Patient and Family Management of Asthma: Theory-Based Techniques for the Clinician
ABSTRACT Several model asthma education programs are available to improve patient self-management, and elements of these models are discussed as they relate to the teaching role of health-care providers. Self-regulation is being explored in current asthma education research, and preliminary findings of a study are presented that show self-regulation behaviors to be associated with more frequent use of asthma management strategies by patients. Using more management strategies was associated with being observant of symptoms (p = .0001) and feeling confident to manage them (p = .01). Taking more preventive actions was associated with being observant (p = .001) and feeling confident to keep the child out of the triggering situation (p = .02) and prevent symptoms (p = .001). Important issues arising from recent psychosocial research are outlined for consideration by the clinician. These include ways that counseling by the health professional can encourage self-regulation and better at-home management of asthma.
Article: Compliance with Asthma Therapy[Show abstract] [Hide abstract]
ABSTRACT: Asthma is a common disease. World-wide experience has shown an increase in prevalence and severity, although whether the natural history of the disease is changing is unknown. International practice guidelines are presented for a stepwise treatment approach, emphasising the chronic nature of the inflammatory component of the disease. Compliance is a major issue. Physicians need to understand the problem and be actively involved in improving compliance. Merely creating a treatment plan is insufficient, and a broad understanding of the problems in dealing with a chronic disease is required. Methods to assess compliance have been developed. Biochemical measurements of biological fluids are familiar to most physicians. Significant limitations are found with their usefulness, including drug interactions, biological variability and practicality. Electronic monitoring of inhaler usage and pulmonary function can help evaluate compliance and effectiveness of treatment. An ideal way to monitor treatment has yet to be developed. Improving compliance has 3 important components: education, skills training and behaviour modification. Programmes for education about the illness, methods to control it and skills training needed for effective use of inhalers and peak flow meters have been developed. Behavioural changes are difficult to achieve and require a multifaceted approach. A self-management programme promotes patient involvement and a sense of control. Effective physicians are acquainted with their patients’ health beliefs and life circumstances. Promotion of compliance is a dynamic process that requires the physician to think in a patient-centred approach. Practical suggestions are made to identify areas where compliance is a problem and how to deal with it. Outcomes management will be assessed as reduced mortality and morbidity, and an improved quality of life.Clinical Immunotherapeutics. 03/1996; 5(3).
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ABSTRACT: To examine the reliability and validity of the Family Asthma Management System Scale for low-income African-American children with poor asthma control and caregivers under stress. The FAMSS assesses eight aspects of asthma management from a family systems perspective. Forty-three children, ages 8-13, and caregivers were interviewed with the FAMSS; caregivers completed measures of primary care quality, family functioning, parenting stress, and psychological distress. Children rated their relatedness with the caregiver, and demonstrated inhaler technique. Medical records were reviewed for dates of outpatient visits for asthma. The FAMSS demonstrated good internal consistency. Higher scores were associated with adequate inhaler technique, recent outpatient care, less parenting stress and better family functioning. Higher scores on the Collaborative Relationship with Provider subscale were associated with greater perceived primary care quality. The FAMSS demonstrated relevant associations with asthma management criteria and family functioning for a low-income, African-American sample.Journal of Pediatric Psychology 09/2009; 36(5):576-85. · 2.91 Impact Factor
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ABSTRACT: Objectives. Asthmatic children and their parents constantly need to adjust their lifestyles due to asthma attacks. We evaluated the effectiveness of a self-management interactive support (SMIS) program for caregivers of asthmatic children. Methods. Children with persistent asthma were randomized into two groups, one receiving self-management interactive support and the other usual care (the control group). The SMIS program involved a three-month multifaceted behavioral intervention. Changes in the caregivers' knowledge and attitude regarding self-management, children's lung function, and number of emergency department visits and hospital admissions were examined at 12 months post enrollment. Results. Sixty-five asthmatic children and caregivers (78% follow-up) completed the study. Primary caregivers in the SMIS group had significant improvements in knowledge and attitude regarding asthma compared to those in the control group (p < 0.05). Most importantly, knowledge about asthma medications and exacerbations significantly improved and attitudes towards medication adherence and dealing with asthma care became more positive in the SMIS group. The FEV1 was significantly improved in the SMIS group after 12 months (p < 0.05), and performance on the methacholine challenge test at the end of the study was significantly better in the SMIS group (p < 0.05). Participants in the SMIS group also had a lower rate of emergency room use (p < 0.05). Conclusion. The SMIS program for the self-management of asthma in children by their caregivers improved lung function and reduced the number of visits to emergency departments. Interactive support interventions reinforce learning incentives and encourage self-care and maintenance of therapeutic regimens.Journal of Asthma 04/2013; · 1.83 Impact Factor