Estudio de las expectativas de autoeficacia en el control del asma en población pediátrica

Résumé

Aims: Asthma, as a chronic disease with high prevalence at pediatric age, is normally associated to deficient control and self-management, which negatively affect the infants and their families’ quality of life. In order to achieve the control of asthma, it is paramount to develop and apply self-management education programs, specifically designed for children and their families. Although cognitive variables, such as self-efficacy, facilitate the involvement of the patients and their caregivers in self-management, it is unknown how they relate to asthma control. The dual goal of this study was: 1) to examine the association between self-efficacy and asthma control, including the complex dimensions that configure this control (symptoms, lung function, inflammation and quality of life); 2) to analyse possible risk factors that may influence the level of self-efficacy in asthma management. Methods: A sample of 176 asthma patients with ages comprised between 6 and 14 years was used. Three levels of self-efficacy (low, medium and high) were established to compare the degree of asthma control according to GINA classification and control dimensions: symptoms (CAN, number of exacerbations, emergency department visits, hospitalisations and days of school absenteeism), lung function (FEV1 and FEF25-75%), inflammation (ONe) and quality of life (PAQLQ and PACQLQ). Furthermore, the influence of sociodemographic and clinical variables and asthma knowledge in the level of children´s self-efficacy has been analysed. Results: Self-efficacy is associated with the degree of GINA control and it is closely related to the quality of life of children and their caregivers. Self-efficacy is also related to other control parameters, such as the number of asthma exacerbations, FEV1 and ONe. The protective factors for high self-efficacy are gender, age, the type of centre where asthma is monitored and the birth-order among siblings. In this way, the oldest first-born girls who is treated in primary care units are prone to develop a greater self-efficacy, while mothers who are housewives or have unqualified professions, have an average level of asthma understanding and perform the primary caregiver role, act as risk factors for low self-efficacy. Conclusions: The level of self-efficacy in children with asthma is associated with control dimensions and is determined by the influence of sociodemographic and clinical variables and by the level of the caregiver´s knowledge about asthma. Self-efficacy can be used to design more effective and efficient self-management plans to achieve and maintain asthma control and to improve the quality of life of the infants and their families.