METHODS TO ASSESS ASTHMA SELF-REGULATION IN FEMALE PATIENTS Noreen M. Clark, Molly Z. Gong, Melissa A. Valerio, Jimmy Yu, Xihong Lin, William F. Bria, Timothy B. Johnson Supported by NHLBI Grant HL60884 May 22, 2001

BACKGROUND Recent research suggests that self-regulatory management of asthma follows a sequential path. A four-phase model of self-regulatory control of asthma was assessed in our research, using a qualitative data collection instrument, the Asthma Self-Regulatory Development Interview (ASRDI), used by Zimmerman and colleagues (1997).

PURPOSE The general purpose of the study was to examine whether the ASRDI and four-phase model of self- regulation development used in childhood asthma could be used to assess self-regulation in women with asthma.

AIMS assess asthma self-regulation phases using the ASRDI explore modifying the ASRDI from a qualitative research instrument to a quantitative one evaluate the modified self-regulation assessment scale

SAMPLE Data were collected by telephone from a total of 100 women,18 years of age or older, with a diagnosis of asthma.

6% 5% % % % % >70 years 1% % < 20 1% African - American Other Ethnicity & Age

Annual Household Income & Education < High School Grad 2%

At Home 21% Full Time 52% Part Time 27% Marital & Working Status Single 14% Married 73% Divorced 10% Widowed 3%

Medical Insurance 98% 2%

METHODS 1. Assessed women’s asthma self-regulation phases using the Asthma Self-Regulatory Development Interview (ASRDI)

THE FOUR PHASES OF ASTHMA SELF-REGULATION (Zimmerman et al.) Phase I - Asthma Avoidance Phase II - Asthma Acceptance Phase III - Asthma Compliance Phase IV - Asthma Self-Regulation

Two differences were identified when using ASRDI to measure self- regulation phases in women with asthma versus children with asthma. 1. The four self-regulatory phases are not as sequential in women with asthma as in children with asthma. Over 25% of the women who correctly answered questions related to a higher ASRDI phase did not pass a lower or previous phase.

Examples of Women’s Scores and Phases

2. When using the ASRDI with women versus children, some responses could not be clearly scored as ‘pass’ or ‘fail’ only. Finer levels of classification of ASRDI responses appear to be needed for women with asthma.

Example 1 - First item in Phase I or II

Example 2 - Third item in Phase III

To allow for greater variation in responses, we developed a Numerical Coding and Scoring System. We classified responses into five categories, from the most self-regulatory-like response (5) to the least (1), for each item in each phase.

NUMERICAL CODING & SCORING SYSTEM

Codes - First item in Phase I or II

Codes - Third item in Phase III

DATA ANALYSIS & RESULTS

Factor Analysis

Association between women’s asthma regulation phases and asthma outcomes using the ASRDI scoring system:

Association between women’s asthma regulation phases and asthma outcomes using the new coding system:

Further Quantitative Plan

TENTATIVE CONCLUSIONS 1. The four-phase self-regulation model and asthma self-regulatory development interview items can be adapted to assess self-regulation in women with asthma. 2. The modified quantitative scoring system can be both effective and efficient to assess self-regulation in women with asthma.