Adolescent Self-management Research Articles

"While Everyone Else was Doing Sports, I Used to Sit on the Sidelines." How Do Adolescents Manage Their Asthma?: A Qualitative Study.

Effective asthma management is a necessity for the control and optimal outcomes of the condition. A number of factors may either facilitate or act as barriers to the management of asthma in adolescents. The objective of this study was to assess the feelings, thoughts, and behaviors of adolescents diagnosed with asthma regarding the management of their condition. This exploratory qualitative study was conducted using semi-structured, in-depth interviews with 12 adolescents aged 12-18 years who were followed up with a diagnosis of asthma at a university hospital pediatric allergy clinic between October 15 October 2023, and December 15 December 2023. The study was written using the COREQ checklist. Three main themes were identified in this study: (1) facilitators, (2) barriers, and (3) information. Adolescents reported that they needed more information about medication use and asthma disease to manage asthma. Asthma control ability, positive beliefs, and supportive relationships were facilitators of asthma management. However, poor asthma control, negative beliefs, lack of support, poor communication, and asthma-related stigma were identified as barriers to asthma self-management. Adolescents had information needs in asthma management. This study highlights that barriers to asthma self-management in adolescents are much greater than the facilitators. For adolescents to manage their asthma well, their information needs must be met. Therefore, pediatric nurses should prepare individualized training to meet the specific needs of adolescents.

A smartphone app for preschool wheezing and reliability of medical history collection

BackgroundThe use of mobile applications helps improving self-management in adolescents with asthma. However, no evidence is available for children with preschool wheezing. In addition, we have no data on the reliability of medical history collected at visits. The first aim was to assess the feasibility of a smartphone app in the management of preschool wheezing; secondly we aimed to evaluate the reliability of anamnestic data collected during face-to-face medical interviews.MethodsChildren with recurrent wheezing, age between 25 and 72 months, were randomly assigned to the intervention group, provided with a smartphone app for symptoms monitoring and asthma attack treatment, or to the control group, with a written action plan. At follow-up medical history was collected and the asthma control test and a clinical questionnaire were completed. App acceptability was also explored. Respiratory symptoms, medication and utilization of healthcare resources were collected. Plus, medical information obtained from the paper questionnaires was compared with data daily recorded by the app.ResultsWe enrolled 85 preschool children with recurrent wheezing: 43 assigned to the intervention and 42 to the control group. The average (SD) adherence to e-Diary compilation was 60 (15)%. The acceptance and usability of the intervention was favorable as 70% and 93% of participants in the intervention arm described the app as ‘’simple and intuitive’’ at Visit1 (after 3 months from enrollement) and Visit2 (3 months later than Visit1), respectively and 95% and 98% found it useful in symptoms management. There were no significant differences between the two groups in clinical outcomes. At Visit1, the cACT median score (IQR) was 23,5 (21–25) for the control group (42 patients) and 23 (21–24) for the intervention group (43 patients). At Visit2 (41 controls and 42 in the intervention group) it was 25 (24–25) and 24 (24–25), respectively. Secondary analysis of data from the intervention group showed higher incidence of daily symptoms recorded by the app in comparison with the paper questionnaire, suggesting that collection of retrospective medical history may not be completely reliable.ConclusionsThe smartphone app is usable and acceptable by families of preschool wheezers. Future controlled trial are needed to prove an impact on clinical outcomes or its efficacy in a telemedicine program. Finally a daily questionnaire could provide physicians with a more reliable clinical picture as reflected better daily asthma symptoms than the written retrospective questionnaire filled at clinical visit.

“Surviving against the odds. The impact of peer support workers on a chronically suicidal adolescent in secure residential youth care: a single case report from the Netherlands”

ABSTRACT Background The use of peer support workers to support suicidal adolescents is underdeveloped. This study focuses on the effects of a one-year intervention with peer support workers on a chronically suicidal adolescent residing in a secure residential youth care facility in the Netherlands. Moreover, we explore the mechanisms that underpin the role of peer support workers in detail. Method This study employed a single case study design. We conducted seven semi-structured interviews with staff, peer support workers, and a chronically suicidal adolescent. The interviews were analysed using a thematic analysis. Results The results indicate that the suicidal tendencies of the adolescent decreased significantly one year after the peer support intervention compared to the initial baseline. Working mechanisms that underpinned the peer support intervention emphasized building meaningful and trust-based relationships, providing recognition and hope, and practical support from a recovery-oriented perspective. Conclusion The results suggest that peer support has a beneficial impact on the adolescent and treatment teams. Peer support workers contribute to a sense of belonging and connection, coping with suicidality, rediscovering life goals, and improving adolescent self-management. Barriers and facilitators to implementing peer support workers are also discussed.

Psychometric Properties of the Revised Self-Efficacy for Diabetes Self-Management Scale among Spanish Children and Adolescents with Type 1 Diabetes.

A longitudinal design was used to examine the psychometric properties of the Self-Efficacy for Diabetes Self-Management (SEDM) for children and adolescents with a diagnosis of type 1 diabetes (T1D). The SEDM was adapted to Spanish and the best factorial solution was selected to test the invariance of the measures of age and gender. Individuals between the ages of 10 and 19 years old with a diagnosis of T1D completed a self-reported questionnaire (167 at Time 1 [mean age = 14.49, SD = 2.76; 56.9% boys] and 122 at Time 2 [mean age = 14.77, SD = 2.58; 56.6% boys]). Two unifactorial solutions were tested. The psychometric properties of the scale were validated. The proposed validation obtained excellent reliability indices (χ2 (26) = 25.59, p > 0.49, RMSEA = 0.00, 95% CI [0.00, 0.07], CFI = 1.00, GFI = 0.96, AGFI = 0.92, TLI = 1.00, and CMIN = 0.98), and it appeared to be invariant for gender and for age groups. The Cronbach's α was 0.85. The test-retest reliability was high (r = 0.69 [p < 0.001]). Convergent, discriminant, and external validity were proven. The nine-item SEDM is a brief measure with satisfactory structural validity. From our knowledge, this study provides the first reliable tool to assess self-efficacy in the management of T1D for Spanish children and adolescents.

Contextual predictors of self-management and independence trajectories in adolescents and young adults with spina bifida.

To examine socioeconomic, condition-related, and neuropsychological predictors of self-management trajectories in adolescents and young adults with spina bifida. In this longitudinal study, participants completed the Adolescent/Young Adult Self-Management and Independence Scale interview. Socioeconomic status (SES), shunt status, lesion level, and executive functioning were assessed. Growth in self-management was estimated using linear mixed-effects models. Participants (n = 99) were aged 18 to 27 years. Approximately half (52.5%) were female and White; 15.2% were Black; and 32.3% Hispanic or Latino. Although none of the predictors were associated with growth in self-management from ages 18 to 27 years (p > 0.05), several factors were associated with the intercept at age 18 years for total self-management. Higher SES at baseline predicted a higher total self-management score at age 18 years (b = 0.03, standard error [SE] = 0.01; p < 0.001). On average, participants at age 18 years with a shunt scored lower than those without a shunt (b = -0.90, SE = 0.32; p = 0.01); those with a thoracic lesion scored lower than those with lower lesion levels (lumbar: b = -1.22, SE = 0.34; sacral: b = -1.20, SE = 0.36; p = 0.001 for both). Better parent-reported and teacher-reported executive functions predicted higher total self-management (metacognitive: b = -0.03, SE = 0.01; behavioral regulation: b = -0.04, SE = 0.01; p < 0.05 for both). On average, all participants improved in self-management over time. Additionally, baseline superiority in self-management for adolescents and young adults without a shunt, less severe lesions, better executive functions, and higher SES persisted over time.

The usability and effectiveness of eHealth and mHealth interventions that support self-management and healthcare transition in adolescents and young adults with chronic disease: A systematic review (Preprint)

The usability and effectiveness of eHealth and mHealth interventions that support self-management and healthcare transition in adolescents and young adults with chronic disease: A systematic review (Preprint)

A qualitative study of motivation to self-management in pediatric diabetes health care consultations with adolescents with type 1 diabetes.

Background. The impact of health care professionals on the motivation for self-management in adolescents with type 1 diabetes has been highlighted as important. It is, however, not well understood how health care practitioners can help increasing motivation to self-management. The aim of the study was to investigate how practitioners can motivate their patients to self-management in consultation and how adolescents with type 1 diabetes experienced that consultation could facilitate motivation to self-management. Methods. The study triangulated participant observations of 11 consultations at a pediatric health care clinic and 10 interviews of the adolescents (age 15-17) about their experiences of consultations. The analysis showed five categories: 1. Consultation dialogue, 2. Roles in treatment, 3. Assuming consultation-facilitated responsibility for self-management, 4. Relationship in treatment, and 5. Consultation context. Results. Overall findings showed that the adolescent’s developmental process of becoming autonomous in relation to self-management was influenced by consultations, and that the need of feeling related was experienced as valued by the adolescents. Conclusions. The feeling of relatedness and development of autonomy were experienced as important for how consultations could facilitate motivation to self-management in 15-17-year-olds and may be fundamental to adolescents’ experience of competence in relation to self-management.

Exploring adolescent and parent perspectives on facilitating health self-management in adolescents with autism spectrum disorder

BackgroundAs many as 95% of individuals across the lifespan with autism spectrum disorder (ASD) have at least one comorbidity. While research focused only on the health of autistic adolescents is limited, we do know that fewer than 14% of these youth receive appropriate transition services to self-manage their health. These limitations have resulted in poor outcomes and premature mortality. Little is known about how parents and their adolescent children address this health burden. ObjectiveThe objective of this study is twofold. First to compare the perceptions of adolescents with ASD and their parents regarding adolescents’ contextual and process variables (depressive symptoms, health knowledge, health communication/planning, self-efficacy, self-determination) and health self-management (HSM) behavior. The second is to examine social facilitation for HSM behaviors in adolescents with ASD and their parents. MethodsIn this community-based study, an online survey was used to compare the perspectives of 40 adolescents with ASD aged 12 to 22 years and their parents on the adolescents’ HSM behaviors. Contextual and process variable measures (PROMISE, Starx, General Self-efficacy Scale, AIR Self-determination Scale, Social Facilitation Questionnaire) were completed by both adolescents (adolescent/pediatric version) and parents (parent version). ResultsDescriptive analysis indicated that parents were teaching self-management to adolescents for monitoring and preventing illness, including medication knowledge and how to talk to their doctor. The largest differences were found between parents’ and adolescents’ perceptions regarding teaching and learning about independent management of existing health conditions. Additionally, adolescents rated their self-efficacy (t (38) = 3.62, p < .001) and self-determination (t (39) = 4.55, p < .001) significantly higher than their parents did. ConclusionsThis study contributes perspectives on what parents and adolescents are doing to enhance adolescents’ health self-management. Adolescence is a developmental period of social facilitation when parents may teach their adolescent children with ASD to self-manage their health and when those adolescents may learn to do so. During this period, providers should offer adequate planning and guided training to support parents and their adolescent children with ASD to improve adolescents’ self-management behaviors and improve health outcomes for this vulnerable population.

Feasibility of mobile phone application “Epilepsy care” for self-management of children and adolescents with epilepsy in Phramongkutklao hospital: A randomized controlled trial

Epilepsy is a common neurological disorder in children. Mobile applications have shown potential in improving self-management for patients with chronic illnesses. To address language barriers, we developed the first Thai version of the “Epilepsy care” mobile application for children and adolescents with epilepsy in Thailand. A prospective, randomized controlled trial with 220 children and adolescents living with epilepsy who had a smartphone and were treated at the pediatric neurology clinic was conducted, with one group using the mobile application and the other receiving standard epilepsy guidance. The primary outcome assessed epilepsy self-management using the Pediatric Epilepsy Self-Management Questionnaire (PEMSQ) in the Thai version, which comprised 27 questions. These questions aimed to determine knowledge, adherence to medications, beliefs about medication efficacy, and barriers to medication adherence. The secondary outcome evaluated seizure frequency at baseline, 3, and 6 months after initiation of an application. Eighty-five participants who were randomized to a mobile application achieved significantly higher PEMSQ scores in the domain of barriers to medication adherence (p < 0.05) at 6 months follow-up. Other domains of PEMSQ showed no statistically significant difference. Baseline median seizure frequencies per month were 7 in the control group and 5.5 in the intervention group. At 3 and 6 months, these decreased significantly to 1.5 and 1 for the control group and 2.5 and 1 for the intervention group (p < 0.001). In addition, the study revealed that 94.9 % of the participants in a mobile application group were highly satisfied with using application. These findings suggest that the mobile application “Epilepsy care” may serve as an effective adjunctive therapy to enhance self-management and seizure control in children and adolescents with epilepsy.

A Nationwide Survey on Patient Empowerment in Pediatric Inflammatory Bowel Disease in Germany.

The incidence/prevalence of pediatric inflammatory bowel disease (IBD) is increasing. IBD places a significant burden on young patients during important developmental stages and affects their families. Children and adolescents with IBD require increased support from health care services. However, little is known about the additional support needed and how to provide it. Therefore, a large survey was conducted with a focus on patient empowerment. For the anonymous survey, called CEDNA, a patient questionnaire for adolescents with IBD and a questionnaire for parents of children and adolescents with IBD were made available throughout Germany (distributed n = 2810). Questions covered various aspects of coping with the disease, utilization of care, use and need of information and communication services, and how information should be provided. From October 2021 to April 2022, 1158 (n = 708 parents (61.1%), n = 450 patients (38.9%)) questionnaires were completed. The results show a deficit in pediatric IBD care and revealed a large gap in knowledge about core IBD topics (e.g., 74.8% of patients feel poorly informed about transition, 62.4% know little about patient organizations and self-help groups, and 54.7% have little information about preventive health measures), indicating a low level of health literacy among affected children and adolescents. Pediatric IBD poses significant challenges for patients, their families, and healthcare teams. By empowering patients and families, and providing targeted information and communication tailored to the age of the child or adolescent and the needs of the parents, care can be improved and better adapted to the needs of patients. Actions would include providing quality information online through scientific societies and patient organizations and facilitating self-management in adolescents.

Diabetes Duration, Perceived Comfort with Self-Management and Glycaemic Control in Adolescents with Type 1 Diabetes: A Cross-Sectional Study.

Evidence is lacking on whether diabetes duration is associated with type 1 diabetes (T1D) self-management during late adolescence before transfer from paediatric to adult care. We examined associations of diabetes duration with dimensions of perceived comfort with diabetes self-management (self-efficacy, transition readiness, diabetes distress) and glycaemic control in late adolescence. Using a cross-sectional design, we conducted a secondary analysis of baseline data of adolescents (ages 16-17 years) with T1D followed at paediatric diabetes academic hospitals in Montreal and enrolled in the Group Education Trial to Improve Transition (GET-IT-T1D). Participants completed validated questionnaires on self-efficacy (Self-Efficacy for Diabetes Self-Management Measure [SEDM], score 1 to 10), diabetes distress and transition readiness, as well as a haemoglobin (HbA1c) capillary blood test. Our primary outcome was self-efficacy. We examined associations of diabetes duration with self-efficacy, diabetes distress, transition readiness and HbA1c using linear and logistic regression models adjusted for sex, socioeconomic status, insulin pump use, glucose sensor use, and psychiatric comorbidity. Of 203 adolescents with T1D, mean diabetes duration (SD) was 7.57 (4.44) years. Mean SEDM score was 6.83 (SD 1.62). Diabetes duration was not associated with self-efficacy, diabetes distress or transition readiness. Each additional year of diabetes duration was associated with 0.11% (95% CI, 0.05 to 0.16) higher HbA1c. Whereas diabetes duration is not associated with dimensions of perceived comfort with diabetes self-management, adolescents with longer diabetes duration are at risk for higher HbA1c and may need additional support to improve glycaemic control before transition to adult care.

502 A pilot feasibility trial to evaluate a tele-coaching intervention to improve self-management in adolescents and young adults with cystic fibrosis

502 A pilot feasibility trial to evaluate a tele-coaching intervention to improve self-management in adolescents and young adults with cystic fibrosis

Behavioral Dilemmas and Support Requirements of Self-Management for Chinese Adolescents with Epilepsy During Transition Readiness: A Mixed-Methods Study.

The study aimed to describe and explore the behavioral dilemmas and support-requirement characteristics of self-management for epileptic adolescents during transition readiness. A convergent mixed-methods study was conducted. Patients (N=654) in eight hospitals in China completed a demographic and disease characteristics questionnaire and measures of epilepsy transition readiness, self-management of epilepsy, and perceived social support, and 17 patients and family care-givers were interviewed simultaneously. Adolescents with epilepsy (AWEs) had low levels of self-management and transition readiness, and moderate levels of social support. Multivariate linear regression showed that age, antiepileptic drug type, comorbidities, family structure, transition readiness, and social support were statistically significant in the regression model (p<0.05). Seven themes emerged in the qualitative analysis related to self-management behavioral dilemmas, and 11 themes emerged for support requirements. The findings from the qualitative and quantitative analyses were combined to create a conceptual model based on the SMART framework and the social cognitive theory. The findings indicate that the state of self-management behaviors of Chinese AWEs is not promising. The influential factors and characteristics are complex and systematic. This study provides insights into the self-management practices of AWEs in China and expands previous self-management and transitional readiness strategies and models.

Improving self-management and diabetes indicators in adolescents with type 1 diabetes through self-care education

ABSTRACT Introduction: The frequency of type 1 diabetes (T1D) as one of the most prevalent endocrine disease in adolescents is increasing globally. This type of diabetes is a progressive degeneration β cells of the islets of Langerhans, which decreases insulin production and causes permanent dependence on insulin injection. It is essential to control diabetes in adolescents and increase awareness about the effective factors (self-care) on the health of adolescents with diabetes. Therefore, this study aimed to evaluate the effect of self-care training intervention on self-management subscales and some diabetes indicators (glycosylated hemoglobin level and fasting blood sugar) in adolescents with T1D. Materials and Methods: This study was conducted on 50 adolescents with T1D, who were referred to the Diabetes Clinic of Golestan Hospital, aged 12 to 18 and selected for this semi-experimental intervention and case–control study by the census. Six one-hour self-help sessions were held for adolescents and their parents. The data collection tools were the Adolescent Self-Care Questionnaire and the Diabetes Index Form for T1D (SMOD-A), used before and three months after the intervention. Chi-square, t-pair tests, and SPSS software version 23 were utilized for statistical data analysis. Results: There was no significant difference between the case and control group regarding gender, age, race, course of the disease, education level, and family history of diabetes (P = 0.771, 0.551, 0.074, and 0.111, respectively). Three months after the intervention, a significant increase was observed in all subscales of self-management and total self-management (P &lt; 001), and a significant decrease was seen in fasting blood sugar (P = 0.001) and glycosylated hemoglobin changes (P = 0.001). Conclusion: Based on the results, training adolescents through a T1D self-care program effectively improved their overall and subscale self-management and reduced fasting glucose and HbA1c levels.

A conceptual framework for asthma self-management in Ecuadorian children and adolescents: A qualitative study

Asthma symptoms can be controlled through proper self-management, medication adherence, and avoidance of triggers, thus avoiding high costs for multiple hospitalizations, emergency or outpatient visits. This article seeks to develop a conceptual framework of the factors that influence asthma self-management in a pediatric population living in the Andean urban area of Cuenca-Ecuador. A phenomenological study was carried out (February-April 2021) in 10 children and adolescents from 7 to 17 years old with asthma attending public and private hospitals. In-depth interviews were applied using open questions created after reviewing the literature. Factors influencing asthma self-management include individual (attitudes, self-education, seeking medical attention, managing crisis triggers) and environmental (health system, school/family support). The interviews were audio-recorded, transcribed, and analyzed by two independent researchers. Our results show that the pediatric population identifies individual and environmental influences that affect asthma self-management, with age and socioeconomic status moderating the influential factors. The participants described the beliefs, attitudes, practices, perceptions, and specific experiences in the family, school, and health system contexts as relevant to comply with asthma self-management. In addition, problems or barriers that hinder the self-management of the disease, mainly related to adherence to treatment, were identified. In conclusion, our analysis highlights the need to empower the pediatric population in asthma self-management. When delivering patient-centered education for effective asthma management, future interventions must consider children´s age and socioeconomic status influences in individual and environmental factors.

A self-management plus mind body intervention for adolescents and young adults with type 2 diabetes: Trial design and methodological report

BackgroundThe onset of type 2 diabetes (T2D) is increasingly common in adolescents and young adults (AYAs). Improving self-management skills and the mental health of this population is important, but understudied. MethodsThe goal of this research was to develop a mind-body intervention which could serve as an adjunctive therapy to support AYAs with T2D (INTEND intervention). Toward that end, we used an iterative process, including use of focus groups, advisory board, and cognitive semi-structured interviews with patients, parents of patient and clinical providers, to understand the gaps in the current information provided to AYAs with T2D. Based on the data gathered from the focus groups and interviews, we enhanced an existing self-management intervention for adults with T2D to include an additional mind body intervention for AYAs with T2D. The INTEND intervention will be piloted in a group of AYAs with T2D. ResultsThis report describes the methodology and design of the InterveNTion for Early oNset type 2 Diabetes (INTEND) study. The details of this single arm pre-post pilot feasibility trial are described. DiscussionIf successful, the INTEND approach has the potential to advance care for vulnerable youth with T2D.

What Are the Various Comprehensive Treatment Models to Improve Self-Efficacy and Self-Management in Adolescents with Diabetes Mellitus? A Scoping Review.

This review aimed to synthesize intervention models involving the role of adolescent and family support as part of comprehensive care to improve self-efficacy and self-management among adolescents with Diabetes Mellitus (DM). A review was conducted to conform to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards. We searched PubMed, Research Gate, Science Direct, Cochrane Library databases, and grey literature. We included articles exploring family intervention models on improving self-efficacy and self-management among adolescents with DM, published from January 1, 2009, to June 30, 2022, and in English. Articles were declared eligible, reviewed critically, and then synthesized narratively. We identified 487 abstracts and title records from the initial search and excluded 409 irrelevant studies. Sixty-six full-text articles were screened, and nine were included in the synthesis. Five articles presented findings from using models focusing on child and adolescent intervention, while in the remaining four articles, the intervention models involved adolescents and their caregivers or parents. Only two models provide comprehensive care that requires collaboration among healthcare providers, patients, and families. Adolescent self-efficacy and self-management schemes as intermediary variables are closely related to everything that can influence health behavior, metabolic control, and quality of life for adolescents, which requires support from a multidisciplinary collaborative team. Excellent comprehensive care team collaboration involving family support is essential to increase the self-efficacy and self-management of adolescents with DM.

Effectiveness of Self Management Technique Intervention in Reducing Addictive Behavior towards Online Games in Adolescents: A Literature Study

Generally, the handling of online game addiction in adolescents is still dominated by conventional counseling interventions, even though along with the rapid development of science there are many alternative interventions that can be applied in handling internet addiction in adolescents. One of them is intervention with self management techniques in recent years began to be widely used for handling online game addiction. Therefore, this study intends to examine and map the use of self management technique interventions in reducing adolescent online game addiction behavior. Through a literature study, the researcher tries to compile, analyze, and present the study material systematically in accordance with the research objectives. The results of the study of the ten articles analyzed, the researcher concluded that efforts to improve self-management in adolescents are effective to suppress and prevent addiction from getting worse, as well as self-management interventions proven effective in reducing online game addiction, and have a positive impact on adolescent mental health. Therefore, school counselors need to learn and practice self-management-based interventions in an effort to deal with online game addiction gradually.

Promoting Self-Management in Adolescents With Celiac Disease: An Occupation-Based Mobile Application

Abstract Date Presented 04/21/2023 Celiac disease is a chronic disease treated by maintaining a lifelong restrictive gluten-free diet. A mobile application, Plan My C-Day, with food-related simulations was developed to promote self-management skills among youth with celiac disease. Primary Author and Speaker: Sonya Meyer Additional Authors and Speakers: Gali Naveh

Causal relationships among self-management behaviors, symptom control, health-related quality of life and the influencing factors among Thai adolescents with asthma

ObjectiveTo examine causal relationships among asthma self-management behaviors, asthma symptom control, health-related quality of life and the influencing factors among Thai adolescents. MethodsA cross-sectional study was conducted using convenience sampling. A total of 240 adolescent-caregiver dyads from three tertiary hospitals in Bangkok, Thailand was ultimately included. Interviews and self-administered questionnaires assessing health-related quality of life, asthma symptom control, asthma self-management behaviors, health literacy, depression, comorbidities, family support, peer support, home environmental management, and relationships with health care providers were administered between November 2020 and July 2021. A hypothesized model based on the revised self- and family-management framework was proposed. Data were analyzed using descriptive statistics and path analysis. ResultsIt was shown that the proposed model was a good fit for the empirical data and accounted for 67.2% of the variance in health-related quality of life. Depression and asthma symptom control directly affected quality of life (β = −0.132, P < 0.05; and β = 0.740, P < 0.05, respectively), while asthma self-management behaviors did not. Both depression and asthma self-management behaviors had indirect effects on the quality of life through asthma symptom control (β = −0.382, P < 0.05; and β = 0.225, P < 0.05, respectively). Health literacy (β = 0.343, P < 0.05), family support (β = 0.167, P < 0.05), peer support (β = 0.163, P < 0.05), and relationships with health care providers (β = 0.181, P < 0.05) also showed direct effects on asthma self-management behaviors. ConclusionThe findings confirmed the causal relationships among asthma symptom control, self-management behaviors, depression and health-related quality of life. Health literacy, support from family and peers, and relationships with health care providers were also found to influence asthma self-management behaviors. To achieve effective asthma control and good quality of life, a nursing intervention promoting asthma self-management for Thai adolescents should be developed. Early detection and intervention of depressive symptoms are also suggested.