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.