Asthma morbidity in adolescents often results from poor or inadequate asthma self-management. Rhee and coworkers explored barriers to self-management perceived by adolescents, and examined the associations between barriers and psychosocial factors including knowledge, attitude, and self-efficacy. The study included a total of 126 adolescents with asthma (13-20 years), representing diverse race/ethnicity groups with a wide range of socioeconomic status. Self-reported data were analyzed using descriptive statistics, factor analysis, and hierarchical regression. The most frequently endorsed barrier (63%) was adolescents' unwillingness to give up "the things the doctors say I have to give up," followed by difficulty in remembering to take care of their asthma (53%), and "trying to forget" that they have asthma (50%). Psychosocial factors accounted for 32% of the variance in total barrier perceptions. Factor analysis revealed barriers in four domains including: (a) negativity toward providers and the medication regimen; (b) cognitive difficulty; (c) peer/family influence; and (d) denial. Self-efficacy was found to be the most influential factor that showed strong negative associations with all four barrier subscales independent of the levels of asthma control and sociodemographic characteristics. Poor attitudes toward asthma were also associated with barriers of cognitive difficulty and social influence after adjusting for other factors. Males consistently reported higher total barriers and barriers of negativity, social influence, and denial. The gender differences were not explained by psychosocial and sociodemographic factors.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that psychosocial factors are strong predictors of barriers to self-management in adolescents. Promoting self-efficacy may be beneficial in addressing the barriers.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Learning and consistently performing self-management skills can make be significant in the control of your asthma. However, you must not only develop and refine these skills, but you must continue to perform them as long as necessary. It is only through such repeated performance that you can develop self-efficacy with respect to confidence that you can manage your asthma over time and across settings.

H Rhee et al. Barriers to asthma self-management in adolescents: Relationships to psychosocial factors. Pediatric Pulmonology, January 13, 2009.