Asthma Self-Management In African American Emerging Adults

Author

Amy Hall, Wayne State University

Access Type

WSU Access

Date of Award

January 2025

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Nursing

First Advisor

Debra Schutte

Abstract

Advisor: Dr. Debra SchutteMajor: Nursing Degree: Doctor of Philosophy

Rationale: African American emerging adults aged 18-29 have higher asthma-related morbidity and mortality, yet few studies explore asthma self-management in this population.Purpose: Explore several aspects of asthma self-management in African American emerging adults, including COVID-19 vaccine intentions and attitudes using secondary risk theory and relative autonomy for asthma controller medication adherence during and after the completion of a technology-based randomized controlled trial exploring the effect of patient education versus a motivational interviewing-based intervention using a new middle range theory of asthma self-management. Methods: Parallel convergent mixed methods exploration of COVID-19 vaccine attitudes and intentions using surveys and semi-structured interviews; Secondary data analysis to explore predictors of relative autonomy for medication adherence using data collected from a technology-delivered randomized controlled trial aimed at increasing controller medication adherence. Independent Measures: Asthma control, access to healthcare, sociodemographic factors (mixed methods); access to healthcare, sociodemographic factors, level of clinical distress (secondary data analysis) Dependent Measures: Vaccine attitudes and intentions (mixed methods study); relative autonomy, asthma control (secondary data analysis) Analysis: descriptive statistics and thematic analysis (mixed methods study); growth mixture modeling (secondary data analysis) Results: Only half of the participants were highly likely to receive the vaccine and asthma control was related to increased intention to discuss the vaccine with their healthcare providers, but not to receive the vaccine. Interview participants discussed safety and efficacy of the vaccine as important factors when deciding whether to receive the vaccine; however, societal factors were also associated with vaccine intention as participants who were unemployed or felt that they were protecting themselves by staying home were more likely to discuss not needing the vaccine. There were 2 latent classes of relative autonomy. Approximately a third started with low relatively autonomy, did not increase initially, but increased later. The rest of the participants started with high relative autonomy, increased during the intervention period and gradually increased until 6 months before starting to decrease. Membership in the latent class with higher autonomy at baseline was associated with having a primary care provider and an education greater than high school. Logistic regression revealed that lower autonomy at baseline was driven by higher controlled motivation and this controlled motivation decreased over time. Asthma control and medication adherence were not significantly related to latent class membership. Conclusion: Only half of the African American emerging adults with asthma interviewed were highly likely to receive the COVID-19 vaccine with concerns being driven by safety and efficacy of the vaccine. Participants who were unemployed were less likely to say they were highly likely to receive the vaccine and during interviews discussed protecting themselves in other ways, including staying home. Almost 2/3 of the participants in a randomized clinical trial had high relative autonomy at baseline but this relative autonomy was not associated with increased asthma control or medication adherence compared to a group with lower relative autonomy.

Recommended Citation

Hall, Amy, "Asthma Self-Management In African American Emerging Adults" (2025). Wayne State University Dissertations. 4181.
https://digitalcommons.wayne.edu/oa_dissertations/4181