Asthma is the most common chronic disease in teens. This age group has higher risk of asthma morbidity and mortality than other groups, which has been attributed to poor asthma self-management. Most research in this population has focused on the ways in which teen asthma self-management is inadequate to achieve asthma control. However, very little is known about the process of asthma self-management from teens' perspectives. In order to promote better asthma self-management, it is imperative to understand teens' perspectives of managing their asthma, including what they do to self-manage, what their rationales are for their choices, and how self-management behaviors may vary across life-contexts. This type of contextually specific knowledge of teen-self-management will facilitate the development of effective self-management interventions, and assist clinicians i shaping and delivering health information in a way that is both developmentally appropriate and meaningful to teen patients. Therefore, the purpose of this study is to explore teens' experiences of asthma self-management across their different life-contexts through use of asthma self-management diaries and in-depth qualitative interviews with teens and their parents.
The aims of this study are to (1) describe how teens manage their asthma and what is important from the perspective of teens and their parents; (2) compare the asthma self- management of minority versus non-minority teens having well-controlled and not-well-controlled asthma. The study design is case-based qualitative description, focusing on teen-parent dyads. Each case will comprise: (1) a primary interview with the teen; (2) an interview with the parent; (3) a two-week digitally recorded self-management voice-diary; and (4) a follow up interview with the teen. Thus, the estimated sample size of 14 to18 cases will provide a minimum of 56 sources of data. Teens will be recruited through the Emergency Department, Pediatric Pulmonary Department, and from previous study databases to increase between subject variability. Purposeful and criterion-based sampling will be used to select for dyads best able to contribute to a broader understanding of the phenomena of teen asthma self-management. The in-depth interviews, in conjunction with digitally recorded daily voice diaries, will be used to capture both retrospective and contemporaneous data on teen asthma self-management. Four domains of self-management (symptom prevention, symptom monitoring, acute symptom management, and communication) will be explored across four primary contexts (home, school, community, and healthcare settings). Directed content analysis of transcribed interviews and diaries will be used to critically evaluate and extend the existing conceptualization of teen asthma self-management while highlighting teen perspectives and goals. Analysis will also include comparison of self-management between minority and non-minority teens, as well as teens with well-controlled and not-well-controlled asthma.
Teens often have poorly controlled asthma, which is associated with increased asthma-related illness, poorer quality of life, and increased use of costly health care services. Improving asthma self-management is critical to helping teens achieve good asthma control and preventing negative health outcomes. Understanding asthma self-management from the perspectives of teens and their parents is a crucial first step towards this goal, and will help to increase the effectiveness of teen asthma education and interventions.
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