Effectiveness of a Self-Management Enhancement Program Among Adults with Uncontrolled Asthma: A Randomized Controlled Trial

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Pornthip Kaewsing
Darawan Thapinta
Jindarat Chaiard
Chomphoonut Srirat


                People with uncontrolled asthma are faced with many difficulties as the disease progresses and self-management is one approach to improve their health outcomes. This randomized controlled trial aimed to test the effects of a self-management enhancement program on symptom control and quality of life among adults with uncontrolled asthma. The study was implemented from April to September 2018 at a tertiary care hospital in northeast Thailand. One hundred people were randomly assigned to the experimental (n = 50) and control groups (n = 50). The experimental group participated in a 6-week self-management enhancement program, whereas the control group received standard care. The outcomes were assessed at 12 weeks after the completion of the program. Questionnaires used were the Asthma Control Test and the Mini Asthma Quality of Life. Data were analyzed using descriptive statistics, paired t-tests, independent t-tests, and Mann-Whitney U tests.
               The results indicated that participants in the experimental group showed improvements in symptom control, as well as their quality of life, compared to before the program. After the program, they had a statistically significant better improvement in symptom control and quality of life when compared with the control group at 12 weeks. These findings suggest that the program for self-management can be used to improve symptom control and the quality of life among persons with uncontrolled asthma, but we suggest further testing with groups in other regions. Such an intervention could be directly beneficial to either nurses or other health care professionals to enhance health behaviors among people with uncontrolled asthma. Nurses need to be trained to provide information and motivate people with uncontrolled asthma to sustain their self-management efforts.

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Kaewsing P, Thapinta D, Chaiard J, Srirat C. Effectiveness of a Self-Management Enhancement Program Among Adults with Uncontrolled Asthma: A Randomized Controlled Trial . PRIJNR [Internet]. 2021 Jun. 15 [cited 2022 Dec. 9];25(3):375-88. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/245150
Original paper


Global Initiative for Asthma. A pocket guide for health professionals updated in 2019. [Internet] 2019 March 15 [cited 2019 March 15]. Available from: http: //ginasthma.org

World Health Organization. Asthma. [Internet] 2019 June 12 [cited 2019 June 12]. Available from: http: //who.nhlbi. nih.gov/ health-topics/asthma

Boonsawat W. Asthma. [Internet] 2019 July 12 [cited 2019 July 12]. Available from: http://eac2.easyasthma.com/ site_data/ dbregistry_eac/1/Asthma.pdf

Boonsawat W. Asthma: the textbook of respiratory. Bangkok: Parbpim; 2017.

Sangsawang N, Sangsawang B. Depression in adults asthmatic patients: pathophysiology, impacts, related factors and nursing care. Journal of Medicine and Health Sciences. 2015;22(2):61-70.

Deci EL, Ryan RM. Intrinsic motivation and self-determination in human behavior. New York: Plenum; 1985.

Lorig KR, Holman HR. Self-management education: history, definition, outcome, and mechanisms. The Society of Behavioral Medicine. 2003;26(1):1-7. doi:10.1207/ S15324796ABM2601_01.

Adachi M, Hozawa S, Nishikawa M, Yoshida A, Jinna T, Tamura G. Asthma control and quality of life in a real-life setting: a cross-sectional study of adult asthma patients in Japan (ACQUIRE-2). J Asthma. 2019;56(9): 1016-25. doi:10.1080/02770903.2018.1514628.

Pinnock H, Parke HL, Panagioti M, Daines L, Pearce G, Epiphaniou E, et al. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Med. 2017;15(64):1-32. doi:10.1186/ s12916-017-0823-7.

Griffiths C, Bremner S, Islam K, Sohanpal R, Vidal D, Dawson C, et al. Effect of an education programme for South Asians with asthma and their clinicians: a cluster randomised controlled trial (OEDIPUS). Education for South Asians with Asthma. 2016;11(12):1-16. doi:10.1371/journal. pone.0158783.

Liao Y, Gao G, Peng Y. The effect of goal setting in asthma self-management education: a systematic review. Int J Nurs Sci. 2019;6:334-342. doi: 10.1016/ j.ijnss.2019.04.003.

Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and overdiagnosis of asthma. Am J Respir Crit Care Med. 2018;198 (8):1012-1020. doi:10.1164/rccm.201804-0682CI.

Martin MA, Catrambone CD, Kee RA, Evans AT, Sharp LK, Lyttle C, et al. Improving asthma self-efficacy: developing and testing a pilot community-based asthma intervention for African American adults. J Allergy Clin Immunol. 2009;123(1):1-17. doi: 10.1016/j.jaci.2008.10.057.

Namrata H, Xinyue F, Weifen L, Soong YK. Evaluation of a chronic disease self-management program in Singapore. J Chronic Dis. 2016;1(1):1-4.

Smith L, Bosnic-Anticevich SZ, Mitchell B, Saini, Krass I, Armour C. Treating asthma with a self-management model of illness behaviors in an Australian community pharmacy setting. Soc Sci Med. 2007;64(7):1501-11. doi:10. 1016/j.socscimed.2006.11.006.

Speck AL, Hess M, Baptist AP. An electronic asthma self-management intervention for you young African American adults. J Allergy Clin Immunol Pract. 2015;4:89-95. doi: 10.1016/j.jaip.2015.08.007.

Londono AMM, Schulz PJ. Influences of health literacy, judgment skills, and empowerment on asthma self-management practices. Patient Educ Couns. 2015;98: 908-17. doi: 10.1016/j.pec.2015.03.003.

Seifert CM, Chapman LS, Hart JK, Perez P. Enhancing intrinsic motivation in health promotion and wellness. Am J Health Promot. 2012;26(3):1-12. doi:10.4278/ ajhp.26.3.tahp. doi:10.4278/ajhp.26.3.tahp.

Polgar-Bailey P. Asthma. In: Buttaro TM, Trybulski J, Polgar- Bailey P, Sandberg-Cook, editors. Primary care [internet]. 5th ed. Elsevier, Inc; 2020 [cited 2020 Oct 18]. Available from: http://clinical key for nursing.com

National Heart Lung and Blood Institute (NHLBI). Expert Panel Report 3: guidelines for the diagnosis and management of asthma 2007. [cited 2020 June 1]. Available from https:// nhlbi.nih.gov/health-topics/all-publications-and-resources/ expert-panel-report-3-epr-3-guideline/full-report

Jimenez-Ruiz CA, Andreas S, Lewis KE, Tonnesen P, Schayck CP, Hajek P, et al. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J. 2015;46:61-79. doi 10.1183/09031936.00092614.

Johnson PH, Chambers P, Dexheimer JW. Asthma-related emergency department use: current perspectives. Open Access Emerg Med. 2016;13(8):47-55. doi: 10.2147/ OAEM.S69973.

Juniper EF. Asthma quality of life questionnaires (AQLQ, AQLQ(S), miniAQLQ and acute AQLQ). 2016. [cited 2018 June 15]. Available from: http://qoltech.co.uk

Ferrans CE Powers MJ. Psychometric assessment of the quality-of-life index. Res Nurs Health. 1992; 15:29-38. doi:10.1002/nur.4770150106.

Lorig K. Self-management of chronic illness: a model for the future. Generations XVII. 1993;3:11-4.

Kanfer FH. Implications of a self-regulation model of therapy for treatment of addictive behaviors. In: Miller WR., Heather N. editors. Treating addictive behaviors. Springer; 1986. pp. 29-47.

Hankhuan S, Wannapornsiri C Vichitkaew N. The effects of self-efficacy program for health care behavior on asthma control. Nurs Health Sci. 2010;4(2): 72-81.

Ruengkajorn O, Kittiwatanapaisan W. The effectiveness of self-management program on self-management behavior and asthma controlled level in asthma patient at Ranode Hospital, Songkhla Province. Journal of Nursing Science & Health. 2011;34(3):11-21.

Wongwai C, Khampulikit S, Poachanukoon O. The effects of a self-management program on asthma control scores and lung function of asthmatic patients. Thai Journal of Tuberculosis Chest Diseases and Critical Care. 2012;33(3): 89-99.

Pimkhot N, Suebsoh W, & Teewunda D. Effect of perceived self-efficacy and social support on behavior modification of asthma patients. PHJBUU. 2013;8(2):81-91.

Sirithongsuk A, Theeranut A, Boonsawat W. Effects of a self-efficacy promotion program on self-efficacy and preventing behavioral of acute exacerbations in asthmatic patients. Journal of Nursing Science & Health. 2016; 39(1):61-69.

Suwannachart W, Uakit N. The effect of perceived self-efficacy promoting program on self-management behavior in asthma adult patients. KJN. 2016;23(1):60-72.

Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li T, Marcus P, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59-65. doi: 10.1016/j.jaci. 2003.09.008.

Vongsa et al. Asthma Control Test (ACT). In: Thai Asthma Council guidelines for the diagnosis and treatment of asthma in Thailand V5 for adult and children 2012. Bangkok: Union Ultra Violet; 2012. pp.61-2.

Juniper EF, Wisniewski ME, Cox FM, Emmett AH, Nielsen KE, O’Byrne PM. Relationship between quality of life and clinical status in asthma: a factor analysis. Eur Respir J. 2004;23(2):287-91. doi:10.1183/09031936.04.0 0064204.

Leurmarnkul W. Health-related quality of life questionnaire development. Thai J Pharm Sci. 2000;24(2):71-5.

Hodkinson A, Bower P, Grigoroglou C, Zghebi SS, Pinnock H, Kontopantelis E, et al. Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: systematic review and network meta-analysis. BMJ. 2020;370:1-12. doi:10.1136/bmi.m2521.

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 Psychol. 2004;23(1):58-66. doi: 10.1037/0278-6133.23.1.58.

Kosse RC, Koster ES, Kaptein AA, Vries TW, Bouvy ML. Asthma control and quality of life in adolescents: the role of illness perceptions, medication beliefs, and adherence. J Asthma. 2020;57(10):1145-54. doi:10.1080/027 70903.2019.1635153.

Khusial RJ, Honkoop PJ, Usmani O, Soares M, Simpson A, Biddiscombe M, et al. Effectiveness of myAirCoach: a mHealth self-management system in asthma. J Allergy Clin Immunol Pract. 2020;8(8):1972-9. doi: 10.1016/ j.jaip.2020.02.018.