A Causal Model of Self-Management Behavior for Adolescents with Asthma

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Daranee Serametakul
Tipaporn Wonghongkul
Pimpaporn Klunklin
Jutarat Mesukko


                 Self- management behavior is important for controlling symptoms and preventing death from asthma attack. Recent studies have shown that self-management of asthma among adolescents is mostly inadequate. For better design intervention to support self-management, understanding factors and how they influence self-management behaviors is necessary. Thus, this descriptive cross-sectional study developed and tested the Self-Management Model for Adolescents with Asthma. The participants were 442 Thai adolescents with asthma from 13 regional hospitals in Thailand. Data were collected by six self-administered questionnaires including; a demographic and Illness-Related Data Form, the Basic Need Satisfaction in Life Scale, Perception of Parents Scale, the Health Care Climate Questionnaire, the Aspiration Index, and the Thai Version of Asthma Self-Care Practice. Pearson’s product moment correlation coefficient and structural equation modeling were used for analyzing the data.

             The results showed that the final model fitted the empirical data, in which relatedness need satisfaction, intrinsic life goals, parental autonomy support, and extrinsic life goals variables explained 78% of total variance in self-management behavior. Relatedness need satisfaction and intrinsic life goals had positive direct effect on self-management behaviors. Parental autonomy support had a positive indirect effect, whereas extrinsic life goals had an negative indirect effect on self-management behaviors through relatedness need satisfaction. These findings suggest that nurses can use the model as a guideline for developing nursing interventions to promote relatedness need satisfaction and intrinsic life goals, promote extrinsic life goals for adolescents with asthma, and enhance autonomy support skills for parents. 

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Serametakul D, Wonghongkul T, Klunklin P, Mesukko J. A Causal Model of Self-Management Behavior for Adolescents with Asthma. PRIJNR [Internet]. 2019 Sep. 16 [cited 2022 Sep. 28];23(4):320-33. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/151662
Original paper


1. Mallol J, Aguirre V, Mallol-Simmonds M, MatamalaBezmalinovic A, Calderón-Rodriguez L, Osses-Vergara F. Changes in the prevalence of asthma and related risk factors in adolescents: three surveys between 1994 and 2015. Allergologia et Immunopathologia. 2018 Nov 30. [Science Direct ahead of print]

2. Chinratanapisit S, Suratannon N, Pacharn P, Sritipsukho P, Vichyanond P. Prevalence and severity of asthma, rhinoconjunctivitis and eczema in children from the Bangkok area: The Global Asthma Network (GAN) Phase I. Asian Pacific Journal of Allergy and Immunology. 2018.

3. Chipps BE, Haselkorn T, Rosén K, Mink DR, Trzaskoma BL, Luskin AT. Asthma exacerbations and triggers in children in TENOR: Impact on quality of life. Journal of Allergy and Clinical Immunology: In Practice. 2018 6(1):169-176.

4. Junghans-Rutelonis AN, Tackett AP, Suorsa KI, Chaney JM, Mullins LL. Asthma-specific cognitions, self-focused attention, and fear of negative evaluation in adolescents and young adults diagnosed with childhood-onset asthma. Psychology, Health & Medicine. 2018 23(1): 69-81.

5. Sullivan P, Ghushchyan VG, Navaratnam P, Friedman HS, Kavati A, Ortiz B, Lanier B. School absence and productivity outcomes associated with childhood asthma in the USA. Journal of Asthma. 2018 55(2): 161-168.

6. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma: GINA. 2018. [cited 2019 February 21]. Available from https://www. ginasthma.org/. GINA 2018.

7. Branje S. Development of parent–adolescent relationships: Conflict interactions as a mechanism of change. Child Development Perspectives. 2018 12(3): 171-176.

8. De Simoni A, Horne R, Fleming L, Bush A, Griffiths C. What do adolescents with asthma really think about adherence to inhalers? Insights from a qualitative analysis of a UK online forum. BMJ Open. 2017 7(6):e015245.

9. Nabors L, Odar-Stough C, Peugh J, Merianos AL, Cunningham J, Yockey RA. Adolescent flourishing in relation to having asthma: Results from a population-based cross-sectional study. Journal of Asthma. 2018. 55(2): 132-136.

10. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist. 2000 55(1):68-78.

11. Holley S, Morris R, Knibb R, Latter S, Liossi C, Mitchell F, Roberts G. Barriers and facilitators to asthma self‐management in adolescents: A systematic review of qualitative and quantitative studies. Pediatric Pulmonology. 2017 52(4): 430-442.

12. Gao Q, Huang H, Zhu K, Liu X, Hou X, Guan H, et al. Clinical course and factors associated with asthma control in children under control-based asthma management: a prospective study. Iranian Journal of Allergy, Asthma and Immunology. 2018 17(1): 18-28.

13. Kneale D, Harris K, McDonald VM, Thomas J, Grigg J. Effectiveness of school-based self-management interventions for asthma among children and adolescents: findings from a Cochrane systematic review and meta-analysis. Thorax, thoraxjnl-2018 [Internet]. 2019 [cited 2019 Feb 21]. Available from: https://thorax.bmj.com

14. Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Annual of Behavioral Medicine. 2003 26(1): 1-7.

15. Preechawong S. Self-esteem, learned resourcefulness, and self-management behavior of Thai adolescents with asthma (PhD dissertation). Cleveland, Ohio: Case Western Reserve University; 2004.

16. Rhee H, Wicks MN, Dolgoff JS, Love TM, Harrington D. Cognitive factors predict medication adherence and asthma control in urban adolescents with asthma. Patient Preference and Adherence. 2018 12: 929-937.

17. Bruzzese JM, Idalski CA, Lam P, Ellis DA, Naar-King S. Adherence to asthma medication regimens in urban African American adolescents: application of selfdetermination theory. Health Psychology. 2014 33(5): 461-464.

18. Ahmad A, Sorensen K. Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review. Journal of Asthma. 2016 53(8): 862-878.

19. Grolnick WS, Ryan RM, Deci EL. Inner resources for school achievement: motivational mediators of children's perceptions of their parents. Journal of Educational Psychology.1991 83(4): 508-517.

20. Austin S, Senécal C, Guay F, Nouwen A. Effects of gender, age, and diabetes duration on dietary self-care in adolescents with type 1 diabetes: a self-determination theory perspective. Journal of Health Psychology. 2011 16(6), 917–928.

21. Ryan RM, Patrick H, Deci EL, Williams GC. Facilitating health behaviour change and its maintenance: Interventions based on self-determination theory. The European Health Psychologist. 2008 10(1): 2-5.

22. Kasser T, Ryan RM. Further examining the American dream: differential correlates of intrinsic and extrinsic goals. Personality and Social Psychology Bulletin. 1996 22:280 –287.

23. Thogersen-Ntoumani C, Ntoumanis N, Nikitaras N. Unhealthy weight control behaviours in adolescent girls: A process model based on self-determination theory. Psychology and Health. 2010 25(5): 535-550.

24. Vansteenkiste M, Lens W, Deci EL. Intrinsic versus extrinsic goal contents in self-determination theory: Another look at the quality of academic motivation. Educational Psychologist. 2006 41(1): 19-31.

25. Hatano K, Sugimura K, Schwartz SJ. Longitudinal links between identity consolidation and psychosocial problems in adolescence: using bi-factor latent change and cross-lagged effect models. Journal of Youth and Adolescence. 2018 47(4): 717-730.

26. World Health Organization-WHO. Maternal, Newborn, Child and Adolescent Health: Adolescent Development. 2017. [cited 2019 February 20]. Available from https:// www.who.int/maternal_child_adolescent/en/

27. Özdemir A, Utkualp N. Physical and psychosocial effects of the changes in adolescence period. International Journal 2016 9 (2):717-723.).

28. Saxby N, Beggs S, Battersby M, Lawn S. What are the components of effective chronic condition self-management education interventions for children with asthma, cystic fibrosis, and diabetes? a systematic review. Patient Education and Counseling 2018 Nov 13. [Science Direct ahead of print]

29. Imam L, Zilioli S, Tobin ET, Saleh DJ, Kane HS, Slatcher RB. Youth secrets are associated with poorer sleep and asthma symptoms via negative affect. Journal of Psychosomatic Research. 2017 96: 15-20.

30. Garson GD. Structural equation modeling. North Carolina State University. College of Humanities and Social Sciences. 2006 [cited 2014 August 25]. Available from https:// www2.chass.ncsu.edu/garson/pa765/structur.htm

31. Cha ES, Kim KH, Erlen JA. Translation of scales in cross‐ cultural research: issues and techniques. Journal of Advanced Nursing. 2007 58(4): 386-395.

32. Gagné M. The role of autonomy support and autonomy orientation in prosocial behavior engagement. Motivation and Emotion. 2003 27(3):199-223.

33. Williams GC, McGregor HA, Zeldman A, Freedman ZR, Deci, EL. Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychology. 2004 23(1):58-66.

34. Tian L, Zhang X, Huebner ES. The effects of satisfaction of basic psychological needs at school on children's prosocial behavior and antisocial behavior: the mediating role of school satisfaction. Front Psychol. 2018 9:548.

35. Riley BH, McDermott RC. Applying self-determination theory to adolescent sexual-risk behavior and knowledge: a structural equation model. Journal of the American Psychiatric Nurses Association. 2018 24(6): 482-494.

36. Bradshaw EL, Sahdra BK, Calvo RA, Mrvaljevich A, Ryan RM. Users' intrinsic goals linked to alcohol dependence risk level and engagement with a health promotion website (Hello Sunday Morning): observational study. JMIR Ment Health. 2018 5(4): e10022.

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