An examination of self-efficacy as a mediator of the relationship between asthma knowledge and self-management in urban adolescents.

Abstract

Uncontrolled asthma disproportionately affects urban adolescents, yet effective self-management in this population is poorly understood, with prior research emphasizing acute symptom management over symptom prevention. While Social Cognitive Theory provides an established framework for chronic disease self-management, its application to adolescent asthma is largely unexplored. In a sample of urban adolescents with poorly controlled asthma, this study aims (1) to characterize asthma-related knowledge, self-efficacy, and two aspects of asthma management - preventive symptom management and acute symptom management and (2) to evaluate the application of Social Cognitive Theory to asthma self-management. Adolescents (n = 377; mean age = 15.7 years; 64% Hispanic; 43% Black/Black American) who were part of a school-based clinical trial to improve asthma outcomes reported their (1) asthma knowledge, (2) self-efficacy in managing asthma, and behaviors (3) to prevent symptoms and (4) to manage acute symptoms. Poisson and linear regression models evaluated demographic differences. Baron and Kenny's causal steps approach assessed if self-efficacy mediated the relationship between asthma knowledge and self-management. Adolescents' mean knowledge score was 78.2% (SD = 8.21). On average, adolescents reported taking 5.8 of 9 prevention steps and 4.9 of 7 management steps. Mean self-efficacy score was 4.5 of 6 (SD = 0.71). Higher asthma knowledge was associated with taking more steps to prevent symptom onset (β = 0.032; 95% CI = 0.004, 0.060; p = 0.026); self-efficacy fully mediated this relationship. Asthma knowledge was not significantly associated with steps to manage acute symptoms. Therefore, mediation was not assessed. Self-efficacy mediated the association between knowledge and preventive symptom management, but not acute symptom management. To improve asthma outcomes among urban adolescents, this study underscores the importance of patient education aiming to enhance asthma knowledge, promote preventive symptom management and acute symptom management strategies, and strengthen adolescents' confidence in managing their disease.