Self-determination theory and caregiver smoking bans for asthmatic children

描述(由申请人提供)：了解人们从事健康行为的动机是至关重要的，特别是在风险很大的情况下。对于哮喘儿童来说，风险是很大的。哮喘是一种慢性、衰弱、危及生命和代价高昂的疾病，对幼儿、贫困儿童和少数族裔儿童的影响不成比例，他们还必须依赖照顾者来满足他们的卫生保健需求。国家心肺血液研究所(NHLBI)制定了一项战略计划，以解决哮喘患者的健康差距问题。此外，NHBLI协调了一个专家小组，以制定哮喘诊断和管理的国家临床指南。尽管有这些指导方针和治疗方面的进步，但儿童哮喘的发病率和死亡率并没有改善。照顾者的行为可能是一个因素，特别是当它与环境烟草烟雾(ETS)等哮喘触发因素的控制有关时。自我决定理论(SDT)在许多情况下预测健康行为是有用的。根据SDT，当人们感到自主动机(AM)并认为自己有能力(PC)从事特定行为时，他们就会坚持行为。研究人员已经证明，当临床医生支持患者的自主性和能力时(支持自主性；AS)，就会促进行为改变，改善健康结果。然而，到目前为止，SDT的研究重点是为了自己的健康行为改变(例如戒烟)，而为了他人的主要利益的利他行为改变还没有研究。将SDT作为一个与动机访谈(ML)技术相一致的理论框架来考察也是一项新的研究。ML有望帮助照顾者采取利他行为，如ETS控制，并且是更大的随机临床试验(RCT)的干预组件，在RCT中嵌套了这项横断面的相关研究。将对304名参加学校药物治疗计划的持续性哮喘儿童的照顾者进行调查，以解决这些具体目标：1.确定AM和PC在通过照顾者禁烟预测利他主义ETS控制中的作用；2.描述自主性支持(AS)对ML干预组照顾者行为变化的SDT变量的影响；3.确定在接受ML的照顾者中，如果支持直接关系，AS通过AM和PC与ETS控制行为之间的间接关系。研究结果将提高人们对是什么促使照顾者让患有哮喘的孩子远离吸烟的理解。这些信息将有助于指导未来的研究和干预措施，以减轻哮喘负担，特别是对风险最高的家庭。

Description (provided by applicant): It is essential to know what motivates people to engage in health behaviors, especially when risks are great. Risks are great for children with asthma. Asthma is a chronic, debilitating, life-threatening, and costly disorder that disproportionately affects young, poor, and minority children, who must also rely on caregivers to meet their health care needs. The National Heart, Lung and Blood Institute (NHLBI) has created a strategic plan to address health disparities for asthma. In addition, the NHBLI coordinated an expert panel to develop national clinical guidelines for the diagnosis and management of asthma. Despite these guidelines and advances in treatment, morbidity and mortality rates of pediatric asthma are not improving. Caregiver behavior may be a factor, particularly as it pertains to the control of asthma triggers like environmental tobacco smoke (ETS). Self-determination theory (SDT) has been useful in predicting health behaviors in many contexts. According to SDT, persons persist in behaviors when they feel autonomously motivated (AM) for and perceive themselves to be competent (PC) about engaging in a particular behavior. Investigators have demonstrated that when clinicians support patients' autonomy and competence (are autonomy supportive; AS), behavior change is facilitated and health outcomes improved. SDT research to date, however, has focused on health behavior change for one's own sake (e.g. stopping smoking) while altruistic behavior change, for the primary benefit of others, has not been studied. Research to examine SDT as a theoretical framework consistent with the technique of motivational interviewing (Ml) is also new. Ml holds promise in assisting caregivers to adopt altruistic behaviors such as ETS control and is an intervention component of the larger randomized clinical trial (RCT) in which this cross-sectional, correlational study is nested. A sample of 304 caregivers of children with persistent asthma enrolled in a school-based medication program will be surveyed to address these specific aims: 1. To determine the role of AM and PC in predicting altruistic ETS control via caregiver smoking bans; 2. To describe the influence of autonomy support (AS) on SDT variables of behavior change for caregivers in the Ml intervention group; and 3. To determine the indirect relationships between AS, through AM and PC, and ETS control behavior among caregivers receiving Ml, if direct relationships are supported. Study findings will improve understanding of what motivates caregivers to keep smoke away from their children with asthma. This information will help to guide future research and interventions to reduce asthma burden, especially for families at greatest risk.