Abstract
The 2007 U.S. National Institutes of Health EPR-3 guidelines emphasize the importance creating a provider-patient partnership to enable patients/families to monitor and take control of their asthma, so that treatment can be adjusted as needed. However, major shortfalls continue to be reported in provider adherence to EPR-3 guidelines. For providers to be more engaged in asthma management, they need a comprehensive set of resources for measuring self-management effectiveness of asthma, which currently do not exist. In a previously published article in the Journal of Asthma and Allergy, the authors conducted a literature review, to develop a holistic framework for understanding self-management effectiveness of pediatric asthma. The essence of this framework, is that broad socioecological factors can influence self-agency (patient/family activation), to impact self-management effectiveness, in children with asthma. A component of socio-ecological factors of special relevance to providers, would be the quality of provider-patient/family communication on asthma management. Therefore, the framework encompasses three key constructs: (1) Provider-patient/family communication; (2) Patient/family activation; and (3) Self-management effectiveness. This paper conducts an integrative review of the literature, to identify existing, validated measures of the three key constructs, with a view to operationalizing the framework, and discussing its implications for asthma research and practice.
Highlights
Asthma affects over 43 million Americans, and is associated with enormous healthcare expenditures, including an estimated $56 billion per year in direct costs [1,2]
Prior to the development of Patient Activation Measure (PAM), there were limited methods available for assessing different aspects of activation, such as health locus of control, self-efficacy in self-managing behaviors, and readiness to change health-related behaviors; these measures tend to focus on the prediction of a single behavior [56,57,58,59]
PAM, on the other hand, enables assessment of a broad range of elements reflected in patient activation, including the knowledge, skills, beliefs, and behaviors needed to manage a chronic illness
Summary
This paper performs an integrative review of the asthma management literature to address the stated first aim of this paper, i.e., to identify existing, validated measures of the key constructs in the holistic framework for assessing self-management effectiveness in pediatric asthma, with a view to operationalization. Owing to variation in the maturity of the literature streams associated with the measurement of the three key constructs in the framework, a variety of approaches are needed to conduct the integrative review of the literature. The three broad literature streams that need to be reviewed in accordance with the key constructs of the holistic framework are as follows:
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