Adolescent asthma management self-efficacy and responsibility: impact on asthma control and quality-of-life

Illness Expectations and Asthma Symptoms: A 6-Month Longitudinal Study

BACKGROUND

After receiving a diagnosis, individuals often develop expectations about how their condition will evolve. This cognitive framework, known as 'Illness Expectations' (IEs), encompasses future-oriented beliefs regarding the course of the illness and its symptoms. In chronic conditions such as asthma, IEs may play a critical role in shaping patient-reported outcomes and clinical markers of disease progression. This study aims to empirically evaluate the impact of IEs on asthma symptoms and respiratory function.

METHODS

A cohort of 310 individuals diagnosed with asthma was followed over a 6-month period, with three assessment points. Asthma control was measured using the Asthma Control Test (ACT), while respiratory function was evaluated through forced expiratory volume in 1 s (FEV1) using spirometry. IEs were assessed using the validated 'Illness Expectation Test' (IET), which captures both explicit (conscious) and implicit (unconscious) expectations. Predictive analyses were conducted using latent growth modelling and linear regression to examine the influence of IEs on asthma symptoms and respiratory function over time.

RESULTS

People with more negative explicit IEs about their asthma reported worse symptoms over time (β = -0.50, SE = 0.21, p = 0.01). Implicit IEs were not statistically significant (β = -0.014, SE = 0.008, p = 0.09). Explicit IEs about symptom progression were also associated with changes in lung function, with more negative expectations predicting greater declines in respiratory performance (β = 0.51, SE = 0.11, p = 0.001).

CONCLUSIONS

These findings suggest that IEs may be meaningfully associated with asthma outcomes, highlighting their potential relevance in understanding patient experiences and symptom perception. These results support further research into interventions targeting cognitive frameworks, with the aim of informing more personalised, patient-centred approaches to asthma management.

PATIENT OR PUBLIC CONTRIBUTION

This study was developed in response to patient-reported challenges in asthma management, particularly around understanding and managing IEs. Patients contributed to identifying key areas of concern, and their perspectives informed the choice of outcomes and tools. While direct involvement in recruitment and dissemination was limited due to the pandemic, the study's design and focus were guided by patient priorities, with potential applications in clinical consultations and future co-designed interventions.

"While Everyone Else was Doing Sports, I Used to Sit on the Sidelines." How Do Adolescents Manage Their Asthma?: A Qualitative Study

Effective asthma management is a necessity for the control and optimal outcomes of the condition. A number of factors may either facilitate or act as barriers to the management of asthma in adolescents. The objective of this study was to assess the feelings, thoughts, and behaviors of adolescents diagnosed with asthma regarding the management of their condition. This exploratory qualitative study was conducted using semi-structured, in-depth interviews with 12 adolescents aged 12-18 years who were followed up with a diagnosis of asthma at a university hospital pediatric allergy clinic between October 15 October 2023, and December 15 December 2023. The study was written using the COREQ checklist. Three main themes were identified in this study: (1) facilitators, (2) barriers, and (3) information. Adolescents reported that they needed more information about medication use and asthma disease to manage asthma. Asthma control ability, positive beliefs, and supportive relationships were facilitators of asthma management. However, poor asthma control, negative beliefs, lack of support, poor communication, and asthma-related stigma were identified as barriers to asthma self-management. Adolescents had information needs in asthma management. This study highlights that barriers to asthma self-management in adolescents are much greater than the facilitators. For adolescents to manage their asthma well, their information needs must be met. Therefore, pediatric nurses should prepare individualized training to meet the specific needs of adolescents.

Psychometric validation of the Chinese version of the Adolescent Asthma Self-Efficacy Questionnaire

Background

Self-efficacy was considered as a promising target for the self-management of symptoms for adolescents with asthma. The measurement of self-efficacy in adolescents with asthma requires effective self-report tools, which have not been met with at present. So, the aim of this study was to cross-culturally validate the Adolescent Asthma Self-Efficacy Questionnaire (AASEQ).

Methods

As many as 408 adolescents with asthma were invited to take up the psychometric properties test between July 2021 and June 2022. We conducted the confirmatory factor analysis (CFA) to determine the structure of the AASEQ. The relationship between the AASEQ and General Self-Efficacy Scale was tested to evaluate the construct validity. The reliability was evaluated by retest reliability, internal consistency, and interfactor correlation.

Results

The results of the present study showed that the confirmatory factor analysis indicated a significantly good fit for a four-factor model, which explained 62.697% of the total variance. The fit indices of the four-factor model were acceptable, and the standardized factor loading ranged from 0.631 to 0.880. The C-AASEQ showed an acceptable internal consistency (Cronbach's α = 0.810-0.927) and test-retest reliability (intraclass correlation coefficient = 0.64-0.89). Content validity index at the scale level was 0.96, and content validity index at the item level was 0.86 to 1.

Conclusion

The Chinese version of Adolescent Asthma Self-Efficacy Questionnaire showed consistently acceptable positive psychometric properties and can be used as an instrument to assess the self-efficacy of adolescents with asthma in China, as corroborated in the present study.