DOI: 10.14457/tu.the.2019.1620
title: Effectiveness of a family-based asthma self-management program in enhancing asthma health outcomes in school-age children: mixed methods study

description: Asthma is a childhood chronic disease that is a predominant health problem for many countries worldwide, including Thailand. Self-management is a cornerstone for achieving positive asthma outcomes, namely, good asthma control, normalized pulmonary function, and optimized quality of life. School-age children begin to develop self-management ability for asthma with the supervision of parents. The key to successful asthma management among school-age children can be found in the use of the important aspects of family functioning, consisting of communication, roles, and affective responsiveness. Accordingly, the individual and family self-management theory and the McMaster model of family functioning were used as the framework for understanding the self-management of school-aged children. The purpose of this study was to develop and evaluate a family-based asthma self-management program in enhancing asthma health outcomes, including asthma control status, pulmonary function, and quality of life in school-age children.This study employed an exploratory sequential mixed-method as the research design. The first phase was designed as a qualitative method using in-depth interviews to identify the effective patterns of family functioning regarding the asthma management of school-age children. Purposive sampling was employed to select 15 (age 7-12 years old) school-aged children with asthma attending an outpatient department and 15 family caregivers. Data were collected via in-depth individual interviewing. Content analysis was used for the qualitative data analysis. The second phase used a quantitative method to evaluate the family-based asthma self-management program. During this phase, the developed program was implemented and evaluated using a quasi-experimental design, with a two-group, pre-posttest design, in order to examine the health outcomes of asthma, including asthma control status, pulmonary function, and the quality of life of children before and after implementation at two months. The participants consisted of the family caregivers and their children aged 7 to 12 that had been diagnosed with asthma and that were attending the pediatric allergy clinic of the outpatient department at Thammasat University Hospital. The sample in this quantitative phase comprised 37 child-parent pairs randomly assigned to the experimental group and 37 child-parent pairs assigned to the control group for a total of 74 pairs. Data collection occurred using the Childhood Asthma Control Questionnaire and Pediatric Asthma Quality of Life Questionnaire, and the measurement of pulmonary function was performed using peak flow meters. Descriptive statistics, chi-squared test, t-test, and multivariate analysis of covariance (MANCOVA) were employed for analyzing the quantitative data. The qualitative results revealed that the key findings from the in-depth interviews can be classified according to three major themes: (1) family communication about asthma care; (2) the family’s role in managing asthma; and (3) the affective response of the family. Additionally, these findings from the interviews revealed the necessary role of parents and children in terms of managing asthma, suggestions for future intervention programs, and problems with asthma management by the family. These themes were used as a guideline for creating interventions to enhance the self-management of school-age children. The family-based asthma self-management program was designed for individual families and consisted of three interactive sessions (60 min each) conducted in a clinical setting over a period of two months. The quantitative results indicated that the school-aged children that participated in the family-based asthma self-management program significantly increased their asthma control, pulmonary function, and quality of life scores. The family-based asthma self-management program is useful for promoting self-management of school-age children, enabling control of symptoms, and enhancing health outcomes of asthma.