Causal relationships among self-management behaviors, symptom control, health-related quality of life and the influencing factors among Thai adolescents with asthma

Objective: To examine causal relationships among asthma self-management behaviors, asthma symptom control, health-related quality of life and the influencing factors among Thai adolescents. Methods: 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. Results: 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 (beta = -0.132, P < 0.05; and b = 0.740, P < 0.05, respectively), while asthma selfmanagement behaviors did not. Both depression and asthma self-management behaviors had indirect effects on the quality of life through asthma symptom control (beta = -0.382, P < 0.05; and beta = 0.225, P < 0.05, respectively). Health literacy (beta = 0.343, P < 0.05), family support (beta = 0.167, P < 0.05), peer support (beta = 0.163, P < 0.05), and relationships with health care providers (beta = 0.181, P < 0.05) also showed direct effects on asthma self-management behaviors. Conclusion: The findings confirmed the causal relationships among asthma symptom control, selfmanagement 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 selfmanagement 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. (c) 2023 The authors. Published by Elsevier B.V. on behalf of the Chinese Nursing Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).