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

Abstract

Background: Little 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.

Methods: This 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.

Results: Path 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).

Conclusion: Children'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.

Figure 1

Path analysis for the relationships between health literacy, perceived self-efficacy, satisfaction with shared decision-making, asthma control, and asthma-specific HRQoL. HRQoL: health-related quality of life. Dotted lines indicate statistically non-significant pathways and solid lines indicate statistically significant pathways. Values represent standardized pmeter estimates and t-values (in parentheses). Model fit for the model includes solid lines only: χ² (degrees of freedom): 1036.69 (624), and RMSEA (90% CI): 0.064 (0.057 – 0.071). *p < 0.05; **p < 0.01; ***p < 0.001.