Behavioral and cognitive processes in the self-management of asthma.

The commonly used research approach to asthma self-management is based on black box theory where emphasis is placed on input (manipulation of independent variables) and output (the assessment of dependent variables). In this paradigm, little attention is paid to the behavioral and cognitive processes that occur between input and output. This paper discusses six processes--goal setting, information collection, information interpretation, decision-making, action, and self-efficacy--that mediate the transition from acquiring self-management skills to their performance over time. Operant learning and social cognitive theory provide the foundation for a process model of self-management. Each process, as well as the interactions of processes, is described by presenting information obtained from direct observation and patient reports gathered over a 40-year period with both children and adults. It illustrates that patients are far more consistent, imaginative, and confident in utilizing self-management skills to manage their asthma than might be expected. The conclusion is that in the majority of cases the combination of factors--unknown physiological changes, potent asthma medications, and the sustained performance of self-management skills--results in remission of asthma symptoms.