Illness Representations and Self-Management Behaviors of African-American Adolescents with Asthma

Purpose: Many African American adolescents have inadequate self-management behaviors, particularly during middle adolescence (14–16 years of age). Inaccurate beliefs, degree of asthma impairment (well controlled or not well controlled), and gender could influence asthma self-management (symptom management, medication management, and environmental control). The concept of illness representations concept from the common sense self-regulation model provided the framework for this study. This descriptive correlational study explored (1) differences in illness representations (cognitive and emotional) and self-management behaviors by gender, asthma impairment, and gender by asthma impairment of African American adolescents with asthma; and (2) relationships between illness representations and asthma self-management behaviors, gender, and asthma impairment in 133 African American adolescents with asthma.

Methods: Data were collected using the Asthma Control Test, the Illness Perceptions Questionnaire-Revised, and the Asthma Self-Care Practice Instrument. Data were analyzed using ANOVA, MANOVA, Pearson correlations, and multiple regressions.

Results: Findings indicated that females whose asthma was not well controlled had more beliefs about the chronicity of their asthma than those who were well controlled. However, there were no differences in such beliefs among males whose asthma was not well controlled from those who were well controlled. Well controlled adolescents differed from not well controlled adolescents for cognitive representations of cyclic timeline, treatment control, psychological attributes, and consequences as well as for emotional representations. There were no significant differences in the means of the self-management behaviors by gender, by asthma impairment, or by gender by asthma impairment. A significant bivariate relationship was found between representations of identity, consequences, treatment control, and symptom management. In the multiple regression model, representations of treatment control and consequences contributed to variances in symptom management; however, no other representations, gender, or asthma impairment variables were statistically significant. The representations, gender, and asthma impairment variables did not contribute to variances in medication management or environmental control.

Conclusion: Limited studies have been conducted with African American adolescents with asthma; therefore, the findings of this study add to the current knowledge of illness representations, gender, and asthma impairment and their relationship with self-management behaviors, particularly symptom management. The findings of this study also contribute to the literature on  how African American adolescents' self-management behaviors can be improved.