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The perception of quality of life in asthma is associated with variables such as control and adherence to treatment.
•
Perception of quality of life is related to perceived threat of disease, better mental health, and healthy family styles. • Jointly assessing psychological variables and medical indicators is necessary for the improvement of quality of life.
Abstract
Background
Quality of life (QoL) is a widely studied term concerning asthma because it allows the impact of the disease on the patient's life to be assessed through the patient's perception. The study aims to analyze which asthma-related, psychological, and family variables affect the QoL of adolescents with asthma.
Design and methods
This cross-sectional design involves 150 patients diagnosed with asthma aged between 12 and 16 years. The patients' emotional symptomatology, the threat of illness, self-esteem, bonds, quality of life, family, and disease variables were assessed. Statistical analyses were performed using QCA models.
Results
The results indicate that girls have a poorer QoL, and age is negatively associated. QCA models found that the variables that best explained the quality of life of these patients, in the case of the medical indicators, were control, good compliance, shorter diagnosis times, and improvement. Regarding psychological variables: a lower threat of illness, less emotional distress, and better parental mood explained the high QoL.
Conclusions and practical implications
Adolescent QoL is affected by variables related to their asthma that are beyond their control and other psychological and family variables that may increase the perception of their QoL.
Quality of life (QoL) is a widely used concept in the field of health that helps to assess the evolution of the disease and plan therapeutic interventions (
Calidad de vida relacionada con la salud, percepción de enfermedad, felicidad y emociones negativas en pacientes con diagnóstico de artritis reumatoide.
) as an individual's perception of their position in life in the context of the culture and value systems in which they live and about their goals, expectations, standards and concerns.” Health-related quality of life (HRQOL) is an individual's or a group's perceived physical and mental health over time (
In recent years, there has been a greater appreciation of the QoL and its relationship to health, recognizing that health care should focus on patient survival and their QoL (
Calidad de vida relacionada con la salud, percepción de enfermedad, felicidad y emociones negativas en pacientes con diagnóstico de artritis reumatoide.
), with figures indicating that 30% of children and 10% of adults are affected by it. In developed countries, such as Spain, where this study takes place, its rate has probably increased because of industrial development (
In defining the QoL of patients with asthma and their families, the main domains are symptoms and limitations of daily activity or interference in their daily life like sleep disturbance, tiredness during the day, poor concentration, physical activity limitations, absence from school and work, and financial impact on the family (
). The scientific literature has focused on analyzing which variables may influence QoL. In this way, moderate-severe asthma has a great impact on the QoL of patients and their families compared to mild persistent asthma, so appropriate asthma control is necessary (
), as well as modifications of other aspects related to daily functions and activities.
Adolescents with asthma report poorer perceived health, increased interference with physical activity in their daily lives, and greater deterioration in their psychological health relative to their healthy peers (
). Moreover, this difference was exacerbated when adolescents with asthma were symptomatic, as they showed greater physical functioning limitations, with a significant loss of school days and increased psychological disorders (
Gender differences in asthma perception and its impact on quality of life: A post hoc analysis of the PROXIMA (Patient Reported Outcomes and Xolair((R)) In the Management of Asthma) study.
Allergy, Asthma, and Clinical Immunology.2019; 15: 65
On the other hand, it has been reported that the early onset of asthma allows patients to adapt better to the disease, showing better QoL. Therefore, infants and adolescents with long-diagnosed asthma seem to suffer less anxiety and may cope better than those with newly diagnosed asthma (
Age also seems to influence the QoL of these patients: the older they are, the lower their QoL (especially in older children, as they are more capable of detecting interferences in their lives and have a greater burden due to the disease) (
). This relationship was only observed in older children, suggesting that asthma management routines become more complicated as the child acquires greater responsibility for asthma care (
Finally, different variables have been associated with the quality of life of these patients. On the one hand, self-esteem seems to be a significant predictor of perceived QoL in patients with asthma (
). On the other hand, the role of the family or family characteristics can be understood as a determining factor in the QoL of the adolescent with asthma (
). Routines, communication, cohesion, family functioning and coping dynamics are important in establishing a good adjustment of the child to asthma and help to develop better medication adherence, favoring QoL (
The importance of psychological factors in expressing and treating asthma has been well documented, especially the presence of anxious-depressive symptoms (
). Numerous studies indicate that adolescents with asthma experience increased anxiety prevalence rates especially compared to their peers and relate this to the uncertain nature of attacks and symptoms (
In addition, the evidence recognizes that knowledge, attitudes, and beliefs are major determinants of health care, especially treatment adherence. In this line, if a patient has inadequate knowledge, beliefs, tools and confidence in the management of their respiratory disease, this increases the likelihood that they will make poor decisions about their health or cause further delay in seeking/receiving the care they need (
) proposed the common-sense model of illness self-regulation, whose fundamental variable is the representation of disease. The representation of the disease would determine the coping strategies people use to deal with the threat to their health. Thus, this model would propose that, depending on people's coping strategies, their sense of threat (related to identity, control, duration, and consequences) may be affected when adjusting to the illness.
Although previous studies have focused on analyzing these variables by analyzing their contributions using linear methodologies, the present study attempts to analyze all these variables using a combined methodology such as qualitative comparative analysis (QCA).
Given the above, the present study aimed to study the medical indicators and psychological variables that explain the QoL of adolescents with asthma using a combined and non-linear methodology, as other studies have done. Based on this objective, the following hypotheses were proposed: H1: Girls with asthma will present lower scores in QoL than boys; H2. More age in adolescents with asthma will be negatively related to QoL. H3. Adolescents with uncontrolled and more severe asthma will show lower QoL scores. H4. Adolescents with higher visit frequency and a higher number of hospitalizations will be negatively related to the QoL. H5. Adolescents with asthma with a longer time of diagnosis and with higher daily doses will show lower QoL scores. H6. QoL of the adolescent with asthma will be positively associated with self-esteem and healthy family characteristics. And negatively with the threat of illness and emotional distress.
Design and methods
Participants
The participants were a total of 150 adolescents with asthma, aged between 12 and 16 years (M = 13.28; SD = 1.29), with 60.7% being male and 39.3% female. Of the adolescents with asthma, 86% had controlled asthma for at least the last six months, compared to 14% with uncontrolled asthma. Regarding the severity of asthma: 60.4% had persistent-moderate asthma, 32.3% had frequent episodic asthma, 6% had occasional episodic asthma, and 1.3% had severe asthma. For more data on participants and medical indicators, see Table 1.
Table 1Descriptive statistics for medical indicators.
It is a single-pass cross-sectional design. The procedure consisted of identifying all patients with asthma who attended pediatric pulmonology consultations at the hospital. For pediatric patients, the inclusion criteria were that they were aged between 12 and 16 years and had been diagnosed with asthma at least six months ago.
Participants (and their main caregivers) who met these diagnostic criteria and agreed to participate in the study by signing the informed consent form were included. As an exclusion criterion, those patients with asthma who, despite meeting the criteria, had a previously diagnosed physical or psychological pathology, or cognitive difficulties, were excluded. The questionnaires were completed in a single visit, while the adolescents were waiting for routine medical tests such as spirometry or to enter the medical visit with the pulmonologist. Evaluation through the questionnaires was performed on an outpatient basis, i.e., at their medical appointments and not at the time of hospitalization. For more information, see Fig. 1. The present study was approved by the corresponding ethics committee.
Fig. 1Flowchart for selection and participation in the study.
Utilizing an ad hoc questionnaire and together with the pulmonologist, the patients' medical records were reviewed to adequately record the data related to medical issues and their interpretation. The variables were: Asthma control and severity following the GEMA criteria, Spanish Guideline on the Management of Asthma (
). Medical treatment: the type of treatment taken by asthmatic patients was recorded, differentiating between aerosol, nebulized, and pill therapy. Therapeutic compliance: the way to determine therapeutic compliance was based on medical judgment and recorded medical history. Indications: it was recorded whether, at the time of evaluation, treatment was increased, maintained, or reduced. Other: time of diagnosis (months), frequency of visits, and the number of hospital admissions.
Patient variables
Quality of life (QoL): The Chronic Respiratory Questionnaire (CRQ) was used to assess health-related quality of life in its self-administered version translated into Spanish (
): A measure of patients' cognitive and emotional representations of their illness. A new version adapted and validated for adolescents (9-16 years) was used (
Evaluación del bienestar psicológico en estudiantes adolescentes argentinos. [Psychological assessment of psychological well being in Argentine adolescent students].
). The bonding scale assesses the subject's ability to create warm and trusting bonds with others and the subject's empathic and affective capacity. The reliability for this scale was 0.71.
Psychological control and parental mood: This subscale of the Parental Styles questionnaire was used (
). Reliability indices were adequate .86. In the present study's reliability indices were similar: 0.85.
Data analyses
First, descriptive statistics were performed, comparing means according to sex and medical indications through t-tests, and finally, the variables were related utilizing Pearson's correlation. The SPSS v26 statistical program was used for this purpose. Next, the qualitative comparative analysis (QCA) was performed. The QCA allows the quantitative analysis of a small number of cases, using Boolean algebra as a formal tool to identify which of a series of factors (causal conditions) are associated with a given result (result condition). It proposes pathways (which combine a particular interaction between the study variables) to optimize the prediction of the independent variable analyzed (
I’m not good for anything and That’s why I’m stressed: Analysis of the effect of self-efficacy and emotional intelligence on student stress using SEM and QCA.
The results on the health related QoL scale indicated good QoL for these patients. The higher the score, the better the QoL, and as displayed in Fig. 2, all the scores are above 3.5, which seems to indicate that, in general, the adolescents with asthma in the sample would not show major interferences in their daily life concerning their QoL. However, the most affected QoL dimensions were emotional function (experiencing feelings of nervousness and sadness) and the presence of fatigue or tiredness. The rest of the scores obtained in the psychological variables for the study sample can be consulted in Table 2.
Fig. 2Mean quality of life scores in the adolescent bronchial asthma patient.
Regarding the sex of adolescent patients with asthma (Figure 2), girls have obtained lower scores in QoL (t142 = 3.01; p = .003; d = 0.51) especially in the emotional function (t142 = 3.69; p ≤ .001; d = 0.63), the sensation of fatigue (t110 = 2.56; p = .01; d= 0.42) and control of their disease (t109 = 1.96; p = .05; d= 0.36).
Concerning the medical indicators, in general, differences in QoL were observed. Patients with uncontrolled asthma reported a poorer QoL (in the factor linked to the degree of control over their disease) (t142 = 3.41; p ≤ .001; d= 0.82). In turn, those with more frequent medical appointments (quarterly or every four months) (F142 = 24.34; p = .01; η2= 0.09) reported a worse QoL (related to the sensation of dyspnea) compared to patients who attended on a biannual or annual basis. No statistically significant differences were found for the other variables, such as severity, therapeutic compliance, or indications.
Relationship between QoL, medical and psychological variables
Firstly, for the relationships between medical indicators and QoL, the data indicate that the more medication received daily, the lower the QoL scores (worse QoL and higher dyspnea) (r = −0.18; p≤.05) as with the lack of control over the disease (r = −0.25; p≤.01). On the other hand, the frequency of visits was positively related to QoL indicators linked to the sensation of dyspnea (r = 0.25; p≤.01). Thus, patients who attended medical consultations more frequently obtained higher scores in QoL linked to the feeling of dyspnea. The time under treatment and the number of hospitalizations were negatively associated with the QoL indicator of dyspnea (r = −0.21, p≤.05 and r = −0.27, p≤.01, respectively).
Moreover, it was observed that the QoL of patients was lower when associated with greater anxious-depressive symptomatology respectively (r = −0.51; p≤.001)., a greater number of psychopathological difficulties (r = −0.50; p≤.001), and increased perception of illness threat (r = −0.57; p≤.001). Conversely, higher QoL was positively related to higher self-esteem scores (r = 0.35; p≤.001), psychosocial bonds (r = 0.20; p≤.05), and a familiar style where humor predominated. (r = 0.32; p≤.001) and a lower presence of psychological control (r = −0.35; p≤.001).
Finally, the associations between age and QoL were weak and negative with the “fatigue” subscale (r = −0.22; p≤.01), emotional function (r = −0.25; p≤.01) and total QoL (r = −0.22; p≤.01). Thus, age is associated with lower QoL scores.
Quality of life prediction models: QCA models
First, the main descriptors and calibration values for the study variables are presented (Table 3).
Table 3Calibration values for the QCA model for predicting quality of life.
In the analysis of necessity for both the presence and absence (high and low levels) of QoL, there was only one necessary condition for the occurrence or not of the variable “quality of life” of the pediatric patient, since, in this case, the consistency was >0.90 (
), with good therapeutic compliance being the only variable required. In the Sufficiency analysis, the resulting models for the “quality of life” dimension of the pediatric patient offered the results shown in Table 4.
Table 4Sufficiency analysis for high and low levels of quality of life (Medical parameters).
Frequency cut-off: 1;
High levels of QoL Consistency cut-off 0.78
Low levels of QoL Consistency cut-off 0.84
1
2
3
1
2
3
Control
●
○
●
●
Severity
●
●
○
●
●
Therapeutic indications
○
○
○
○
Compliance
●
●
○
●
○
Visits
○
○
Time of diagnosis
○
○
○
●
●
●
Daily doses
○
○
●
Raw coverage
0.23
0.07
0.05
0.52
0.25
0.08
Unique coverage
0.21
0.04
0.01
0.25
0.01
0.02
Consistency
0.77
0.81
0.85
0.77
0.83
0.89
Overall solution consistency
0.80
0.78
Overall solution coverage
0.41
0.59
Note. ● = presence or high levels; ○ = absence or low levels. All paths are consistent because the consistency is above 0.74. Expected vector for high levels of quality of life [47]: 1,0,0,1,0,0,0, Expected vector for low levels of quality of life: 0,1,1,0,1,1,1.
In the prediction of high QoL levels, eight pathways were observed that explained 41% of the cases with high QoL levels (Total Consistency = 0.80; Total Coverage = 0.41). The three most relevant pathways for predicting high QoL levels were: the combination of taking less daily medication, shorter time of diagnosis, good therapeutic compliance, being in time to taper medication, and presenting controlled asthma and with higher severity, asthma and with higher severity, explaining 23% of the high levels (Consistency = 0.77; Raw Coverage = 0.23). The second most relevant pathway was the interaction between shorter time of diagnosis, lower frequency of visits, good therapeutic compliance, being in time to taper medication, but presenting uncontrolled asthma with greater severity, explaining 7% of the high levels (Consistency = 0.81; Raw Coverage = 0.07). Finally, the third combination explained 5% of the high QoL levels, resulting in the combination of shorter time of diagnosis, poor compliance, being in the process of tapering medication, and controlled asthma (Consistency = 0.85; Raw Coverage = 0.05).
Four pathways were observed in predicting low QoL levels, explaining 59% of cases with low QoL levels (Total Consistency = 0.78; Total Coverage = 0.59). The three pathways predicting low QoL levels were: the combination of longer time of diagnosis, lower frequency of visits, and good compliance explaining 52% of the low levels (Consistency=,77; Raw Coverage=,52). The second most relevant pathway was the interaction between lower daily doses of medication, longer time of diagnosis, presenting controlled asthma, and greater severity, explaining 25% of the low levels (Consistency = 0.83; Raw Coverage = 0.25). Finally, the third combination explained 8% of the low QoL levels, resulting in the combination of higher daily medication doses, longer time of diagnosis, poorer compliance, being at the time of tapering medication, and asthma with greater severity (Consistency = 0.89; Raw Coverage = 0.08).
Prediction models through psychological and family variables
In the analysis of necessity for both the presence and absence (high and low levels) of the dependent variable, observing the results gathered, there was a necessary condition for the occurrence or not of the variable “quality of life” of the pediatric patient, with a greater number of psychosocial links being the only necessary variable. The sufficiency analysis results were as follows (Table 5).
Table 5Sufficiency analysis for high and low levels of quality of life (Psychological and familiar variables).
Frequency cut-off: 1
High levels of QoL
Low levels of QoL
Consistency cut-off 0.88
Consistency cut-off 0.91
1
2
3
1
2
3
Threat
○
○
○
●
●
●
Self-esteem
●
●
○
Emotional distress
○
○
●
●
Psychopathological Difficulties
○
○
●
●
Bonds
●
Psychological control
○
○
●
Parental mood
●
●
●
Raw coverage
0.44
0.44
0.43
0.39
0.27
0.20
Unique coverage
0.10
0.06
0.05
0.08
0.03
0.03
Consistency
0.87
0.87
0.87
0.95
0.93
0.95
Overall solution consistency
0.82
0.94
Overall solution coverage
0.70
0.50
Note. ● = presence or high levels; ○ = absence or low levels. All paths are consistent because the consistency is above 0.74. Expected vector for high levels of quality of life (Fiss,2011): 0,1,0,0,1,1,0. Expected vector for low levels of quality of life:0,1,1,0,0,1.
In predicting high levels of QoL, eight pathways were observed that explained 70% of the cases with high levels of QoL (Total Consistency = 0.88; Total Coverage =0.70). The three most relevant pathways predicting high levels were: the combination of a low perceived threat of illness, high self-esteem, low levels of emotional distress, and low psychological control, explaining 44% of cases (Consistency = 0.87; Raw Coverage = 0.44). The second most relevant pathway was the interaction between a low perceived threat of illness, low levels of emotional distress, high psychosocial bonding scores, and high parental mood, explaining 44% of the high levels (Consistency = 0.87; Coverage = 0.44). Finally, the third combination explained 43% of the high QoL levels, resulting in the combination of low perceived illness threat, high self-esteem, and high parental mood (Consistency = 0.87; Raw Coverage = 0.43).
In the prediction of low QoL levels, six pathways were observed that explained 50% of the cases with low levels (Overall Consistency = 0.94; Overall Coverage = 0.50). The three most relevant pathways for predicting low QoL levels were: the combination of a high perceived threat of illness and increased emotional distress, explaining 39% of cases (Consistency = 0.95; Raw Coverage = 0.39). The second most relevant pathway was the interaction between a high perceived threat of illness, low self-esteem, high levels of emotional distress, and low psychological control, explaining 27% of the low levels (Consistency = 0.93; Raw Coverage = 0.27). Finally, the third combination explained 20% of the low levels, resulting in the combination of a high perceived threat of illness, high emotional distress, high psychological control, and high parental mood (Consistency = 0.95; Raw Coverage = 0.20).
Discussion
The aim of the present study was to study the medical indicators and psychological variables that explain the quality of life of adolescents with asthma.
The results found that adolescents had lower scores for QoL, especially in QoL indicators related to fatigue, emotional function, and symptom control, and these data are consistent with previous studies (
). Adolescents with symptomatic asthma report the lowest levels of QoL as these symptoms may interfere significantly with their daily life, which is even more acute when the patients are young.
Hypothesis 1 indicated that adolescent girls with asthma would have higher QoL scores than their male peers. In this study, girls have also been found to perceive their disease as more threatening, i.e., they feel that their asthma puts their physical health at risk. This is consistent with previous studies (
Gender differences in asthma perception and its impact on quality of life: A post hoc analysis of the PROXIMA (Patient Reported Outcomes and Xolair((R)) In the Management of Asthma) study.
Allergy, Asthma, and Clinical Immunology.2019; 15: 65
), which indicated that girls have higher scores for symptoms and emotional impact, as reported in these findings, with girls presenting lower scores for fatigue and emotional function (indicating lower QoL scores).
Secondly, the results found are in line with the approach of H2, as the older adolescents in the sample also obtained lower scores for QoL, as in previous studies (
). Possible explanations for this would include aspects such as the fact that as adolescents grow and mature, they become more aware of the interference of asthma in their daily lives, the burden it generates, and the risks it can pose to their health, and therefore tend to report a lower perceived QoL with age.
Regarding medical indicators, Hypothesis 3 stated that adolescents with uncontrolled and more severe asthma and the presence of uncontrolled allergy would show lower scores for QoL, psychological well-being, and more emotional and behavioral symptoms. The results indicate that adolescents with uncontrolled asthma perceived a worse QoL, consistent with previous studies (
). In the QCA models, the role of control and severity is not observed; it is necessary to analyze them in combination with other variables such as compliance, time to diagnosis, and therapeutic indications to understand their impact on QoL. Although a limitation of the study is that the adolescents had controlled asthma and persistent-moderate severity, so it would be necessary to expand the sample to analyze the influence of these variables on QoL (
On the other hand, collected data support the formulation of H4 and H5. The results show that the number of hospitalizations was negatively associated with QoL. In this case, adolescents who needed to go to the emergency department more often and require hospitalization had a lower QoL, especially related to dyspnea symptoms (
). These same results were repeated for the variable frequency of visits where adolescents with asthma who attended quarterly medical appointments reported lower QoL scores (especially for dyspnea). Previous studies indicate that medical treatment, in terms of either time or number of daily doses as well as treatment adherence, variables that need to be considered to improve adherence and to reduce the risk of exacerbations (
Based on the results found using the QCA models, the most important variables predicting quality of life were found to be time to diagnosis and medical indications. Thus, a shorter time and a reduction in treatment improve the QoL perceived by the adolescent. The results displayed that the high QoL of the patient is mainly explained by short diagnosis times. This may be due to the lack of knowledge about the interference that asthma can generate in their lives and linked to a reduction in medication following medical indications and, in general, to the presentation of controlled asthma. On the other hand, low levels of QoL are explained by a longer time since diagnosis, poorer compliance, and more doses. The contribution of these models is that they demonstrate how the severity and control themselves are not variables that affect QoL to the extent we had previously found. However, when combined with others, such as compliance with treatment, frequency of visits, time since diagnosis, or the number of daily doses, they inform about high and low levels of QoL. In addition, results have been found that are remarkably similar to those indicated in the previous studies discussed in the previous paragraphs. Low levels of anxiety and depression, i.e., a better emotional adjustment to asthma, would occur in cases of controlled asthma, with good therapeutic compliance and a reduction in daily treatment.
Finally, for Hypothesis 6, the results found in the relationships between variables indicate that a patient's high QoL is associated with high scores for self-esteem and healthy family styles (low psychological control and high scores on mood) as indicated by previous studies discussing the protective role of self-esteem (
), family support in promoting better adjustment or adaptation to the disease. Self-esteem is one of the variables that are considered protective because it facilitates adaptation to the disease and reduces the emotional impact (
). Meanwhile, the family system is where attitudes and beliefs are acquired, and as such, many parents convey to their children the belief that if there are no symptoms, there is no asthma, reducing treatment adherence and negatively impacting their QoL. Healthy family styles promote increased self-esteem and therefore also have a positive impact on the QoL of the adolescent with asthma.
On the other hand, there are risk factors such as the presence of psychopathology or the threat of disease that can negatively influence the QoL. The results indicate that a greater presence of emotional (anxiety and depression) and behavioral symptoms, together with a greater sense of illness threat, would be associated with lower levels of QoL. This would be in line with previous studies. In adolescence, mental and physical health are closely related, more than at other stages of the life cycle (
). A chronic condition such as asthma has therefore been associated with more emotional and behavioral problems, with a negative impact on the QoL of adolescents (
). The causes, the expectations of duration, the short- and long-term consequences of their disease and their idea of control influence the level of threat perceived by the adolescents. Previous studies have indicated that when the threat level is high, it is associated with a poorer QoL, because there is such uncertainty about when the next crisis may occur, or what disruptions it may generate in their lives (
The main contributions of this study are that, although the results coincide with those of previous studies, there are no known asthma studies that combine both medical indicators and psychological variables in the same study. Additionally, attempts are usually made to explain the influence of, for instance, control, severity or number of doses on an individual basis following linear methodologies. Something similar occurs with psychological variables. However, in this study the combination of different variables has been analyzed using QCA models to predict high and low levels. In this way, the same result can be reached through different combinations, which allows a deeper understanding of the elements that influence quality of life in asthma.
Practice implications
Results indicate how variables that are more dependent on the disease and less controllable by the adolescent worsen their quality of life. For example, in the case of daily doses, i.e., an increase in medication and needing to take more inhalations may be associated with a poorer quality of life. For healthcare professionals, it may be helpful to concentrate medication at one point in the day, reducing the number of times they must take the medication and thus encouraging treatment adherence.
On the other hand, research reveals that psychological variables influence the quality of life of adolescents with asthma, making the threat of illness one of the main variables in explaining inferior quality of life. One way to reduce this threat is to inform adolescents about their own disease and to provide them with information about its medical treatment and evolution. Other variables, such as emotional distress or improvements in the family nucleus (such as communication and emotional regulation strategies, among others), they can be improved through psychoeducational intervention programs. In this way, multidisciplinary work among health professionals can help increase these adolescents' quality of life, ensuring a better adaptation to their disease.
Limitations
This study is not without limitations, as it would be advisable to extend the sample to a larger number of participants (patients), including a more considerable number of girls to equalize the sample. Other geographical areas could also be included in the study.
Another limitation is that the use of self-reports may sometimes entail social desirability bias, making it advisable to use other objective measures such as spirometry. It would also be interesting to ask other informants (caregivers, health personnel or teachers) to contrast the information gathered. To further verify the impact of the disease, a comparative study could be conducted with adolescents without bronchial asthma, or a longitudinal follow-up of these adolescents to assess whether there are changes in their quality of life.
Conclusions
In conclusion, adolescents' QoL is affected by variables related to their asthma that are beyond their control (such as severity or control) and other psychological and family variables that may increase their perceived QoL. As shown in this study, healthy parenting styles together with high self-esteem and lower levels of anxious-depressive symptomatology can have a positive impact on the quality of life of these adolescents.
Funding (information that explains whether and by whom the research was supported)
Supported by Ayuda predoctoral de la Generalitat Valenciana (ACIF17/389) and by fondo social europeo, (Spain) and Grants to Emerging Research Groups funded by the Generalitat Valenciana, Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital (CIGE2021-119).
Conflicts of interest/Competing interests (include appropriate disclosures)
No conflict the interest.
Availability of data and material (data transparency)
If the database is required, please contact the corresponding author.
Code availability (software application or custom code)
Not applicable.
Authors' contributions
All authors have participated equally in the preparation of the manuscript.
Ethics approval (include appropriate approvals or waivers)
The present study was approved by the UV-INV_ETICA-1,226,194 ethics committee.
Consent to participate (include appropriate statements)
All participants signed the informed consent form and their legal guardians and have been informed of the purpose of the present study.
References
Achstetter L.I.
Schultz K.
Faller H.
Schuler M.
Leventhal’s common-sense model and asthma control: Do illness representations predict success of an asthma rehabilitation?.
Evaluación del bienestar psicológico en estudiantes adolescentes argentinos. [Psychological assessment of psychological well being in Argentine adolescent students].
Gender differences in asthma perception and its impact on quality of life: A post hoc analysis of the PROXIMA (Patient Reported Outcomes and Xolair((R)) In the Management of Asthma) study.
Allergy, Asthma, and Clinical Immunology.2019; 15: 65
I’m not good for anything and That’s why I’m stressed: Analysis of the effect of self-efficacy and emotional intelligence on student stress using SEM and QCA.
Calidad de vida relacionada con la salud, percepción de enfermedad, felicidad y emociones negativas en pacientes con diagnóstico de artritis reumatoide.
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