social, psychological, political or cultural (World Health Organization ¹⁹⁹⁸). The history of empowerment in healthcare can be traced back to 1986, when the World Health Organization introduced the Ottowa Charter. With a greater focus on empowerment, there was a shift in healthcare to include more participatory thinking (Halvorsen et al. 2020). A synthesis of the concept analyses of empowerment to understand empowerment from the perspective of the health service user found that descriptive themes of empowerment include both intrapersonal and interpersonal aspects (Halvorsen et al. 2020). Common themes related to antecedents to empowerment include powerlessness/ loss of control, competence need, motivation/change, support and trust. Themes related to attributes of empowerment include mutual partnership, change, and self‐determination strengthening. Finally, themes related to the consequences of empowerment included improved quality of life, mastery and control, and trusting participatory relationships (Halvorsen et al. 2020).

The Caregiver Empowerment Model (Jones et al. 2011) was created to show how different variables interact in order to contribute to empowerment. This model shows the relationship and interactions between background, caregiving demands, filial values, resources, and appraisal, all leading to the outcome of caregiver empowerment. Caregiver outcomes include perceived health, personal growth, and existential wellbeing (Jones et al. 2011). Thus, this model concludes that caregiver empowerment consists of positive caregiver outcomes related to health, growth, and wellbeing.

Empowerment interventions can have the goals of both improving caregiver health and child health, including emotional health and physical health outcomes. Empowerment has been studied in caregiver populations and empowerment interventions have been found to be significantly associated with an increase in knowledge and self‐efficacy in parents of children seeking mental health treatment (Bickman et al. 1998), decreased stress and anxiety in caregivers of patients with epilepsy (Etemadifar et al. 2018), and an increase in competence for caregivers of children with leukemia undergoing chemotherapy (Saeui et al. 2009). Empowerment can play a role in mitigating the burden of disease, specifically in caregivers.

While empowerment has been studied in caregivers, there have been limited studies in the specific population of caregivers of children with asthma. The aim of this article is to examine the current state of the science by reviewing, analyzing, and synthesizing the literature related to the empowerment of caregivers of children with asthma in order to report what is currently known about empowerment in caregivers of children with asthma.

2. Methods

To examine the current state of the science of caregiver empowerment for caregivers of children with asthma, a traditional, narrative literature review was conducted. MEDLINE, CINAHL, and APA PsycInfo Databases were searched to retrieve relevant articles. The search terms used were empower* and asthma* and (parent* or caregiver* or mother or father). The search returned 66 results and exact duplicate articles were removed. After examining the abstracts for relevant content, 38 articles were retained for further review. Inclusion criteria were studies that used an empowerment measure or caregiver empowerment intervention, studies of caregivers of children with asthma, and studies that were available in full text and in English. Exclusion criteria were articles that examined personal empowerment (individual empowerment not related to caregiving), articles that examined healthcare provider empowerment, studies that were not completed, and studies in which an empowerment measure or intervention were not included. Once full‐text review was completed, 18 articles were retained to include in the review, as they met all inclusion and exclusion criteria (See Figure 1). Before publication, databases were searched again to look for any updated literature, and 12 more articles were reviewed, with 4 being added to the review after meeting all inclusion criteria. Therefore, this literature review includes a total of 22 articles reviewed.

Figure 1.

PRISMA Flow Diagram of Literature Review Process.

3. Results

In the articles selected, there was varying quality of evidence as selected articles included randomized control trials (n = 4), qualitative studies (n = 5), quasi‐experimental studies (n = 3), longitudinal studies (n = 1), descriptive studies (n = 2), prospective studies (n = 1), expert opinion (n = 1), quality improvement (n = 1) and literature reviews (n = 4).

The 2022 John Hopkins Evidence‐Based Practice Model for Nurses and Healthcare Professionals© (Johns Hopkins Health System/Johns Hopkins School of Nursing) was used for critical appraisal (See Table 1) (Dang et al. 2022). This model is used for clinical decision making and has an interdisciplinary focus, where the goal is to identify the highest quality evidence among healthcare professions to inform clinical decision making and optimize patient outcomes. The model uses a system to rate articles from Level I to Level V, based on study design and rigor, to determine the strength of evidence. All levels of evidence were included in this review in order to more broadly understand the concept of caregiver empowerment in caregivers of children with asthma.

Table 1.

Review of Articles.

Reference	Type of Study	Sample size (n)	Tool/measures	Factors studied/study aim	Significant results
Level I Studies *
Canino et al. (2008)	Randomized control trial	221 children Puerto rican; living below 100% above poverty level	Juniper Pediatric Asthma Care Quality of Life Questionnaire; Caregiver Asthma Knowledge Scale; Family Empowerment Scale	CALMA (“Take Control, Empower Yourself and Achieve Management of Asthma”) intervention utilized to examine its effect in reducing morbidity in children who are Puerto Rican diagnosed with asthma	– study found no difference in symptom free days, activity limitation, and medication use between control/intervention group – intervention group had more symptom‐free nights, were more likely to have their asthma under control, and were less likely to visit the emergency department/be hospitalized – Caregivers receiving treatment less helpless/upset; more likely to have confidence in asthma management – no difference in caregiver empowerment to manage healthcare system
Dardouri et al. (2020)	Randomized control trial	37 families (experimental), 39 families (control) Patients at a pediatric outpatient clinic in Tunsia	Pediatric Asthma Caregiver Quality of life Questionnaire (PAQLQ); Pediatric Asthma Quality of life Questionnaire Demographics; spirometry	In children with asthma and the parents of the children, examined how an educational asthma program impacted pulmonary function and quality of life	– quality of life was improved in both children and their parents after the intervention – forced expiratory maneuver was better in intervention group vs control group while there was no difference in FEV1/FVC ratio between groups – no difference in activity limitations between groups after intervention
Wang et al. (2025).	parallel, two‐arm pilot randomised controlled trial. Level I	n = 56 (parent‐child dyads)	Parental Stress Scale, Childhood Asthma Control Test, 7‐item Generalized Anxiety Disorder, 9‐item Patient Health Questionnaire, 6‐item self‐report PsyFlex questionnaire, 34‐item self‐report Family Empowerment Scale, 25‐item Asthma Knowledge Questionnaire, Chinese Self‐Management Scale for Asthmatic Children	‐To examine an empowerment intervention (Acceptance and Commitment Therapy‐based empowerment intervention) for school‐aged children with asthma and their parents (assessed for feasibility, acceptability, and efficacy)	– participants reported: enhanced knowledge/behavioral skills for asthma management, reduced stress/negativity, peer support, increased family involvement – challenged faced included barriers to attendance for face‐to‐face sessions, learning environment disruptions – intervention group showed better asthma control – intervention group parents reported lower stress levels – intervention group showed better self‐management – ‐intervention group parents demonstrated better asthma knowledge and higher family empowerment related to asthma management. – no effect shown for: parental anxiety, depression, psychological flexibility
Yeh et al. (2016).	Randomized control trial	65 (families) Low‐ function families in Taiwan	– Parental stress index – Family Environment Scale	Examine effect of family empowerment program on parental stress, family environment, pulmonary function, and asthma symptoms	– With program: – parental stress dec – family function inc – PEF/FEV1 improved – coughing/wheezing/dyspnea improved – no change in FEV1/FVC or in sleeping problems between groups
Level II Studies *
Kashaninia et al. (2018).	Quasi‐experimental	45 children (6–12 years) and parents 23 intervention 22 control Enrolled in pediatric asthma clinic in Masih Daneshvari Hospital	Childhood Asthma Control Test (C‐ACT); Demographics questionnaire	Examined the role family empowerment plays in control of asthma for school‐aged children	– intervention group (empowerment intervention) had higher post‐test scores for asthma control than control group
McCarthy et al. (2002).	Quasi‐experimental	‐n = 57 families with children with asthma Children aged 3–16 from centers in rural Eastern Canada	Parents sense of control scale; Asthma facts	Examine the different outcomes that occurred from the traditional approach versus the empowering approach for asthma education to determine differences related to: 1. Knowledge 2. Sense of control 3. Decision‐making ability 4. Asthma care ability	‐higher scores were found for the empowering approach for control, ability to make decisions, and ability to provide care ‐Overall asthma knowledge was similar for both groups over time
Payrovee et al. (2014).	two‐group semi‐experimental study	−45 children age 7–11 with asthma and their parents (intervention n = 23, control n = 22) Children age 7–11 referred to an asthma clinic in Masih Daneshvari Hospital in Tehran	The Pediatric Asthma Quality of Life Questionnaire with Standardized Activity (PAQLQ); 27 demographic questions	Aimed to assess the effect of family empowerment on the quality of life of school‐aged children with asthma	– Quality of life scores were higher after the empowerment intervention – Total and all subscale scores (except symptoms) higher in intervention group versus control group
Level III Studies *
Coutinho et al. (2016)	Longitudinal/self‐selected participation	141 children and caregivers Children age 7–9 who lived in an urban school district and guardians who identified as Non‐Latino White (NLW), Latino, or African American (AA)	Family Empowerment Scale, Patient Activation Scale; Asthma symptoms, ED visits, caregiver nativity, demographic survey	To explore the relationship between asthma symptoms, ED use, and caregiver empowerment in a diverse urban population.	– Demographics: caregivers 51.8% US‐born, and 71.5% living below the poverty threshold – family empowerment was related to less asthma symptoms, while asthma service empowerment was related to more asthma symptoms – greater empowerment existed within the family for foreign‐born caregivers, while greater empowerment existed within asthma services for US‐born caregivers – caregiver empowerment not associated with ED use – families who preferred English (compared with those who preferred Spanish) had higher engagement/collaboration with providers – higher patient activation, more collaboration, and more information‐seeking for us‐born caregivers
Coutinho et al. (2025)	Cross‐ sectional observational study	N = 141 (child‐ caregiver dyads)	Family Empowerment Scale, Psychological Empowerment Scale, Family Asthma Management System Scale, Patient–Provider Relationship Scale	‐In caregivers of children with asthma residing in urban areas, examine the relationship between caregiver empowerment, family asthma management, and patient‐provider relationships.	– No significant association between caregiver empowerment and family asthma management – family asthma management positively associated with: English‐speaking, US born caregiver, family income above poverty threshold – inverse relationship between caregiver empowerment and patient‐provider relationship
Foronda et al. (2020a).	Qualitative descriptive	13 healthcare providers interviewed Providers from Midwest and Southeastern US		Amongst healthcare providers, examined experience with gaps in healthcare system, barriers to care, and facilitators to care for caregivers of children who have respiratory disease	– Implications from the study include that nurses play a role in empowering caregivers with skills, resources, and connection to providers – themes emerged: gaps caregivers faced in obtaining care (fragmented healthcare system), barriers to obtaining care (poor access to healthcare/medications, non‐adherence, and linguistic diversity/poor health literacy), and facilitators of optimal respiratory management (edu‐cation, improved communication, and peer support)
Kelo et al. (2013).	Qualitative descriptive	12 Children (age 5–12) and 19 parents 5–12‐year‐ old Children with chronic diseases (allergy, asthma, epilepsy or type 1 diabetes) in Helsinki		School age children with chronic illness and their parents described significant education events during hospital visits	– both positive and negative educational experiences were identified – The themes related to the educational sessions included: nurse competence, didactic competence, and interpersonal competence – the educational outcome goal was empowerment (positive education) ‐ this included sufficient information, ability to manage the disease, positive learning experiences, and satisfaction with education
Krieger et al. (2000).	Descriptive (closed‐ended interviews)	‐preliminary study = 112 enrolled households (children age 4–12 with asthma) Households in urban Seattle, WA with household income less than 200% of poverty or Medicaid enrollment		Study to examine childhood asthma in low‐income communities	– demographics: 70.9% low incomes less than Federal Poverty Level, 43.2% haven't completed high school, and 89.1% rent their home – upon home inspection: 37.5%‐ smoker present, 26.8%‐ mold, 64.8%‐ damp conditions, 76.6‐ carpeting in child's bedroom – 19.8% had allergy covers for bed – study shows that methods to empower families to improve the quality of indoor environment are needed (families are part of project to empower families in indoor exposure to asthma triggers)
Martínez et al. (2009).	Prospective study	‐n = 221 caregivers of children with asthma Puerto Rican children age 5–12; income 200% or lower Federal Poverty Level	Center for Epidemiological Study‐Depression (CES‐D), Parent Asthma Self‐Efficacy Scale, Family empowerment, service system subscale (FES), Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), Asthma Assessment Form	Among caregivers of children with asthma, who were Puerto Rican, the following relationships were studied: ‐depressive symptoms and 1. asthma beliefs; 2. Child asthma outcomes; 3. Caregiver quality of life	– Caregivers with high depressive symptoms felt less empowered to deal with child's condition effectively, had fewer symptom‐ free days/nights, had lower quality of life, and more likely reported the ability to perform asthma‐related behaviors, and were less likely to use preventive strategies – no difference in hospitalization/emergency room use
Sullivan (2008).	phenomenological thematic analysis	An online parent support group		Better understand the lives of caregivers of children with asthma	– mothers shared about decisions/regimens to empower other mothers – authors suggest that online support groups can empower caregivers through confidence and competence building – feelings of empowerment can come from Internet use, allowing caregivers to participate in healthcare more fully
Trollvik and Severinsson (2005).	Qualitative (interviews)	9 parents of 5 children with asthma		Examine the influence that an asthma education program has for parents of children with asthma	– By participating in a program, parents were able to identify an increased understanding of their child's asthma experience – themes included: accepting the illness, sharing experiences, and partnership building
Valery et al. (2016).	Qualitative study based on a randomized control trial	88 children with asthma (and 81 parents) Children from the Torres Strait	Standardized forms with structured and open‐ended questions	Develop themes that describe an asthma education intervention clinical model based on caregiver's perspectives	– 97.5% of parents rated asthma education as good, very good, or excellent – researchers state that empowerment in parents is apparent because they learn to manage the asthma of their child (after education sessions with trained indigenous healthcare workers) – Seven themes identified: “clear communication by health professional, service delivery quality, professional approach, clear transfer of knowledge and education/clinical knowledge of asthma, established rapport/caregiver satisfaction, importance of coming into the local community, and areas of concern for the carers/parents” (Valery et al. (2016), p 172)
Level V Studies *
Foronda et al. (2020b).	Integrative review	80 items		Identified psychological/socioeconomic burdens of caregivers for children with asthma; Examined burdens and facilitators	– psychological = poor mental health, QOL, sleep, stress, disparities, communication (healthcare) – socioeconomic = access to care, financial challenges – caregiver health → child's health – facilitators of caregiver health = empowerment, education, technology, caregiver support (social)
Horowitz et al. (2024).	Quality improvement; pre‐post implementation design	n = 21 (parents of children with asthma)	Asthma Knowledge Questionnaire (AKQ)	– Implement an asthma education program (The Asthma Academy) aimed at empowering caregivers to manage acute asthma exacerbations. – The goals of this program were to: improve caregiver's asthma knowledge and confidence in asthma management, and evaluate program satisfaction	– After education intervention: caregiver asthma knowledge improved, caregiver confidence in asthma management improved, and participants were satisfied with the program
Isik et al. (2019).	Systematic literature review	8 articles Articles included studies conducted in the US, Iran, the Netherlands, and India		Looks at effectiveness of education intervention programs on asthma management of school‐aged children in outpatient settings	– results‐ school/community based interventions help manage asthma well; asthma education programs need to continue beyond the inpatient setting – asthma education leads to caregiver/child empowerment; school nurses help empower caregivers/children
Prather et al. (2020).	Integrative review	40 studies included All articles related to African American caregivers		Examine both barriers and facilitators in the management of asthma for African American caregivers	– Barriers to management that were identified were caregiver burden, and lack of home/neighborhood safety – Facilitators to management included family/community support, education/empowerment, and healthcare providers who were culturally competent
Reeder et al. (2026)	Scoping review	n = 212 sources		‐Examine existing evidence related to interventions that support parent carer empowerment for children with long term health conditions (including asthma).	– The most common goals of parent carer empowerment interventions include improving health literacy, well‐being, and self‐efficacy. – The most common scale used for evaluation was the Family Empowerment Scale – Most interventions focused on parent carer behavior change to improve empowerment – One challenge was the lack of reporting of empowerment intervention design and development
Sander (2002)	Expert opinion			Identify the role of nurses as educators and advocates to help empower families of children with asthma	– asthma/allergies/anaphylaxis are life‐threatening conditions (immediate emergency treatment is essential) – nurses are educators and can help empower families in the health of children with asthma/allergies – education/advocacy important solutions

^*Based on Johns Hopkins Evidence‐Based Practice Model for Nursing and Healthcare Professionals Evidence Appraisal Tool (The Johns Hopkins Hospital/Johns Hopkins University School of Nursing ^2022a; The Johns Hopkins Hospital/Johns Hopkins University School of Nursing ^2022b).

There were a variety of different target populations addressed throughout the studies. Studies were conducted in different countries including Tunisia (Dardouri et al. 2020), Taiwan (Yeh et al. 2016), Iran (Kashaninia et al. 2018; Payrovee et al. ²⁰¹⁴), rural Canada (McCarthy et al. ²⁰⁰²), the United States (Coutinho et al. 2025; Foronda et al. ^2020a; Horowitz et al. ²⁰²⁴; Krieger et al. ²⁰⁰⁰), Finland (Kelo et al. 2013), the Torres Strait (Valery et al. 2016), China (Wang et al. 2025) and Puerto Rico (Canino et al. 2008; Martínez et al. ²⁰⁰⁹). One study focused specifically on African American caregivers (Prather et al. 2020) while others focused on a diverse urban population consisting of non‐latino white, latino, or African American caregivers (Coutinho et al. 2016). Other studies focused on low‐income or low function households (Canino et al. 2008; Krieger et al. ²⁰⁰⁰; Martínez et al. ²⁰⁰⁹; Yeh et al. ²⁰¹⁶). The target ages of children studied varied from as young as three to as old as 19. Many studies did not mention very specific demographic inclusion and exclusion criteria.

Common ideas emerged related to caregiver empowerment. Articles included either an empowerment intervention or mentioned the concept of empowerment. Results related to empowerment interventions included asthma management and quality of life. Results related to the concept of empowerment include facilitators for empowerment, consequences of empowerment, and the need for further development of empowerment methods.

3.1. Empowerment Interventions

3.1.1. Asthma Management/Control

Interventions showed greater control of asthma and management of symptoms after empowerment interventions. One study found improved asthma symptoms (coughing, wheezing, and dyspnea) in children with asthma after participation in a family empowerment intervention consisting of four 50 min treatment sessions in which primary family caregivers and other family members were assisted in addressing problems and making actionable changes to help with family asthma management. FEV1/FVC did not change in this study and there was no significant improvement in sleeping problems (Yeh et al. 2016). Another study by Dardouri et al. found that child forced expiratory maneuver improved, but FEV1/FVC did not improve after a family empowerment intervention consisting of group information sessions and follow up in which families could be in contact via phone with the researcher (2020). A third study by Canino et al. (2008), in which 8 educational modules were delivered throughout two home visits with follow‐up via phone, found that an empowerment intervention led to caregivers having a greater likelihood of being confident in asthma management, yet did not make a difference in caregiver empowerment in healthcare system management. Yet another study showed an empowering approach to asthma education, in which participants received three interactive weekly sessions including traditional content and content on parent‐professional relationships. This study, including follow‐up phone calls for 6 months, compared with the traditional approach, led to a greater sense of control in asthma management and a greater increase in ability to make decisions and provide care. Asthma knowledge overall did not increase compared with the control group (McCarthy et al. ²⁰⁰²). In a more recent study by Horowitz et al. (2024), after caregivers of children with asthma participated in an “Asthma Academy,” a 30–45 min nurse‐led asthma education session, caregivers demonstrated an improved knowledge of asthma and confidence in asthma management. Another recent randomized control trial in China tested an empowerment intervention for children with asthma and their parents that included Acceptance and Commitment Therapy, family empowerment strategies, and asthma self‐management education training. This trial showed that those who received the intervention displayed improved parental knowledge and better asthma control in the child (Wang et al. 2025). Overall, empowerment interventions have shown a positive impact on asthma symptoms, caregiver confidence, and asthma management, however no change has been seen in spirometry measurements.

3.1.2. Quality of Life

Caregiver empowerment interventions were shown to improve quality of life in both parents and in their children. One study on empowerment education in families found an increase in quality of life for both parents and their children (Dardouri et al. 2020). Another study on a family empowerment intervention consisting of 4 weekly 2‐h sessions as well as contact with the researcher via phone, found an increase in the quality of life of the children who had asthma (Payrovee et al. 2014). According to a study by Canino et al. caregivers who took part in an empowerment intervention felt less helpless after the intervention (2008). The empowerment intervention in the randomized control trial by Wang et al. (2025) led to reduced parental stress and anxiety. Finally, a study by Yeh et al. (2016) that examined the impact of a family empowerment intervention showed a decrease in parental stress and increase in family functioning. Empowerment interventions not only help the child, but also the caregiver and family as well.

3.2. Concept of Empowerment

3.2.1. Facilitators of Empowerment

3.2.1.1. Education

Education about asthma has been shown to be a facilitator of empowerment for caregivers (Isik et al. 2019). A study by Kelo et al. (2013) mentions asthma empowerment as the result of education sessions and says that it includes the attainment of sufficient information, disease management, and satisfaction with education. Another study with an online group of caregivers of children with asthma showed that mothers shared their regimens and decisions to empower other mothers. The authors suggest that confidence and competence building in online support groups can empower caregivers (Sullivan 2008). In a third study researchers state that empowerment in parents is apparent after education sessions because parents learn to manage the asthma of their child (Valery et al. 2016). Finally, a randomized control trial by Wang et al. (2025) showed improved family empowerment scores after an empowerment intervention that included education on asthma and self‐management. Education is often a part of empowerment interventions, but also can lead to increased empowerment.

3.2.1.2. Healthcare Providers

A qualitative descriptive study by Foronda, Jawid, et al. (2020), suggests that healthcare providers have a role in helping to empower parents of children with respiratory diseases. Sander (2002) also comments on the role of the healthcare provider in the empowerment process, saying that education and advocacy are important components of empowerment, and nurses can be important contributors to family empowerment. A systematic literature review by Isik et al. (2019) also supports the ability of school nurses to help empower children with asthma and their caregivers. On the contrary, a study by Coutinho et al. (2025) found an inverse relationship between caregiver empowerment and positive patient‐provider relationships. A different study by Coutinho et al. (2016) found that families who preferred speaking English (compared to Spanish) had higher engagement and collaboration with providers. These studies combined suggest that demographics may be a mitigating factor for the impact of patient‐provider relationships on empowerment.

3.2.1.3. Demographics

One descriptive study by Coutinho et al. (2025) found that English‐speaking caregivers had greater family asthma management ratings. This also applied to families with a caregiver born in the United States, and to families above the poverty threshold. Another previous study by the same researcher showed that family empowerment was greater with foreign‐born caregivers, while asthma‐service related empowerment existed among US‐born caregivers (Coutinho et al. 2016).

3.2.2. Consequences of Empowerment

3.2.2.1. Asthma Control/Management

In one study, family empowerment was related to asthma control, while health system empowerment was related to more asthma symptoms (Coutinho et al. 2016). Interestingly, a later study by the same researcher (Coutinho et al. 2025) found that there was not a significant relationship between caregiver empowerment and family asthma management. Another study of African American caregivers found empowerment to be a facilitator of asthma management (Prather et al. 2020). A different study found that an education program with parents of children with asthma showed that parents better understood their child's experience with asthma after taking part in the program (Trollvik and Severinsson 2005).

3.2.2.2. Caregiver Health

Research suggests that empowerment can be a facilitator of caregiver health in caregivers of children with asthma (Foronda et al. ^2020b). Similarly, caregivers with depressive symptoms felt less empowered to manage their child's asthma and had lower quality of life (Martínez et al. 2009).

3.2.3. Need for Empowerment Methods

While a few studies have mentioned the use of empowerment interventions for caregivers, other studies recognize the need for further research to better understand empowerment and its function. Krieger et al. (2000), mentions the need for the development of methods to empower families to improve their indoor environment. Additionally, a scoping review looking at parent carer empowerment interventions shows a lack of intervention design and development reporting (Reeder et al. 2026), suggesting the need for clearer dissemination of empowerment intervention models.

4. Discussion

As asthma is a common chronic disease, much research has been conducted to better understand the disease. Empowerment has also been studied in many different fields, including in healthcare. This literature review showed both the importance of empowerment in caregivers of children with asthma, as well as gaps that exist related to the concept in this population.

The gaps identified by this review are related to asthma demographics, measurements of empowerment, environment and caregiver empowerment, and components of empowerment.

4.1. Asthma Demographics

When examining the concept of empowerment related to caregivers of children with asthma, few studies have been conducted that are generalizable to the entire population. Most studies are with small cohorts and tailored to specific populations. There is a need for more studies with larger experimental groups as well as studies that examine demographics and their relationship to the empowerment of caregivers with asthma. Specifically, the effect of socioeconomic status on empowerment for this population has not been well‐ studied.

4.2. Caregiver versus Personal Empowerment

Another gap in the literature exists related to the study of caregiver empowerment specifically. While empowerment and empowerment interventions have been mentioned in studying people with asthma, few studies have looked at empowerment in relation to caregivers of children with asthma. Asthma is a disease largely prevalent in the pediatric population (Zahran et al. 2018), therefore empowering caregivers is an important topic to study.

4.3. Measurements of Empowerment Related to Caregivers of Children with Asthma

Scales to measure caregiver empowerment exist, but few have been used in the population of caregivers of children with asthma. There is a need for further validation and development of scales to measure empowerment. Additionally, many studies mention empowerment interventions, but do not mention how they will measure the concept of empowerment. In order to truly understand if the empowerment intervention was effective, there must be measurable outcomes of empowerment itself including all components of the concept of empowerment.

4.4. Environment and Caregiver Empowerment

While it is well known that the environment has a large influence on asthma triggers and asthma control, little has been done to study the relationship with the environment and caregiver empowerment. Both indoor and outdoor environmental exposures must be considered in asthma management. Indoor environmental exposures include air pollution, particulate matter, nitrogen dioxide, secondhand smoke, ozone, and indoor allergens like mold, rodents, cockroaches, dust mites, and pets. Outdoor environmental exposures include air pollution, particulate matter, ozone, nitrogen dioxide, sulfur dioxide, and pollen allergens (Diette et al. 2008). While all of these different exposures have been studied in relation to asthma, very few studies examine the role that these exposures play in empowerment. In this literature review, only one study mentioned the environment in relationship to empowerment (Krieger et al. 2000). This also relates to the social determinants of health and asthma demographics as environmental exposures often stem from poor health equity.

4.5. Support and Empowerment

This literature review identifies both education and healthcare provider support to be facilitators of empowerment for caregivers of children with asthma. However, there is little evidence that shows how caregivers can be supported in these areas in order to facilitate empowerment. There is a need for further research related to the types of support that help to facilitate empowerment in caregivers of children with asthma.

As both asthma management and quality of life were found to be results of empowerment interventions, it is important for providers to understand what empowerment is and to incorporate it into asthma management practice. As healthcare providers were also shown to be facilitators of empowerment, they can play a large role in the development of competent and confident caregivers by both learning about and incorporating empowerment techniques into their practice with their patients.

With education being a key facilitator of empowerment, it is important to continue to emphasize caregiver education in asthma management practice. Integration of effective education techniques can lead to greater empowerment. Since nursing bears much of the burden of parent and patient education, it is important for nurses to understand how to effectively educate. This includes nurses embodying characteristics of good educators, respect for patients, both subject and didactic knowledge and skills, and encouraging patient participation in learning (Kelo et al. 2013). Creating and implementing asthma education resources for nurses and caregivers that focus on these aspects can help to facilitate greater empowerment in caregivers of children with asthma.

5. Conclusion

Empowerment is a key concept that has been addressed in many different populations and disciplines. When looking at caregiver empowerment, however, there is less known about how it can be facilitated and what components exist. This literature review shows that in caregivers of children with asthma, studies related to empowerment have mainly focused on empowerment interventions and facilitators and consequences of empowerment. There is a need for further research in this area, specifically in relation to caregiver‐focused empowerment and the impact mitigating factors like the environment, social support, and demographics have on caregiver empowerment.

6. How Might This Information Affect Nursing Practice?

This affects nursing, as nurses are the forefront of patient care and play a large role in helping to educate and empower patients and their caregivers. Understanding what empowerment is, as well as how to facilitate caregiver empowerment, is key to a nurse's role as a patient advocate and to promoting best nursing practice and best care outcomes. Both current and future research related to caregiver empowerment is important for nurses to understand how to best help caregivers to feel competent and confident in caring for their children and in order to provide continuity of care for pediatric patients with asthma.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.