Understanding participation in an asthma self-management program.

STUDY OBJECTIVE Asthma education programs improve asthma treatment results significantly. Low participation rate is a recurrent problem that impedes the efficiency of those programs. The purpose of this study was to investigate social cognitive determinants of the intention to participate in an asthma self-management program. DESIGN Structured interview. SETTING Outpatient clinic, University Hospital Gasthuisberg, Leuven, Belgium. PATIENTS One hundred seven asthmatic outpatients (mean age 42 years; 35% male). INTERVENTIONS Patients received a standard explanation about the asthma program, were invited to participate, and were questioned about their beliefs about the program offered. MEASUREMENTS AND RESULTS A social cognitive framework (attitude, social influence, and self-efficacy model) was used to compose a structured interview that was administered to assess the patients' attitude toward the program (perceived benefits), their social influence, and self-efficacy expectations to participate (perceived barriers). Asthma-related health behavior and clinical and demographic characteristics were evaluated by means of questionnaires. Fifty-nine percent of the patients expressed the intention to participate. Logistic regression analysis resulted in a model explaining 72% of the variance of intentions (Nagelkerke R(2) = 0.72). Having few structural barriers to participate was a significant predictor of participation (odds ratio [OR], 12.5; 95% confidence interval, 5.2 to 19.3), next to believing in the personal benefits of the program (OR, 7.6; 95% confidence interval, 2.4 to 12.5), social influence (OR, 3.3; 95% confidence interval, 1.3 to 8.4), and education level (OR, 2.7; 95% confidence interval, 1.3 to 5.6). CONCLUSIONS Recruitment of patients with asthma for an educational program should emphasize personal benefits of the program, should include patients' social network, and should consider the impact of structural barriers on participation behavior.