Parents Of Asthmatic Children Research Articles

Human–Environment Interactions and Environmental Justice: How Do Diverse Parents of Asthmatic Children Minimize Hazards?

While environmental justice researchers have established enduring linkages between environmental hazards and poor populations, little is known about the human–environment interactions of urbanites of varying socioenvironmental positions. To investigate how humans interact with differentially polluted urban environments, 53 interviews with parents of asthmatic children living in the central city and the suburbs were conducted. Parents used four techniques to minimize the impact of hazards on their asthmatic child: modify the child's activities; modify home environment; move to another home; and collective action. With its focus on interactions between people and their environments, this study reveals micro-scale hazards and lack of control over the ambient environment as additional dimensions of environmental injustice.

Highlights in this issue

The prevalence of smoking among pregnant women is decreasing but there seems to be a tendency of increased alcohol consumption during pregnancy. While the fetal alcohol syndrome (FAS) is rare, fetal alcohol spectrum disorders (FASD) were found to occur at a rate of 3.5% in an Italian affluent community. See commentary by Ulf Eriksson and the article by Taisto Sarkola and collaborators, who report about child maltreatment in connection to parental alcohol abuse in Finland (Page 1571). The incidence of respiratory distress increases in neonates according to a population study from Switzerland. A doubling of the incidence of respiratory distress occurred from 1974–2004. This was not only due to an increase of surviving preterm infants but also seen among full-term infants. The increase of caesarean sections from 5 to 30% may explain this finding. It is well-established that elective caesarean-section causes a deficient lung liquid absorption due to the lack of the stress of being born naturally. (Page 1577) Probiotics are hype. However, there are few studies showing that the addition of probiotics is of clinical value. In Australia, Colin Binns et al have demonstrated that by giving children milk containing probiotics and prebiotics the incidence of diarrhoea is significantly reduced. (Page 1646). Lilach Singer et al have estimated the use of complementary and alternative medicine by parents of asthmatic children. Surprisingly, they found that the more educated the parents, the more often they seek a rabbi's advice. (Page 1693). Finally, Johanna Edner and collaborators describe an extremely preterm infant, who developed hemophagocytic lymphohistiocytosis and was treated successfully. Although, this is a remarkable medical achievement, some colleagues have expressed concerns about the ethics. The girl is completely blind, probably autistic, and her teeth are black. However, she seems to be happy. My personal view is that an infant, who has started to become conscious, and bonding between the parents and the child has been established, should receive optimal care. This is not the same as with brain damaged neonates, who have never appeared to be conscious. (Page 1703). See my previous editorial (Acta Paediatr 2007;96:327–8).

The characteristics of complementary and alternative medicine use by parents of asthmatic children in Southern Israel

The aim of this study was to estimate the rate and describe the characteristics of complementary and alternative medicine (CAM) use by children with asthma in a paediatric primary care clinic in southern Israel. A cross-sectional study including 252 asthmatic children aged 2-12-years was conducted. Socio-demographic data and asthma history were collected using a telephone questionnaire. Computerized medical records were used to complete the data. Sixteen percent (95% CI 11.5-20.5) of the asthmatic children participating in this study used CAM; most popular were homeopathy (36.6%) and reflexology (14.6%). According to multivariate model, CAM use was more prevalent in families in which fathers had professional training (OR = 4.9, 95% CI 1.82-13.02, p = 0.002), mothers were employed (OR = 4.1, 95% CI 1.018-16.1, p = 0.047), and origin of maternal grandfathers was European (OR = 4.7, 95% CI 1.86-11.8, p = 0.001). Families who used CAM, also more frequently sought rabbinical advice (OR = 11.9, 95% CI 2.94-47.7, p = 0.001). The prevalence of CAM use found in this study is lower than seen in other Western countries. The 'average family' using CAM to treat its asthmatic child includes an educated father, an employed mother and maternal grandfather from Europe, and would more often seek rabbi's advice.

Actividad física y obesidad en niños con asma

Background: Exercise- induced asthma is frequent among children. Objective: To compare physical activity (PA) and nutritional status in asthmatic (A) versus healthy (H) children. Methods: 81 school children were enrolled (40 A and 41 H). A validated interview with opinions and attitude towards PA was performed to parents in both groups. Nutritional status was classified according to body mass index. Answers were associated with % 2 test. Results: 44% girls, average age 9 years-old. Average hours per week of PA = 2.4 in H and 1.9 in A (p=NS); 88%) of A versus 56%o of H performed < 2 hours per week of PA (p < 0.05). 85%o of A reported frequent symptoms associated to PA. Overweight and obesity were diagnosed in 15/40 A and 11/41 H (p < 0.05). Parents of A thought that PA was dangerous more frequently than parents of H (p < 0.05). Conclusions: Asthmatic children practice less PA than recommendations. There is an association between asthma, obesity and less PA level. Parents of asthmatic children have a negative opinion about PA, explaining the diminished PA performed by this group.

Understanding the concept of 'family history' in black asthmatic children

Background . Despite the fact that 71.6% of children at Chris Hani Baragwanath Hospital (CHBH) Asthma Clinic in Soweto, Johannesburg were found to have one or more positive skin-prick tests (SPTs) to common aero-allergens, they reported a low rate of positive family history for atopic conditions (22.2%). In the past this has minimised the importance of family history in determining the nature of chest symptoms in children in this population group, suggesting that some new environmental exposure, rather than the established familial factor, was creating the allergic milieu in this group. Objective . To determine the predictive value of a family history of symptoms of atopic disease (and allergy) by seeking evidence for this condition in the parents of asthmatic children attending the CHBH Children’s Asthma Clinic, and the reason(s) why a positive family history has been found so seldom in these children. Methods . A random group of parents of the atopic asthmatic children attending the CHBH Children’s Asthma Clinic completed a detailed questionnaire regarding their atopic status. Skin-prick testing was performed. Results . Fifty-four sets of parents and 15 single mothers were studied. Of the 48 atopic children, 37 (77%) had at least 1 parent with a positive SPT. Fifty-five per cent of mothers had a positive SPT, while 48% of fathers had at least 1 positive SPT. Seven of 69 mothers (10%) had a definitive diagnosis of asthma. Of these, 5 (71%) were SPT-positive. Only 3 of the fathers (5.5%) had asthma. All had positive SPTs. However, if all the symptoms suggestive of asthma, namely chronic cough or wheeze, were taken into account, the number of potential atopic fathers and mothers increased to 10 (19%) and 18 (26%) respectively. Conclusion . Simple questioning for family history of atopic disease is therefore not a good predictor of atopy in offspring in this cohort of patients. In order to get maximal yield from this question, parents must rather be asked about specific symptoms suggestive of asthma and/or allergic rhinitis.

Validez en el registro del pico espiratorio máximo de niños asmáticos de la Ciudad de México

To determine the concordance between maximum peak expiratory flow records (PEFr) reported by the parents of asthmatic children and the electronic values stored by the AirWatch device (PEFe). Records of PEF measurements between October 1998 and 1999 were obtained from 42 asthmatic children 5 to 15 years of age recruited at the Hospital Infantil de Mexico Federico Gomez, in Mexico City. Parents recorded the maximum value in the health diary. Spearman correlation was calculated between PEFe and PEFr and a mixed-effects logistic model was used. The correlation between PEFe and PEFr was r=0.96 (p<0.05) among children with a diagnosis of moderate or severe asthma and r=0.40 (p<0.05) among children diagnosed with mild asthma. Follow-up time, asthma severity, gender and age of the child and their interactions were predictors of the differences between PEFe and PEFr. Parents of children with moderate or severe asthma from 6 to 8 years of age report PEF values with greater accuracy during follow-up than others.

The relative contributions of parenting practices in smoking behavior of adolescents with and without asthma

This study tested associations between general parenting dimensions, antismoking socialization practices, and parental smoking status on the one hand and adolescent smoking on the other. These associations were examined within asthmatic adolescents, a group particularly vulnerable to the effects of smoking. Participants were 9,008 young adolescents (aged 11-16 years) from the Netherlands. Associations between factors were tested separately as well as in a combined model using multiple logistic regression analyses. Adolescents with current asthma were more at risk of being current regular smokers. Higher scores on parental involvement and strictness, antismoking socialization, and parental smoking abstinence were associated with lower odds of adolescent smoking. Parents of asthmatic adolescents were more likely to use involvement and strictness. Despite the increased health risks of smoking for people with asthma, parents of asthmatic children were generally not more engaged in antismoking socialization; they just talked more about not smoking. Furthermore, parents of adolescents with asthma were more likely to smoke than were parents of adolescents without asthma. In general, multiple logistic regression analyses showed similar effects for nonasthmatic and asthmatic adolescents. Diagnosis of asthma should be followed by suggestions for parents on how to use antismoking socialization (e.g., setting rules). In addition, the importance of having nonsmoking parents in smoking prevention should be emphasized.

Barriers to Reducing ETS in the Homes of Inner-City Children with Asthma

This study assessed knowledge regarding the harm of environmental tobacco smoke (ETS) exposure and barriers to reducing ETS from the point-of-view of urban parents of asthmatic children. We conducted in-depth interviews with 15 mothers of children with asthma. All parents had good knowledge regarding the harmful effects of ETS. While all children of smoking parents were exposed to ETS, parents described using various strategies to keep ETS away from children. Many parents experienced significant stress in their lives and used smoking to relieve their stress. Barriers to a smoke-free home included stress, addiction, and the use of ineffective strategies to reduce ETS exposure.

Learning Preferences of Caregivers of Asthmatic Children

Purpose of the Study. To determine the learning styles of the caregivers of asthmatic children seen in a pediatric allergy and immunology clinic. Study Population. Parents of asthmatic children seen in a tertiary care pediatric allergy and immunology clinic. Methods. Caregivers completed the Visual-Aural-Read/Write-Kinesthetic (VARK) questionnaire anonymously, and the responses were evaluated on the basis of previously validated scoring instructions. Results. Analysis of 98 respondents showed that 42% had a single learning-modality preference, and the remaining 58% were multimodal learners. Of those who reported a single mode of learning, 61% preferred kinesthetic, 27% preferred reading/writing, and &amp;lt;1% each preferred aural or visual stimuli. Of all 98 caregivers, 82% included kinesthetic as a learning preference, 59% included reading/writing, 50% included aural stimuli, and 41% included visual stimuli. Conclusions. The majority of caregivers preferred the kinesthetic learning method, whether as a single learning preference or in combination with other approaches. Incorporating kinesthetic methods of learning, such as role playing and problem-solving case scenarios, into standardized asthma education curricula may be beneficial to patients and families in terms of understanding and using their regimen. Reviewer Comments. This is a novel study that attempted to improve asthma care by identifying the learning preferences of the caretakers of asthmatic children. Asthma regimens can be complex, and simplification and understanding of these regimens can improve overall adherence. Individual caretakers demonstrate multiple modes of learning preference, and the current educational modules should focus on role playing and other visual modalities to enhance the understanding of the caretakers’ asthma knowledge. Streamlining and improving these educational methods could result in significant improvement in medication adherence, symptom recognition, and appropriate utilization of medical care.

Communication between Educators and Parents of Asthmatic Children Improves Academic and Medical Outcomes in Beijing and Detroit

Communication between Educators and Parents of Asthmatic Children Improves Academic and Medical Outcomes in Beijing and Detroit

Impact of children’s respiratory allergies on caregivers

Despite the great attention that has been paid to HRQoL in children with respiratory allergy, few studies have addressed this aspect in relation to caregivers. The aim of our study was to evaluate the impact of childhood respiratory allergies on caregivers by means of a new method. 119 parents of children suffering from allergies (75 suffering from asthma and 44 suffering from rhinitis) were recruited from three Italian Allergy Units. Parents were asked to complete the Disease Impact On Caregiver (DIOC), a new non disease specific questionnaire, validated on the Italian population. The questionnaire consists of 31 items grouped in four factors (Performance, Personal gratification, Psychophysical endurance, Socio-emotional domain) and covers the life aspects that could be affected by the assistance duties towards an ill family member. Child's asthma resulted to have a worse impact on many aspects of a parents' life than rhinitis. Differences resulted to be statistically significant in 19 aspects out of the 31 assessed. The worse impact of asthma versus rhinitis was confirmed in the following domains: Performance (24.0 +/- 18.2 vs 11.5 +/- 17.8), Personal gratification (26.3 +/- 20.5 vs 12.1 +/- 16.5) and Psychophysical endurance (35.0 +/- 24.8 vs 18.8 +/- 21.7). In the Socio-emotional domain no difference emerged. Compared to parents of rhinitics, parents of asthmatic children appear to be more compromised in their resistance to stress, mood, emotional stability, amount of spare time and leisure activities. Our results suggest the need of giving the due attention to these problems both in clinical practice and in research, in order to avoid possible interferences of the caregiver's distress in the optimization of treatment outcome.

Conhecimentos de pais de crianças asmáticas sobre a doença no momento da admissão a um serviço especializado

To assess asthma related knowledge among parents of asthmatic children at the moment of admission to a specialized service. This was a descriptive study. Parents of 93 asthmatic children (aged from 29-18 yr) were interviewed, at the moment of admission to the Pediatric Pulmonary Outpatient Service of a university hospital, using a questionnaire to assess their asthma related knowledge. The assessment focused on understanding of the nature, prognosis and treatment of asthma. Only the data from parents of 87 children aged from 29 days to 10 years were analyzed. Upon self-assessment, 93.1% of the parents considered their asthma related knowledge insufficient and 88.5% showed interest in obtaining more information. With regard to understanding of the nature, prognosis and treatment of asthma, 96.6% of the parents did not know the role of airway inflammation on synthesis of symptoms and 51.7% believed in a cure for the disease. Among the parents whose children use a home nebulizer, 80.6% used it incorrectly; all of the parents whose children use spray without a spacer were not familiar with the correct inhalation technique; 65.5% of the parents were unaware of the importance of environmental control. Presence of allergic sources and of smokers was found in 77.0% and 68.9% of families respectively. This study shows an insufficient asthma related knowledge among parents of asthmatic children at the moment of admission to a specialized service, characterized by ignorance about the nature and prognosis of the disease, inadequate technique to use inhaled drugs and unawareness of home environmental control.

Asthma treatment needs: A comparison of patients' and health care professionals' perceptions

Background: Patients' perceptions of asthma tend to differ from those of clinicians, who primarily focus on asthma control. Patients' treatment needs and preferences may not be adequately addressed. Objective: The aims of this study were as follows: to provide data on unmet treatment needs and to investigate the main finding of a qualitative study using a questionnaire study. Methods: To assess treatment needs in patients with asthma, focus groups were conducted with patients/parents and clinicians. Based on these results, quantitative surveys of adult patients and parents were performed in the United Kingdom, Germany, and Spain. Results: The UK focus group comprised 11 patients and 8 parents; in Germany, there were 10 patients and 11 parents; in Spain, there were 5 patients and 8 parents. The focus groups showed some differences between clinicians' and patients'/parents' perceptions of treatment. For patients, side effects meant long-term effects (ie, 10–20 years); for clinicians, it meant occasional local problems. The quantitative study comprised 454 participants: 310 adult patients (mean [SD] age, 37.13 [13.12] years) and 142 parents (children's mean [SD] age, 13.98 [1.37] years), plus 2 nonspecified. Some patients reported good asthma control and simultaneously reported frequent exacerbations. Most patients and parents expressed a preference for a simpler regimen using fewer drugs, and most had concerns about their treatment. Although some patients concurred with treatment guidelines, 62.2% tended to rely on reliever medication (ie, bronchodilators). Additionally, 6.9% described their asthma as very well-controlled but reported experiencing asthma symptoms ≥3 days per week. Finally, 1.9% of patients and 2.1% of parents reporting very well-controlled asthma also reported visiting the emergency department or calling a physician for a home visit in the previous 3 months. Conclusions: Asthma patients and parents of asthmatic children had unmet treatment needs and may interpret medical terminology differently than clinicians.

Psychometric Testing and Refinement of the Support Needs Inventory for Parents of Asthmatic Children

This study refined the Support Needs Inventory for Parents of Asthmatic Children (SNIPAC) (Coleman, Maltby, Kristjanson, & Robinson, 2001) to produce a more parsimonious tool to assess the importance and meet the support needs of parents of children with asthma. The original tool was completed by 145 parents of 199 children with asthma, and 74 of these also provided test-retest responses. Internal consistency reliability, construct validity, and stability over time were assessed and refinements were made. Internal consistency reliability of the revised 20-item tool ranged from .77 to .95 for the three subscales of the Parent's Priority Scale (PPS), and .92 for the full PPS. Cronbach's alphas ranged from .74 to .90 for the three subscales of the Parent's Fulfillment Scale (PFS) and was .91 for the full scale. Factor analysis results of the PPS were compatible with the tool's conceptual framework. The revised 20-item tool demonstrated adequate psychometric properties in most areas. This tool may be used for research or clinical screening without imposing undue burden on parents. Further work is required to establish the tool's stability over time.

Knowledge of Skin Test Results Among Parents of Asthmatic Children

Background. The control of asthma in children depends upon several factors, among which is the ability of parents to minimize the exposure of their children to specific allergens. If parents are ill‐informed of the specific allergen sensitivity of their children, they may be unable to take the necessary steps to minimize exposure. Objectives. This study seeks to determine the ability of parents to recall accurately the skin test results for their children. Parents were low income, multicultural, urban residents. Methods. One hundred eligible children with persistent asthma, between 6 and 14 years old, who were skin test positive to dust mite or cockroach allergen, were recruited from a mobile asthma clinic in Los Angeles. Caretakers were interviewed in English or Spanish. From skin test results, sensitivity and specificity of parental recall of test results were computed. The sensitivity and specificity were further stratified on demographic and exposure characteristics. Results. The sensitivity was lowest for dogs (65%), but higher for all other allergens: cat 93%, roach 91%; dust mites 88%, and mold 81%. The range of specificity was from 40% to 83%. Thus, parents were more aware of positive than of negative test results. Stratification did not appreciably change the sensitivity or specificity results. Conclusions. We conclude that the sensitivity and specificity of parental response concerning skin test results is high regardless of cultural, demographic, or exposure levels of the child.

Effects of a Self‐Management Asthma Educational Program in Taiwan Based on PRECEDE‐PROCEED Model for Parents with Asthmatic Children

This study was conducted to evaluate the comparative effectiveness of two different asthma educational programs. One was self‐management asthma education based on the PRECEDE‐PROCEED model to change the influential factors based on a previous need assessment study in Taiwan. The other consisted of regular outpatient asthma education. The purposes were: 1) to compare differences in the asthma knowledge, self‐efficacy, perceived effectiveness, children's cooperation, doctor–patient communication, and self‐management behaviors in the experimental and control groups before education, and 2 weeks, 3 months, and 6 months after education; and 2) to compare differences in drug use, medication utilization, asthma severity, signs/symptoms of asthma, school absenteeism, and exercise ability before education, and 2 weeks, 3 months, and 6 months after education. Parents of asthmatic children were recruited from among outpatients of Chang Gung Children's Hospital, Taoyuan, Taiwan. They were grouped by registration number: those with even numbers were assigned to the experimental group, and those with odd numbers were assigned to the control group. Measurements were collected four times from all parents by means of a questionnaire and chart review. The General Linear Model: Repeat Measurement was used to compare variance differences. The following results were found. 1) Asthma knowledge, self‐efficacy, perceived effectiveness, children's cooperation, and self‐management behaviors significantly improved after the self‐management asthma educational program based on PRECEDE‐PROCEED. Except for perceived effectiveness, all variables still had good effectiveness after 6 months of follow‐up. The experimental group was better than the control group in knowledge, children's cooperation, and self‐management behaviors at the 3‐month follow up, as well as in knowledge and children's cooperation at the 6‐month follow‐up. 2) In both the experimental and control groups, the educational program had a good impact on the health outcome. The average degree of drug use was reduced from 2.7 to 2.1. The number of visits was reduced from 4.75 to 3.55 per half year in the experimental group, and from 5.8 to 3.48 in the control group. The severity of asthma was reduced from 2.7 to 2.1. The signs/symptoms of asthma decreased, school absenteeism was reduced, and exercise ability improved after education at the 6‐month follow‐up in both groups. From the results of this study, the theory‐based educational program had a good effect on self‐management behaviors. From the repeat measurement analysis, we can understand the changing trend of the determinants, behaviors, and outcome indicators. The trend indicated that educational effects were sustained for at least 3 months, with some for 6 months. In order to maintain the educational effects, further specific series of educational programs can be designed based on the patterns of self‐management behavior stages every 6 months. The effects of health outcomes may show significant differences using longer follow‐up times in future clinical trials.

Knowledge, Attitudes, and Behavior of the Parents of Asthmatic Children in Maputo

Asthma is increasing in frequency worldwide. The education of affected children and their parents is fundamental for the management of the disease. The aim of our study was to describe the knowledge, attitudes, and behavior of the parents of asthmatic children. We studied 152 adults accompanying asthmatic children to consultations in the pediatrics department of Maputo Central Hospital (Mozambique). In general, knowledge about asthma was poor: 11% of the adults thought that asthma was contagious and transmitted from person to person, and 4% thought that it was transmitted by contaminated food. More than half the parents thought that the child could not lead a normal life even during the periods between attacks. A large proportion of the parents thought that asthma could be cured by medical treatment in 7% of cases and by alternative treatment in 43% of cases. The precipitating factors were well identified by the adults, but they had an inaccurate perception of the symptoms of an asthma attack. The actions of the various classes of drugs used were poorly understood. Education programs for both the children and their parents should be developed to improve the management of asthmatic children. Surveys of this type facilitate the targeting of such programs.

Psychometric Testing and Refinement of the Support Needs Inventory for Parents of Asthmatic Children

Psychometric Testing and Refinement of the Support Needs Inventory for Parents of Asthmatic Children

Complementary and alternative medicine in children with asthma

The popularity of complementary and alternative medicine (CAM), particularly for chronic conditions such as asthma, is growing rapidly, but little is known about its use in asthmatic children. To evaluate the extent, characteristics, and possible predictors of CAM use in a group of Turkish children with asthma. The parents of asthmatic children were invited to participate in a questionnaire-based survey of 13 worldwide and 5 local methods of CAM. Current asthma treatment, asthma exacerbations, emergency admittances and hospitalizations due to exacerbations, and parental education levels were investigated as predictors that influenced the use of CAM. Of the 304 asthmatic children (mean +/- SEM age, 10.5 +/- 0.2 years; range, 1-16 years), 49% (n = 150) had used some form of CAM previously, and 38% had used CAM within the previous year. The most popular forms of CAM were quail eggs (79%), herbal medicine (31%), Turkish wild honey (26%), speleotherapy (5%), and royal jelly (5%). The respondents learned about CAM through friends (61%), relatives (25%), the media (9%), and physicians (6%). Age, sex, and mother's and father's education levels were insignificant between the groups that used and did not use CAM (P = 0.40, P = 0.18, P = 0.15, and P = 0.09, respectively). The use of regular asthma treatment, the use of inhaled corticosteroids, asthma exacerbations, emergency admittances, and treatment score were significantly high in the CAM group (P = 0.006, P = 0.03, P = 0.008, P = 0.02, and P = 0.02, respectively). A significantly high percentage of respondents in the CAM group had considered using CAM for their child's asthma in the future (P = 0.001). Asthmatic children in whom the disease is not well controlled are more likely to use CAM as complementary therapy.

Educational diagnosis of self-management behaviors of parents with asthmatic children by triangulation based on PRECEDE–PROCEED model in Taiwan

This assessment study is an educational and behavioral diagnosis based on the PRECEDE–PROCEED model which identifies factors (predisposing, enabling, and reinforcing) that must be changed to initiate and sustain the self-management behaviors of parents with asthmatic children (aged 3–14 years) in the largest children’s hospital in northern Taiwan. In the first step, 21 self-management behaviors were induced from the content analysis of qualitative interviews of 16 successful parents. The construct validity of 21 self-management behaviors was established by principal component factor analysis, followed by the rotation method with Varimax and Kaiser normalization. Three extracted components were named: preventing behaviors, managing behaviors, and assessing behaviors. The cumulative percentage of variance of the three factors was 48.2%. In order to identify the determinate factors of self-management behaviors, 133 parents with asthmatic children were recruited and investigated at the outpatient department of the hospital, in the second step. All the instruments were developed based on the results of content analysis from an in-depth interview. The results indicated that the self-management behaviors of this group were middle level. Stepwise multiple regression was used to analyze the predicted rate of self-management behaviors by 12 educational factors. The results indicate that self-efficacy, perceived effectiveness, and children’s cooperation can explain 50.2% of the variance in the self-management behaviors. The determinate factors of preventive behaviors were self-efficacy, perceived effectiveness, and children’s cooperation with R 2=0.448. The determinate factor of managing behaviors was perceived effectiveness with R 2=0.262. The determinate factors of assessing behaviors were perceived severity, knowledge, self-efficacy, and perceived effectiveness with R 2=0.311. These results suggest the direction of a self-management education program for different parents of asthmatic children with poor management skills. Future research should be conducted to evaluate the effectiveness of treatment by a more specific self-management education program, which focuses on increasing self-efficacy and perceived effectiveness.