Coping with asthma : investigation and intervention using the self-regulation model
Abstract
The Self-Regulation Model (Leventhal, Nerenz & Steele, 1984)
highlights the roles of patients' illness representations, coping, emotional
reactions and appraisal of coping in the progression of chronic disease. This
thesis incorporates previous literature on adherence, panic-fear and selfmanagement
interventions into the model in order to (a) investigate coping
with asthma and (b) develop an intervention aimed at improving asthmatic
control.
New measures of asthmatic control and illness representations of the
consequences of having asthma were developed in order to operationalise the
model.
A cross-sectional study investigated factors influencing asthmatic
control in a sample of 35 adult asthma sufferers recruited through a single
general practice. Coping was poor, adherence being low and less than 50% of
participants reporting current Peak Flow monitoring or medical contact
during the previous 12 months. Good coping appeared to be a response to
poor asthmatic control, rather than prophylactic. Good asthmatic control was
associated with low perceived consequences, recent medical contact, moderate
panic-fear and low general avoidance coping. These results imply that
asthmatic control may be improved by encouraging sufferers to maintain
regular contact with outpatient services and to implement prophylactic
coping.
Since epidemiological and clinical evidence suggested asthmatic
control to be poor in young adults, an intervention was developed to
improve asthmatic control in this group by modifying illness representations,
coping and panic-fear. The intervention was evaluated in a randomised
controlled study of 50 student asthma sufferers identified initially through an
epidemiological screening of 2,979 students. It led to increased Preventer
medication use and Peak Flow monitoring and decreased distress over the
condition. However, the coping process changed and asthmatic control
improved even in the control group, perhaps because self-monitoring of
asthmatic control for the study constituted a change in coping. This
unanticipated result was entirely compatible with the Self-Regulation Model.
The thesis dearly demonstrates value of the Self-Regulation Model in
understanding asthma self-management and developing clinical
interventions.
Type
Thesis, PhD Doctor of Philosophy
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