Theoretical asthma self-management program for Taiwanese adolescents with self-efficacy, outcome-expectancy, health behaviour, and asthma symptoms: A randomized controlled trial

Booklet and Motivational Interviewing to Promote Self-efficacy in Parents/Caregivers of Children with Asthma: A Clinical Trial

Background

Asthma is the most common chronic disease in childhood which accounts for numerous annual hospitalizations due to a lack of management and proper management of the disease. Thus, this study aimed to evaluate the effect of using an educational booklet with or without combination with motivational interviewing (MI) on the self-efficacy of parents/caregivers in the control and management of childhood asthma.

Methods

A clinical trial was carried out with 86 parents/caregivers of children with asthma aged between 2 and 12 years who were followed up in primary health care units from March 2019 to December 2020. Participants were randomly assigned to two groups: one of the groups read the booklet and the other read the booklet combined with the MI. The Brazilian version of the Self-Efficacy and Their Child's Level of Asthma Control scale was applied before and 30 days after the intervention for assessment of self-efficacy. Data were analyzed using SPSS version 20.0 and R 3.6.3 software. P values<0.05 were considered significant.

Results

There were 46 participants in the booklet group and 40 in the booklet and MI group. Both groups were effective in increasing total self-efficacy scores after the intervention (P<0.001). No statistically significant difference was found between the scores of the two groups (P=0.257).

Conclusion

The educational booklet with or without combination with MI can increase the self-efficacy of parents/caregivers of children with asthma. The findings could be considered by healthcare providers for the empowerment of caregivers of children with asthma in the control and management of their children's asthma.Trial Registration Number: U1111-1254-7256.

Psychological interventions for asthma in children and adolescents

BACKGROUND

Rates of asthma are high in children and adolescents, and young people with asthma generally report poorer health outcomes than those without asthma. Young people with asthma experience a range of challenges that may contribute to psychological distress. This is compounded by the social, psychological, and developmental challenges experienced by all people during this life stage. Psychological interventions (such as behavioural therapies or cognitive therapies) have the potential to reduce psychological distress and thus improve behavioural outcomes such as self-efficacy and medication adherence. In turn, this may reduce medical contacts and asthma attacks.

OBJECTIVES

To determine the efficacy of psychological interventions for modifying health and behavioural outcomes in children with asthma, compared with usual treatment, treatment with no psychological component, or no treatment.

SEARCH METHODS

We searched the Cochrane Airways Group Specialised Register (including CENTRAL, CRS, MEDLINE, Embase, PsycINFO, CINAHL EBSCO, AMED EBSCO), proceedings of major respiratory conferences, reference lists of included studies, and online clinical databases. The most recent search was conducted on 22 August 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing psychological interventions of any duration with usual care, active controls, or a waiting-list control in male and female children and adolescents (aged five to 18 years) with asthma.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were 1. symptoms of anxiety and depression, 2. medical contacts, and 3. asthma attacks. Our secondary outcomes were 1. self-reported asthma symptoms, 2. medication use, 3. quality of life, and 4. adverse events/side effects.

MAIN RESULTS

We included 24 studies (1639 participants) published between 1978 and 2021. Eleven studies were set in the USA, five in China, two in Sweden, three in Iran, and one each in the Netherlands, UK, and Germany. Participants' asthma severity ranged from mild to severe. Three studies included primary school-aged participants (five to 12 years), two included secondary school-aged participants (13 to 18 years), and 18 included both age groups, while one study was unclear on the age ranges. Durations of interventions ranged from three days to eight months. One intervention was conducted online and the rest were face-to-face. Meta-analysis was not possible due to clinical heterogeneity (interventions, populations, outcome tools and definitions, and length of follow-up). We tabulated and summarised the results narratively with reference to direction, magnitude, and certainty of effects. The certainty of the evidence was very low for all outcomes. A lack of information about scale metrics and minimal clinically important differences for the scales used to measure anxiety, depression, asthma symptoms, medication use, and quality of life made it difficult to judge clinical significance. Primary outcomes Four studies (327 participants) reported beneficial or mixed effects of psychological interventions versus controls for symptoms of anxiety, and one found little to no difference between groups (104 participants). Two studies (166 participants) that evaluated symptoms of depression both reported benefits of psychological interventions compared to controls. Three small studies (92 participants) reported a reduction in medical contacts, but two larger studies (544 participants) found little or no difference between groups in this outcome. Two studies (107 participants) found that the intervention had an important beneficial effect on number of asthma attacks, and one small study (22 participants) found little or no effect of the intervention for this outcome. Secondary outcomes Eleven studies (720 participants) assessed asthma symptoms; four (322 participants) reported beneficial effects of the intervention compared to control, five (257 participants) reported mixed or unclear findings, and two (131 participants) found little or no difference between groups. Eight studies (822 participants) reported a variety of medication use measures; six of these studies (670 participants) found a positive effect of the intervention versus control, and the other two (152 participants) found little or no difference between the groups. Across six studies (653 participants) reporting measures of quality of life, the largest three (522 participants) found little or no difference between the groups. Where findings were positive or mixed, there was evidence of selective reporting (2 studies, 131 participants). No studies provided data related to adverse effects.

AUTHORS' CONCLUSIONS

Most studies that reported symptoms of anxiety, depression, asthma attacks, asthma symptoms, and medication use found a positive effect of psychological interventions versus control on at least one measure. However, some findings were mixed, it was difficult to judge clinical significance, and the evidence for all outcomes is very uncertain due to clinical heterogeneity, small sample sizes, incomplete reporting, and risk of bias. There is limited evidence to suggest that psychological interventions can reduce the need for medical contact or improve quality of life, and no studies reported adverse events. It was not possible to identify components of effective interventions and distinguish these from interventions showing no evidence of an effect due to substantial heterogeneity. Future investigations of evidence-based psychological techniques should consider standardising outcomes to support cross-comparison and better inform patient and policymaker decision-making.

Assessing Available Adolescent Self-Reported Measures for Asthma Management: A Systematic Literature Review

Objective: Asthma is a common chronic disease and a substantial public health problem for children, adolescents, and adults. Adolescence, a period of increased independence and striving for autonomy, is an opportune time for youth transitioning to adulthood to assume more responsibility for their own asthma self-management. However, accurate measures of adolescent asthma outcomes are limited. The purpose of this systematic review is to identify self-reported asthma measures currently available in the empirical literature focused on adolescent populations. Methods: Search terms were based on the National Library of Medical Subject Headings and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases searched included CINAHL, Nursing Allied Health Prevention, Medline, ProQuest, and PubMed. Included studies were peer reviewed and published in English between 2010 and 2022. All studies reported on asthma measures for adolescents between 10 and 19 years old. Results: Nineteen studies were included, comprising 15 experimental and 4 quasi-experimental. This review revealed the following asthma measure domains: asthma knowledge, self-efficacy, attitudes, self-care, self-regulation, symptom prevention and management, medication adherence, asthma disease control, symptoms, and quality of life (QOL) for evaluating psychosocial, behavioral, clinical, and QOL outcomes. Conclusion: This review revealed the necessity of developing a comprehensive measure to assess the asthma self-management behaviors of adolescents. A comprehensive tool related to adolescent asthma self-management behavior would enhance the assessment and evaluation of adolescent asthma self-management behaviors and extend the science and clinical practice around adolescent self-management. Present measures for asthma self-management behavior for adolescents are limited; therefore, developing a valid and reliable measure is necessary not only to assess adolescents' asthma self-management behavior outcomes but also to identify and evaluate the essential components to include in educational interventions for adolescent self-management.

Cancer patients' return-to-work adaptation experience and coping resources: a grounded theory study

OBJECTIVE

To explore the return-to-work adaptation experience and coping resources used by cancer patients.

METHODS

With the help of the Nantong Cancer Friends Association, from June 2019 to January 2020, this study recruited 30 cancer patients who had returned to work using purpose sampling, snowball sampling and theoretical sampling. The researchers analyzed the data using initial-, focusing-, and theoretical coding.

RESULTS

The adaptation of cancer patients to return-to-work is a rebuilding process by taking advantage of the available personal and external coping resources. The adaptation experience includes: focusing on rehabilitation, rebuilding self-efficacy, and adjusting plans.

CONCLUSION

Medical staff should help patients mobilize coping resources to adapt to return to work.

The effect of a multidimensional teaching strategy on the self-efficacy and critical thinking dispositions of nursing students: A quasi-experimental study

BACKGROUND

Internships in pediatric nursing often reveal that nursing students lack critical thinking dispositions and self-confidence, which are important and necessary for nursing practice. Therefore, preparing nursing students to engage in critical thinking is an important goal for educators.

OBJECTIVES

The purpose of this study was to explore whether a teaching model combining the 5E learning model and self-efficacy would be effective in enhancing participants' self-efficacy and critical thinking dispositions in a course on child-friendly care.

DESIGN

The quasi-experimental method was single-blind, as the study was conducted with two parallel and unequal groups to address the research questions.

SETTING

Two campuses of a university located in Northern and Southern Taiwan.

PARTICIPANTS

Fifty-eight participants completed this study.

METHODS

Participants completed the pre-test questionnaire in Week 1, after which participants in the experimental group learned via the teaching strategy that combined the 5E learning model and self-efficacy, while participants in the control group were taught the same course via conventional teaching methods. A post-test questionnaire was completed in Week 18. An independent sample t-test was used to determine any mean differences of outcome variables between groups over time.

RESULTS

Significant improvements were found in self-efficacy, t (56) = 3.93, p < 0.01, but non-significant results for the outcome of critical thinking disposition t (56) = 0.88, p > 0.05. A t-test was also performed on the four subscales of critical thinking disposition for the two groups, showing that the only difference for overall reflective thinking was statistically significant, t (56) = 2.09, p < 0.05).

CONCLUSIONS

The multidimensional teaching strategy introduced in this study is more effective than conventional teaching strategies in improving students' self-efficacy and the overall reflective thinking aspect of critical thinking disposition.

A multimodal approach to improve asthmatic adolescents' self-efficacy in Taiwan

BACKGROUND

An efficient asthma self-management for adolescents must be based on adolescents' needs, increase self-efficacy and adherence to treatment. The effects of such program are likely be dose dependent.

AIM

To examine the impact of the dose-effect of multiple components on an asthma self-management program for adolescents aged 12-18 years in Taiwan.

METHODS

A scoring system was developed to classify intervention groups into high- (19-23), medium- (11-18) and low (&lt; 11) dose according to the number of components completed by participants. The impacts of the dose level on outcomes of asthma self-efficacy, prevention behaviors, asthma medication adherence, and asthma symptoms were examined.

RESULTS/CONCLUSION

Our results suggest that a high dose of the intervention can improve adolescents' self-efficacy, asthma prevention behavior, and medication adherence.

TRIAL REGISTRATION

Trial Registration No: ACTRN12613001294741.

The challenges and facilitators of self-management in pediatric asthma

PURPOSE OF REVIEW

Self-management education in asthma can dramatically reduce asthma morbidity, but specific pediatric challenges need to be addressed. The purpose of this review is to discuss the most recent and significant advances regarding self-management interventions in pediatric asthma.

RECENT FINDINGS

Recent evidence supports school-based programs including asthma self-management skills for children to significantly improve asthma control. A defined theoretical intervention framework, parent involvement, child satisfaction, and running the intervention outside the child's own free time are suggested drivers of successful implementation. Real-time telemedically delivered asthma education may also improve asthma-related outcomes in children. Moreover, mobile applications supporting self-management are generally welcomed by children and parents. Current evidence supports the use of models of health behaviors change in mobile application design and content development; self-monitoring alone is ineffective but useful when coupled with decision support for proactive care.

SUMMARY

School-based and e-health interventions are potential facilitators for the implementation of successful self-management asthma programs, providing access to large numbers of children with asthma. This supports the healthcare practitioners to work together with researchers to promote these interventions, while following current recommendations for the effective transition of children into competent and confident adults to continue to successfully self-manage their asthma.