Clark N M, Nothwehr F
University of Michigan School of Public Health, Ann Arbor 48109-2029, USA.
Patient Educ Couns. 1997 Dec;32(1 Suppl):S5-20. doi: 10.1016/s0738-3991(97)00092-x.
Review of eighteen adult self-management education program evaluations comprising clinical trials showed significant achievement in five categories of outcome: (1) asthma knowledge; (2) patient perceptions and psychological status; (3) behavior related to medicine use, delivery devices and environmental triggers; (4) functioning and control of symptoms; and (5) health care use. Not every program achieved in all of these categories, probably because interventions of adequate power to elicit change in one category of outcome were not powerful enough to realize change in another category. An alternative explanation may be that in some studies assessment measures were inadequate. Asthma management by patients is influenced by their social environment and this aspect of control is least well understood. A small qualitative study suggested themes among adult patients that describe intra- and interpersonal factors enabling or hindering self-management including: the ability to acquire information; self-regulation; relations with family, friends and coworkers; and, relationships with clinicians. Research is needed that provides greater understanding of social environments in asthma management, produces standardized measurement tools, and tests more robust and theory-based interventions.
对18项包含临床试验的成人自我管理教育项目评估进行的综述表明，在五类结果方面取得了显著成效：（1）哮喘知识；（2）患者认知和心理状态；（3）与药物使用、给药装置及环境触发因素相关的行为；（4）症状的功能和控制；（5）医疗保健利用。并非每个项目在所有这些类别中都取得了成效，这可能是因为能在某一类结果中引发变化的足够有力的干预措施，在另一类结果中却不足以实现变化。另一种解释可能是，在一些研究中评估措施不够充分。患者对哮喘的管理受其社会环境影响，而这一控制方面最不为人所理解。一项小型定性研究揭示了成年患者中描述促进或阻碍自我管理的内部和人际因素的主题，包括：获取信息的能力；自我调节；与家人、朋友和同事的关系；以及与临床医生的关系。需要开展研究，以更深入了解哮喘管理中的社会环境，开发标准化测量工具，并测试更有力且基于理论的干预措施。
