Understanding the influence of staff stress during implementation of an asthma program in early childhood education: a qualitative design

To evaluate the role of staff stress in the implementation of a school-based asthma program in early childhood education programs for low-income urban families.
Fifteen staff members from four programs participated in focus groups and interviews examining perceptions of the asthma program one year into implementation. Following semi-structured guides, interviews explored general staff workload and stress levels as well as asthma-related stress. Transcripts were coded using thematic analysis with NVivo (Version 13) software.
Using thematic analysis, investigators generated four main themes and 12 sub-themes from the data, characterizing staff stress and experiences at work and with the asthma program. The first two themes detail the inherent stress of working in early childhood education and the specific stress related to providing asthma care. Overall work stress sub-themes relate to busy schedules and overworked staff, while asthma-related subthemes pertain to the anxiety and overwhelm associated with the asthma care responsibilities. The third theme described how this stress impacted program implementation with sub-themes related to understaffing and turnover. The fourth theme detailed how staff asthma education reduced stress and concern. Staff described stress reductions through improvements in asthma knowledge, self-efficacy in asthma skills, reducing uncertainty about asthma symptoms, and agency related to asthma management.
Although they experience high workplace stress levels, early childhood education staff felt that a school-based asthma program both reduced stress and improved their asthma-management competence. By focusing on practicable skills and building confidence, the implementation of an evidence-based program could effectively improve both child health outcomes and staff stress.