title: Knowledge, attitude, and self-efficacy in asthma self-management and quality of life.
abstract: BACKGROUND
  Cognitive variables such as knowledge, attitude, and self-efficacy affect asthma patients' abilities to be effective self-managers.
  
  
  OBJECTIVE
  The objective of this cross-sectional analysis was to determine what patient and clinical factors were associated with these cognitive variables and to assess the contributions of these cognitive variables to clinical status.
  
  
  METHODS
  Primary care asthma patients were interviewed using the three domains of the Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire (KASE), as well as established scales to measure social support, depressive symptoms, and ratings of asthma care. Clinical asthma status was measured with the Asthma Quality of Life Questionnaire (AQLQ).
  
  
  RESULTS
  In total, 180 patients were enrolled, with a mean age of 43 years and 84% were women. Knowledge was low, with only 50% of patients answering half or more questions correctly (mean score = 52, possible range 0-100, higher is more knowledge). Attitude toward asthma was generally positive (mean score = 82, possible range 20-100, higher is more positive attitude) and self-efficacy was moderate (mean score = 76, possible range 20-100, higher is more self-efficacy). In separate multivariate analyses, younger age and higher education level were associated with more knowledge (p ≤ .005); more social support, fewer depressive symptoms, and more favorable prior results of asthma care were associated with more positive attitude (p ≤ .05); and favorable prior results, more satisfaction with asthma status, not having stress-related triggers, and not having had a recent emergency department visit for asthma were associated with more self-efficacy (p ≤ .07 for all variables). In additional multivariate analyses, more knowledge (p = .0005), more positive attitude (p = .02), and more self-efficacy (p = .01) were associated with better AQLQ scores.
  
  
  CONCLUSIONS
  Different patient and clinical characteristics were associated with cognitive variables pertinent to self-management. These variables, in turn, were independently associated with asthma status. Thus, although fostering improvement in all three variables would be desirable, interventions that improve any of these variables potentially could be beneficial.
authors.affiliation: Hospital for Special Surgery, New York, New York 10021, USA. mancusoc@hss.edu
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.forename: Wendy
authors.initials: W
authors.lastname: Sayles
authors.forename: John P
authors.initials: JP
authors.lastname: Allegrante
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D012044:Regression Analysis; D012648:Self Care / Q000523:psychology*; D020377:Self Efficacy; D012944:Social Support; D011795:Surveys and Questionnaires
chemical_list: D018927:Anti-Asthmatic Agents