Asthma self care efficacy and morbidity in polyclinic outpatients

The new guidelines for the management of asthma require patients to participate in the management of their condition by exercising a high level of decision-making skills in self treatment. We evaluated the self care efficacy and morbidity of 198 asthmatic patients in primary care clinics and examined the factors likely to influence these management outcomes. About 70% of the patients were considered by conventional criteria to have significant morbidity requiring medical supervision. The most significant factors determining morbidity were knowledge of medications and attack management skills. Only a minority of the patients had satisfactory levels of these skills and knowledge. A high level of stigmatization from asthma was generally present among the patients but most of them appeared to possess a high level of self-confidence in the management of their asthma. These factors were also associated with asthma morbidity, but they were as likely to have resulted from morbidity as to have influenced it. The patients' attitude towards medications were mostly negative but their confidence in their doctors and their level of family support were high; none of these factors, however, were associated with morbidity. Attack management skills as a behavioural measure of self care efficacy was not significantly predicted by any of these personal or psychosocial factors. A practical implication of these findings is that asthma self management should focus on developing specific knowledge and skills in the self treatment of asthma attacks.