Patient and Family Management of Asthma: Theory-Based Techniques for the Clinician

Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor 48109-2029.
Journal of Asthma (Impact Factor: 1.8). 07/2009; 31(6):427-435. DOI: 10.3109/02770909409089484


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.

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    • "Noreen devoted much of her career to defining and refining the value of self-regulation in behavior change, including examining the relative contribution of discrete elements of self-regulation and their relationship to health behavior and health outcomes (Clark & Dodge, 1999; Clark et al., 1992; Clark & Janevic, 2014; Clark & Zimmerman, 1990). Noreen and colleagues, for example, examined the effect of an intervention for children with asthma that included the three behavioral processes of self-regulation (self-observation, self-judgment, and self-reaction) on health and health behavior (Clark et al., 1994). Later she examined the importance of self-efficacy as a predictor of disease management behaviors of older women with heart disease (Clark & Dodge, 1999). "

    Health Education & Behavior 10/2014; 41(5):469-75. DOI:10.1177/1090198114550471 · 2.23 Impact Factor
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    • "Few asthma educational programs were developed based on a theoretical framework (Clark, Evans, Zimmerman, Levison, & Mellins, 1994; Rachelefsky, 1987). Clark et al. (1994) developed asthma education based on self-regulation theory to promote health behaviors by the use of behavioral science (Clark et al., 1994). Systematization of nursing assistance under Orem's nursing theory of self-care deficit was developed by Monteiro, da Nobrega, and de Lima (2002). "
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    ABSTRACT: This study compared the self-management behaviors of parents with asthmatic children staying in two hospitals and explored barriers to self-management behaviors by interviewing. 227 parents were recruited for quantitative analysis by completing a self-report structured questionnaire, 94 of these parents were from the Taipei area and 133 were from the Taoyuan area. Sixteen parents were interviewed from this population. The results indicated that the parents in theTaoyuan area had younger age, lower socioeconomic status (SES), and higher exercise limitations for children. Their knowledge, enabling factors, and self-management behaviors were also lower than their counterparts in the Taipei area. The determining factors of self-management behaviors were socioeconomic status, self-efficacy, sources of education, and perceived effectiveness (Adjusted R2= .593) in 227 parents. Six major themes about the influencing factors of self-management were deduced from the interview data: lack of understanding and dislike of the asthma label, less self-perceived severity, lack of understanding about asthma medication, lack of confidence in environmental controls, financial burden of anti-mite products, and doubt about effectiveness. Three major barriers to self-management behaviors of parents in the Taoyuan area were inconsistent use of alternative treatments, overdependence on medical service, and lack of use of peak flow meter. Parents with asthmatic children living in the Taoyuan area had poorer self-management behaviors than those in the Taipei area, and SES was one of the determining factors. The health beliefs of Taoyuan parents included many misconceptions. Conducting the educational needs assessment through quantitative and qualitative methods could provide proficiency information for designing educational content appropriate to specific populations.
    The journal of nursing research: JNR 07/2005; 13(2):85-96. DOI:10.1097/01.JNR.0000387530.22642.fd · 0.97 Impact Factor
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    • "care problems associated with the disease [13]. Although there are many asthma education programs that have been developed in different populations [14┬▒17], few of these programs involve theory-based developments [18] [19], and therefore, their effectiveness is limited. Finding the determinate factors for self-management behaviors of parents with asthmatic children, based on the PRECEDE┬▒PROCEED model, can afford a problem-focused education program. "
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    ABSTRACT: This assessment study is an educational and behavioral diagnosis based on the PRECEDE-PROCEED model which identifies factors (predisposing, enabling, and reinforcing) that must be changed to initiate and sustain the self-management behaviors of parents with asthmatic children (aged 3-14 years) in the largest children's hospital in northern Taiwan. In the first step, 21 self-management behaviors were induced from the content analysis of qualitative interviews of 16 successful parents. The construct validity of 21 self-management behaviors was established by principal component factor analysis, followed by the rotation method with Varimax and Kaiser normalization. Three extracted components were named: preventing behaviors, managing behaviors, and assessing behaviors. The cumulative percentage of variance of the three factors was 48.2%. In order to identify the determinate factors of self-management behaviors, 133 parents with asthmatic children were recruited and investigated at the outpatient department of the hospital, in the second step. All the instruments were developed based on the results of content analysis from an in-depth interview. The results indicated that the self-management behaviors of this group were middle level. Stepwise multiple regression was used to analyze the predicted rate of self-management behaviors by 12 educational factors. The results indicate that self-efficacy, perceived effectiveness, and children's cooperation can explain 50.2% of the variance in the self-management behaviors. The determinate factors of preventive behaviors were self-efficacy, perceived effectiveness, and children's cooperation with R(2)=0.448. The determinate factor of managing behaviors was perceived effectiveness with R(2)=0.262. The determinate factors of assessing behaviors were perceived severity, knowledge, self-efficacy, and perceived effectiveness with R(2)=0.311. These results suggest the direction of a self-management education program for different parents of asthmatic children with poor management skills. Future research should be conducted to evaluate the effectiveness of treatment by a more specific self-management education program, which focuses on increasing self-efficacy and perceived effectiveness.
    Patient Education and Counseling 02/2003; 49(1):19-25. DOI:10.1016/S0738-3991(02)00037-X · 2.20 Impact Factor
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