Greater than 50% of the adults with asthma are female, and the prevalence of asthma in women appears to be increasing. Morbidity and mortality rates for this group are significantly higher than rates for men. Recent studies point to unique features in women’s management of asthma potentially attributable to gender. These include, for example, factors associated with hormonal cycles, (e.g. menses, pregnancy, menopause) and social roles (e.g. household tasks exposing one to environmental triggers, care-giving to children and relatives interfering with asthma management etc.).
The Women Breathe Free program aims to provide asthma education to women based upon a model of a successful intervention [link or reference] for women with heart disease shown to improve physical and psychosocial functioning. The Women Breathe Free program and the core principles of the problem solving process, also known as PRIDE, were developed based upon elements of Social Cognitive Theory, particularly principles of Self-Regulation. Research has shown that women managing chronic conditions can internalize and apply the self-regulation processes in effort to change their disease management behavior; further, it has been shown that programs based on these principles have a positive effect on their overall health functioning. Further, a clinical trial [link or reference] conducted by the Center for Managing Chronic Disease at the University of Michigan yielded findings that women randomly assigned to the treatment group or “intervention” exhibited fewer gender-related asthma management problems, higher levels of physical functioning, fewer days of missed work, increased satisfaction with their quality of life, less frequent symptoms, and reduced use of health services when compared to women assigned to the control group who did not receive treatment.
Self-regulatory problem solving process
While engaged in the program, participants are introduced to a self-regulatory problem solving process (PRIDE) designed to increase their ability to engage more effectively in asthma management. Preliminary studies have shown that the problem-solving process based on the self-regulation theory appears to be a useful and effective approach to enhancing self-management skills in adults. All steps of the Women Breathe Free program are carried out within context of the therapeutic plan and partnerships with the women’s clinicians, and are designed to enhance patient-clinician partnership in asthma management.
The initial step in the process is a review of the components of the asthma management recommendations the physician has provided, e.g., use of medications, physical activity guidelines, and avoidance of triggers. Going forward, participants embark upon learning the five elements of PRIDE, each of which reflect the salient processes of self-regulation:
- Problem Identification: Identifying a problem in asthma management
- Researching and observing the current asthma management routine: Observing oneself, one’s environment, and one’ pattern of symptoms to understand the elements of the problem and the way it might be ameliorated.
- Identify a goal: setting an asthma management goal.
- Developing a plan or a strategy to achieve the goal.
- Establishing appropriate reward’s for when goals are reached.
Salient gender related management problems are also addressed. In the WBF intervention, women were asked to focus on such gender-related concerns to better learn the self-regulatory, problem-solving process by examining one aspect of their asthma management, with the goal of eventually applying the process to other dimensions of asthma control.
The complete program workbook is available as a PDF.