Living with and managing a chronic disease: Use of a diary in asthma management.

Abstract

The aims of the study were to identify personal and clinical characteristics associated with the completion of an asthma diary and assess the effect of the use of a diary in the management of asthma over time. Three sources of data were used in the study. Longitudinal quantitative survey data (baseline and two follow-up points), asthma diary data, and qualitative data collected from one focus group and 21 in-depth interviews. A randomized control trial design allowed for the examination of differences between the treatment and control groups over time. Descriptive statistics, logistic regression and hierarchical linear modeling (HLM) were performed to examine the use and completion of the diary and changes in outcomes over time. Participants in the study were women 18 years of age and older with a diagnosis of asthma. Women were recruited from the UM Health System over the study period. Participants with mild intermittent asthma were found to be more likely to begin use of the asthma diary for any amount of time when compared to women with more persistent or severe asthma. However, participants with more severe asthma were more likely to complete the diary for a 6-week period of time when compared to those with milder asthma. Characteristics associated with diary completion included older age, higher educational level, having a history of smoking, and report of co-morbidities. No differences between the treatment group participants completing the diary and those who did not were found across time. Women in the treatment group who completed the diary had significantly higher levels of self-efficacy (p<0.01) and lower rates of unscheduled physician visits (p<0.05) over time compared to those who did not complete the diary. No significant changes in self-regulation or quality of life across time were found between the groups. Results suggest health clinicians and researchers should carefully consider who should be assigned a health diary in asthma management and the support needed to begin its use or use of the diary over time. By documenting daily asthma experiences participants may became more aware of asthma management needs therefore better able to identify and manage their asthma.