Asthma Self-Management Behaviors and Cognitive Autonomy: Developing an Adolescent Questionnaire - Background and Rationale: Asthma is a substantial public health problem with adolescents having substantial
asthma-related morbidity. Adolescence is a critical phase of transition to adulthood, marked by the
development of cognitive and autonomous skills required to assume greater responsibility for asthma care.
Asthma self-management, which plays a pivotal role in achieving asthma control, is suboptimal among
adolescents. Investigating asthma self-management behavior during this period is particularly crucial, to help
them manage their asthma. Despite this, there is a dearth of validated measures assessing asthma self-
management skills tailored specifically for adolescents. Objective: This study aims to fill this gap by developing
and a reliable and valid asthma self-management questionnaire specifically designed for adolescents with
asthma aged 12-21. Method: The asthma self-management behavior framework will underpin the development
of a novel adolescent self-management questionnaire. We will follow the seven-step approach outlined in
published guidelines to compose and validate questionnaire items. To compose questionnaire items, we will
draw on our team’s prior clinical and research experiences with adolescents, asthma, self-management, and
questionnaire development, including our qualitative study and recently published systematic review. We will
integrate TWU student researchers into all phases of our study throughout the three-year grant period. We will
employ a participatory research approach through active involvement of adolescents with asthma in item
writing. The items face and content validity will be established by having experts (n= 8) assess the clarity and
relevance of questionnaire items with respect to the construct of interest. Cognitive interviews will be conducted
with adolescents with asthma (n=10) to ensure the respondents interpret items in the manner that researchers
intended. We will establish the questionnaire’s psychometric properties by evaluating the questionnaire's
factorial validity using a sample of 300 adolescents (12-21 years old) living with asthma (n=150 each in
exploratory and confirmatory factor analysis) recruited from schools, clinics, and national asthma organizations
using purposive and snowballing techniques. Construct validity will be established by examining its
relationships with relevant variables, such as quality of life and self-efficacy, while questionnaire reliability will
be assessed through internal consistency and test-retest reliability tests. Significance: Adolescents are at a
vulnerable yet opportune stage to learn asthma self-management. The newly developed and validated
questionnaire will have the potential to facilitate assessment and feedback in multidisciplinary clinical settings
and offer a research tool to more accurately understand adolescent asthma self-management.
