Exploring factors influencing asthma control and asthma-specific health-related quality of life among children

Abstract

BackgroundLittle is known about factors contributing to children’s asthma control status and health-related quality of life (HRQoL). The study objectives were to assess the relationship between asthma control and asthma-specific HRQoL in asthmatic children, and to examine the extent to which parental health literacy, perceived self-efficacy with patient-physician interaction, and satisfaction with shared decision-making (SDM) contribute to children’s asthma control and asthma-specific HRQoL.MethodsThis cross-sectional study utilized data collected from a sample of asthmatic children (n = 160) aged 8–17 years and their parents (n = 160) who visited a university medical center. Asthma-specific HRQoL was self-reported by children using the National Institutes of Health’s Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Impact Scale. Satisfaction with SDM, perceived self-efficacy with patient-physician interaction, parental health literacy, and asthma control were reported by parents using standardized measures. Structural equation modeling (SEM) was performed to test the hypothesized pathways.ResultsPath analysis revealed that children with better asthma control reported higher asthma-specific HRQoL (β = 0.4, P < 0.001). Parents with higher health literacy and greater perceived self-efficacy with patient-physician interactions were associated with higher satisfaction with SDM (β = 0.38, P < 0.05; β = 0.58, P < 0.001, respectively). Greater satisfaction with SDM was in turn associated with better asthma control (β = −0.26, P < 0.01).ConclusionChildren’s asthma control status influenced their asthma-specific HRQoL. However, parental factors such as perceived self-efficacy with patient-physician interaction and satisfaction with shared decision-making indirectly influenced children’s asthma control status and asthma-specific HRQoL.

Validation and reliability of the scale Self-efficacy and their child's level of asthma control

“…Reinforcing it in parents, guardians, and patients has the potential to improve the capacity of self-management of chronic illnesses, especially childhood asthma (17) . A study carried out in Florida, United States (30) , concluded that parents with a high perceived selfefficacy also showed better results in control parameters of the disease, corroborating the findings of the present study.…”

The Impact of Parent's Health Literacy on Pediatric Asthma Outcomes

“…They found no relationship between parent health literacy and child asthma control or healthcare utilization. 32 Ghandi et al 33 report an indirect relationship only between parent health literacy measured by the s-TOFHLA 34 and child asthma control measured by 10 items. 44 The discrepancy in our findings with these previously reported results may reflect differences in the samples or the measures used to assess health literacy and/or asthma control.…”

“…Lower parent health literacy has been associated with more healthcare utilization by children with asthma in some studies, 29,30 but not in others. 31,32 Two studies examining parent health literacy and child asthma control have disparate findings: one reports an indirect relationship between health literacy and asthma control through satisfaction with shared decision making, 33 while the other found no relationship. 32 This study examines the role of parent health literacy in pediatric asthma health outcomes, including asthma control, healthcare utilization, and school days missed due to asthma.…”

Asthma coalition effects on vulnerable sub groups of children: the most frequent users of health care and the youngest

“…Frequent urgent health care utilization and younger age have been shown to be associated with more disease burden for children with asthma, their families and the health care system [3][4][5][6][7]. High rates of urgent care use for asthma are associated with residing in low income and minority communities [8][9][10].…”