Stepping stones to adolescent asthma self-management: dealing with ups and downs

Asthma, a serious and increasing public health problem, affects about 4 million adolescents in the U.S. with prevalence as high as 8.4% among adolescents aged 11-21. The underlying reasons for poorly controlled asthma are complex, and the specific causes of differences in asthma management behaviors among adolescents are not yet well understood. This study aimed to elucidate the experiences, behaviors, and processes associated with acquiring asthma self-management behaviors among adolescents.

A constructivist grounded theory design guided data collection and analysis. Nineteen participants were recruited using purposive and theoretical sampling. Data were analyzed using constant comparative methods, including initial, focused, and theoretical coding, to generate a substantive theory grounded in participants' experiences.

The substantive theory of "Dealing with Ups and Downs" revealed three major categories: teenage brain, living today, and making decisions. These categories reflected various forms of taking action occurring through nonlinear phases of self-management.

Each category and phase identified in the theory reflects the complex interplay of adolescents' backgrounds, prior experiences, and psychosocial influences within their social environments. Adolescents voiced challenges and asthma self-management strategies such as symptom monitoring, medication adherence, communication, and adapting activities based on asthma status. This substantive theory offers valuable insight that can inform future research and practical applications for public health nurses and healthcare providers related to acquiring self-management behaviors.