Sangngam Jinnaphat, Prasopkittikun Tassanee, Nookong Apawan, Pacharn Punchama, Chamchan Chalermpol
Faculty of Nursing, Mahidol University, Bangkok, Thailand.
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Int J Nurs Sci. 2023 Jun 23;10(3):309-317. doi: 10.1016/j.ijnss.2023.06.001. eCollection 2023 Jul.
To examine causal relationships among asthma self-management behaviors, asthma symptom control, health-related quality of life and the influencing factors among Thai adolescents.
A cross-sectional study was conducted using convenience sampling. A total of 240 adolescent-caregiver dyads from three tertiary hospitals in Bangkok, Thailand was ultimately included. Interviews and self-administered questionnaires assessing health-related quality of life, asthma symptom control, asthma self-management behaviors, health literacy, depression, comorbidities, family support, peer support, home environmental management, and relationships with health care providers were administered between November 2020 and July 2021. A hypothesized model based on the revised self- and family-management framework was proposed. Data were analyzed using descriptive statistics and path analysis.
It was shown that the proposed model was a good fit for the empirical data and accounted for 67.2% of the variance in health-related quality of life. Depression and asthma symptom control directly affected quality of life ( = -0.132, < 0.05; and = 0.740, < 0.05, respectively), while asthma self-management behaviors did not. Both depression and asthma self-management behaviors had indirect effects on the quality of life through asthma symptom control ( = -0.382, < 0.05; and = 0.225, < 0.05, respectively). Health literacy ( = 0.343, < 0.05), family support ( = 0.167, < 0.05), peer support ( = 0.163, < 0.05), and relationships with health care providers ( = 0.181, < 0.05) also showed direct effects on asthma self-management behaviors.
The findings confirmed the causal relationships among asthma symptom control, self-management behaviors, depression and health-related quality of life. Health literacy, support from family and peers, and relationships with health care providers were also found to influence asthma self-management behaviors. To achieve effective asthma control and good quality of life, a nursing intervention promoting asthma self-management for Thai adolescents should be developed. Early detection and intervention of depressive symptoms are also suggested.
探讨泰国青少年哮喘自我管理行为、哮喘症状控制、健康相关生活质量之间的因果关系及其影响因素。
采用便利抽样法进行横断面研究。最终纳入了来自泰国曼谷三家三级医院的240对青少年-照顾者二元组。在2020年11月至2021年7月期间，采用访谈和自填问卷的方式评估健康相关生活质量、哮喘症状控制、哮喘自我管理行为、健康素养、抑郁、合并症、家庭支持、同伴支持、家庭环境管理以及与医疗服务提供者的关系。提出了一个基于修订后的自我和家庭管理框架的假设模型。采用描述性统计和路径分析对数据进行分析。
结果表明，所提出的模型与实证数据拟合良好，解释了健康相关生活质量67.2%的变异。抑郁和哮喘症状控制直接影响生活质量（分别为β = -0.132，P < 0.05；β = 0.740，P < 0.05），而哮喘自我管理行为则没有。抑郁和哮喘自我管理行为均通过哮喘症状控制对生活质量产生间接影响（分别为β = -0.382，P < 0.05；β = 0.225，P < 0.05）。健康素养（β = 0.343，P < 0.05）、家庭支持（β = 0.167，P < 0.05）、同伴支持（β = 0.163，P < 0.05）以及与医疗服务提供者的关系（β = 0.181，P < 0.05）也对哮喘自我管理行为有直接影响。
研究结果证实了哮喘症状控制、自我管理行为、抑郁和健康相关生活质量之间的因果关系。还发现健康素养、家庭和同伴的支持以及与医疗服务提供者的关系会影响哮喘自我管理行为。为实现有效的哮喘控制和良好的生活质量，应制定针对泰国青少年的促进哮喘自我管理的护理干预措施。还建议对抑郁症状进行早期检测和干预。
