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Asthma control is the goal of management to prevent exacerbations and minimize the severity of asthma. To design effective interventions to control asthma, understanding of factors involved and how they work to influence asthma control is needed. This cross-sectional study aimed to develop and test a causal model of asthma control in Thai adults with asthma. A sample of 330 participants were recruited from asthma and chronic obstructive pulmonary disease clinics in four tertiary hospitals in eastern Thailand. Data were collected using a sociodemographic form; the Brief Illness Perception Questionnaire; the Hospital Anxiety and Depression Scale; Job Stress Scale; the Multidimensional Scale of Perceived Social Support; the Functional, Communicative, and Critical Health Literacy Scale; the Self-Efficacy Subscale of the Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire; the Asthma Self-Management Behavior Instrument; and the Asthma Control Questionnaire. Structural Equation Modeling was used to test the asthma control model.
After trimming the initial model, the final model explained 54% of the total variance in asthma control with self-management behaviors having the strongest direct effect. Health literacy, illness perception, and social support indirectly affected asthma self-management behaviors through asthma self-efficacy, then directly affected its control. Illness perception, depression, and social support indirectly affected asthma control via asthma self-management behaviors, whereas job stress directly and indirectly affected asthma control via asthma self-management behaviors. The results suggest that nurses can design an intervention to support asthma self-management behaviors by enhancing asthma self-efficacy through increasing health literacy, improving illness perception and social support, and reducing job stress and depression. This intervention should be combined with innovative technology and further tested for its effectiveness.
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