Asthma is a heterogeneous inflammatory airway disease characterized by recurrent wheeze, cough, chest tightness and shortness of breath that vary over time and in intensity, together with variable expiratory airflow limitation [1]. It remains one of the most common chronic diseases in childhood worldwide and is a major contributor to school absenteeism, emergency care use and impaired quality of life [2,3].   Childhood asthma control is influenced not only by pharmacologic treatment but also by caregiver knowledge, daily management practices, trigger recognition and timely response to worsening symptoms [4-7]. Because mothers are frequently the primary caregivers, their understanding of asthma has a direct influence on home-based care, medication adherence, environmental control and healthcare-seeking behaviour. However, knowledge does not always translate into appropriate practice and this knowledge–behaviour gap remains clinically important.   The burden of asthma remains substantial globally and regionally. The World Health Organization estimated that 262 million people were living with asthma in 2019 and that asthma accounted for 455,000 deaths [8]. In Saudi Arabia, childhood asthma prevalence has been reported to range from 9% to 33.7% and a study from Taif reported a prevalence of 13.1% among children [9,10]. These data support the need for local caregiver-focused assessments to guide asthma education in routine paediatric practice.   The present study aimed to assess asthma-related knowledge and self-reported management behaviours among mothers of children with asthma in Taif city, Saudi Arabia.   The primary focus was to evaluate maternal knowledge and behaviour levels, while the secondary objective was to examine their association with selected sociodemographic characteristics. We hypothesized that better maternal knowledge would be associated with better self-reported management behaviours.

This cross-sectional study was conducted at Children’s Hospital in Taif city, Saudi Arabia, from January 2023 to April 2023. Ethical approval was obtained before data collection from the Ethical Committee for Health Research, Taif, Saudi Arabia.   Data Collection Primary data were collected through telephone interviews with mothers of eligible children with asthma. Contact numbers were obtained from hospital records. Study staff conducted the interviews and completed the questionnaire. Each interview lasted less than 15 minutes. Verbal consent was obtained before participation, anonymity was assured and all behaviour data reflected maternal self-report rather than direct observation.   Study Setting and Targeting Population Inclusion criteria were: (1) children diagnosed with bronchial asthma, (2) age 1–12 years and (3) admission to the hospital with their mothers for an asthmatic attack or a documented history of asthma. Children with other chronic diseases and children whose primary caregiver was not the mother were excluded. The calculated sample size was 384 mothers based on an assumed population proportion of 10%, absolute precision of 5% and 95% confidence interval [11]. However, 224 eligible mothers ultimately completed the interview and were included in the analysis.   Study Instrument Data were collected using a modified Arabic questionnaire adapted from the Chicago Community Asthma Survey-32 (CCAS-32), previously tested in a community-based study in Egypt [12]. The instrument comprised two sections: (1) sociodemographic data and (2) asthma-related knowledge and behaviours. The knowledge domain contained 27 dichotomous items covering symptoms, mechanisms, aggravating factors, complications and severity of bronchial asthma. The behaviour domain contained 19 dichotomous items addressing maternal actions during asthma attacks and preventive practices. Scores were converted to percentages and categorized as good (>75%), fair (60%–75%) or poor (<60%).   Data Analysis Categorical data were summarized using frequencies and percentages. Associations between categorical variables and the main outcomes were assessed using the chi-square test. Because the design was cross-sectional, the analyses were intended to identify associations rather than causality.

This study included 224 mothers of children with asthma in Taif, Saudi Arabia. Among the children, 114 (50.9%) were male and 121 (54.0%) were aged 0–6 years. Among the mothers, 151 (67.4%) were older than 30 years, 199 (88.8%) were married, 136 (60.7%) had 1–3 children, 112 (50.0%) had university-level education, 57 (25.4%) were employed and 167 (71.9%) resided in Taif city (Table 1).   The questionnaire included 27 knowledge items. Scores were converted to percentages and classified as good, fair or poor. Overall, 49.6% of mothers had good knowledge, 30.4% had fair knowledge and 20.1% had poor knowledge (Figure 1).   Mothers of female children showed significantly higher good-knowledge levels than mothers of male children (60.0% vs 39.5%, p=0.006). No other sociodemographic variable showed a statistically significant association with knowledge level (Table 2).   Self-reported management behaviours are summarized in Table 3. Most mothers reported giving necessary asthma medications (95.5%), reducing activity during attacks (88.8%), seeking help during attacks (80.8%), taking medications regularly (92.9%) and cleaning the home regularly to reduce dust (95.5%). However, some practices remained potentially suboptimal: 35.7% reported using homemade or complementary remedies and only 65.2% reported regular breathing exercises.   Overall, 71.0% of mothers had good behaviour scores, 19.2% had fair scores and 9.8% had poor scores (Figure 2). Good behaviour was significantly more common among mothers of female children (p=0.030), mothers younger than 30 years (p = 0.043) and mothers with 4–6 or 7–9 children (p = 0.025) (Table 4).   A strong relationship was observed between maternal knowledge and behaviour: mothers with good knowledge were significantly more likely to demonstrate good behaviour, while mothers with poor knowledge were more likely to demonstrate poor behaviour (p<0.001) (Table 5).     Figure 1: Knowledge level of mothers     Figure 2: Behaviour level of mothers   Table 1: Sociodemographic characteristics of the participants Variables Category N Percent Gender Female 110 49.1 Male 114 50.9 Age of the child 0-6 years 121 54.0 7-14 years 103 46.0 Maternal age <30 years old 73 32.6 >30 years old 151 67.4 Marital status Married 199 88.8 Separated 19 8.5 Widow 6 2.7 The number of children in the family 1 to 3 136 60.7 4 to 6 60 26.8 7 to 9 21 9.4 >9 7 3.1 Mother's educational level No primary education 16 7.1 Primary 13 5.8 Middle 19 8.5 Secondary 64 28.6 University 112 50.0 Mother's job Employed 57 25.4 Housewife 167 74.6 Residence Taif city 161 71.9 Villages and suburbs of Taif 63 28.1   Table 2: Relationship between knowledge level and participants characteristics Knowledge P value Good Fair Poor Total Gender Female N 66 29 15 110 0.006 % 60.0 26.4 13.6 100.0 Male N 45 39 30 114 % 39.5 34.2 26.3 100.0 Age of child 0-6 years N 56 38 27 121 0.519 % 46.3 31.4 22.3 100.0 7-14 years N 55 30 18 103 % 53.4 29.1 17.5 100.0 Maternal age <30 years old N 37 25 11 73 0.382 % 50.7 34.2 15.1 100.0 >30 years old N 74 43 34 151 % 49.0 28.5 22.5 100.0 The mother's marital status Married N 99 60 40 199 0.897 % 49.7 30.2 20.1 100.0 Separated N 10 6 3 19 % 52.6 31.6 15.8 100.0 Widow N 2 2 2 6 % 33.3 33.3 33.3 100.0 The number of children in the family 1 to 3 N 65 43 28 136 0.313 % 47.8 31.6 20.6 100.0 4 to 6 N 28 16 16 60 % 46.7 26.7 26.7 100.0 7 to 9 N 13 7 1 21 % 61.9 33.3 4.8 100.0 >9 N 5 2 0 7 % 71.4 28.6 0.0 100.0 Mother’s educational level No primary education N 13 1 2 16 0.312 % 81.3 6.3 12.5 100.0 Primary N 6 5 2 13 % 46.2 38.5 15.4 100.0 Middle N 10 7 2 19 % 52.6 36.8 10.5 100.0 Secondary N 30 21 13 64 % 46.9 32.8 20.3 100.0 University N 52 34 26 112 % 46.4 30.4 23.2 100.0 Mother’s job Employed N 33 11 13 57 0.109 % 57.9 19.3 22.8 100.0 Housewife N 78 57 32 167 % 46.7 34.1 19.2 100.0 Residence Taif N 79 50 32 161 0.936 % 49.1 31.1 19.9 100.0 Villages and suburbs of Taif N 32 18 13 63 % 50.8 28.6 20.6 100.0   Table 3: Behaviour among mothers in asthmatic children Steps taken N % I give the child the necessary medicines 214 95.5 Massage the baby's chest or back 148 66.1 Let the child cough to remove mucus from the lung 168 75.0 Let the child rest and reduce movement 199 88.8 I wait and watch the development of wheezing 177 79.0 Give the child water or juice 151 67.4 Give the child breathing exercises 117 52.2 I give the child home-made folk herbs 80 35.7 Ask for help 181 80.8 Take medications regularly 208 92.9 House cleaning to remove dust 214 95.5 Remove the irritating factors of the disease from home 212 94.6 Treating the common cold 211 94.2 Allow the child to cough to get rid of mucus 177 79.0 Allow the child to rest 213 95.1 Prevent extreme burnout 203 90.6 Prevent vigorous exercise 182 81.3 Continuous practice of breathing exercises 146 65.2   Table 4: Relationship between behaviour and participants characteristics Parameters Behaviour Total P value Good Fair Poor Gender Female N 84 21 5 110 0.030 % 76.4 19.1 4.5 100.0 Male N 75 22 17 114 % 65.8 19.3 14.9 100.0 Age of child 0-6 years N 86 23 12 121 0.996 % 71.1 19.0 9.9 100.0 7-14 years N 73 20 10 103 % 70.9 19.4 9.7 100.0 Maternal age <30 years old N 57 14 2 73 0.043 % 78.1 19.2 2.7 100.0 >30 years old N 102 29 20 151 % 67.5 19.2 13.2 100.0 The mother's marital status Married N 139 42 18 199 0.113 % 69.8 21.1 9.0 100.0 Separated N 16 1 2 19 % 84.2 5.3 10.5 100.0 Widow N 4 0 2 6 % 66.7 0.0 33.3 100.0 The number of children in the family 1 to 3 N 95 30 11 136 0.025 % 69.9 22.1 8.1 100.0 4 to 6 N 44 5 11 60 % 73.3 8.3 18.3 100.0 7 to 9 N 16 5 0 21 % 76.2 23.8 0.0 100.0 >9 N 4 3 0 7 % 57.1 42.9 0.0 100.0 Mother’s educational level No primary education N 10 4 2 16 0.741 % 62.5 25.0 12.5 100.0 Primary N 10 1 2 13 % 76.9 7.7 15.4 100.0 Middle N 16 1 2 19 % 84.2 5.3 10.5 100.0 Secondary N 44 13 7 64 % 68.8 20.3 10.9 100.0 University N 79 24 9 112 % 70.5 21.4 8.0 100.0 mother's job Employed N 43 8 6 57 0.519 % 75.4 14.0 10.5 100.0 Housewife N 116 35 16 167 % 69.5 21.0 9.6 100.0 Residence Taif N 116 28 17 161 0.501 % 72.0 17.4 10.6 100.0 Villages and suburbs of Taif N 43 15 5 63 % 68.3 23.8 7.9 100.0   Table 5: Relationship between knowledge level and behaviour level among mothers of asthmatic children Parameters Behaviour level Total P value Good Fair Poor Knowledge level Good N 95 15 1 111 <0.001 % 85.6 13.5 0.9 100.0 Fair N 51 11 6 68 % 75.0 16.2 8.8 100.0 Poor N 13 17 15 45 % 28.9 37.8 33.3 100.0

This study showed that maternal knowledge of childhood asthma in this Taif-based sample was moderate, while self-reported management behaviours were generally better. The most important internal finding was the strong association between good knowledge and good behaviour, supporting the practical relevance of caregiver education in paediatric asthma care [13-15]. At the same time, the presence of persistent gaps—such as the continued use of homemade or complementary remedies—suggests that knowledge alone may not be sufficient to ensure optimal evidence-based practice [16,17].   Most mothers reported adherence to prescribed medication and regular healthcare-seeking behaviour, which is encouraging. These findings are consistent with previous studies showing that caregiver engagement, medication adherence and clear response plans contribute to better asthma management in children [18-23]. Nevertheless, the present study measured behaviours through self-report only; therefore, socially desirable responses may have overestimated favourable practices.   Parental education remains a central component of effective asthma management. Education should extend beyond disease awareness and address practical skills such as recognizing symptom deterioration, avoiding triggers, understanding treatment roles and responding appropriately during exacerbations [24-29]. Our results also highlight the need to discuss common home practices directly with caregivers, including complementary remedies, indoor environmental control and safe approaches to symptom relief [30-40].   From a local practice perspective, these findings support brief, repeated and practical caregiver education in paediatric clinics in Taif. Demonstration-based counselling, teach-back methods, simple written or digital action-plan messages and reinforcement during follow-up may be more effective than one-time generic advice. The discussion should remain cautious, however, because this study did not measure clinical outcomes such as emergency visits, hospitalization, asthma control scores or observed inhaler technique.   Our findings are broadly consistent with earlier Saudi data from Aseer, which also showed suboptimal maternal knowledge and behaviour related to childhood asthma [12]. Together, these studies suggest that caregiver-focused asthma education remains an important unmet need in Saudi clinical practice, although regional differences in healthcare access, environment and family practices may influence the pattern of results.

In this hospital-based sample from Taif, maternal knowledge regarding childhood asthma was moderate, whereas self-reported management behaviours were generally better. Better knowledge was strongly associated with better behaviour, but important gaps persisted, especially the continued use of unsupported complementary remedies. Targeted, practical and repeated caregiver education may help strengthen day-to-day asthma management in this setting.   Limitations This study had several limitations. First, its cross-sectional design allows assessment of associations but not causation. Second, behaviour data were self-reported through telephone interviews and may therefore be affected by recall bias and social desirability bias. Third, the study was conducted in a single hospital-based sample, which limits generalizability to mothers not linked to hospital care. Fourth, the achieved sample size was smaller than the calculated target and a response rate could not be reported from the available dataset. Finally, no multivariable analysis or objective asthma outcomes were available and the modified questionnaire would benefit from further psychometric reporting in future studies.   Acknowledgement The authors extend their sincere appreciation to Taif University, Saudi Arabia, for supporting this research through the Deanship of Scientific Research, project number (TU-DSPP-2025-29). The authors would also like to thank Dr. Atheer Awadh Alharthi, Dr. Faten Abdullah Alzaydi and Dr. Reem Muhammad Alsofyani for their valuable contributions to data collection, data verification and meticulous proofreading of the manuscript. Their support and cooperation greatly enhanced the quality and completeness of this work.