Qualitative Health Research 23(10) 1419–1429 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732313507376 qhr.sagepub.com Evidence for Practice In this article we describe research that was designed to qualitatively examine the psychological and communica- tion processes that underpin changes in self-care behav- iors during the delivery of an asthma self-care intervention. In the United States, asthma accounts for more than 10 million outpatient visits. It also accounts for 500,000 hos- pitalizations each year (Akinbarni, Moorman, & Lui, 2011). Various researchers have suggested that poor asthma self-care is responsible for many asthma exacer- bations and symptoms (Global Initiative for Asthma, 2009), including up to 75% of hospital admissions (Blainey, Beale, Lomas, & Partridge, 1994) and 75% of deaths from asthma (Burr et al., 1999). Asthma self-care is complex. For it to be effective, patients need to understand the differing roles of asthma medications, use their medication accordingly, monitor asthma symptoms, adjust medication in response to wors- ening symptoms, recognize and avoid factors that trigger their asthma, and communicate well with health care pro- viders to ensure their needs are addressed. However, con- trol of asthma is not always optimal (Rabe et al., 2004). Qualitative researchers have found that people with asthma are unlikely to use monitoring tools or medica- tions if they do not accept that they have asthma (Adams, Pill, & Jones, 1997; Anhoj, Nielsen, & Anhoj, 2004; Ring et al., 2011). Many patients also believe that using moni- toring tools is burdensome and undesirable (Anhoj et al., 2004; Jones, Pill, & Adams, 2000; Pinnock, Slack, Pagliari, Price, & Sheikh, 2007). Some people with asthma are skeptical about the effi- cacy of asthma medications (Choi, Westermann, Sayles, Mancuso, & Charlson, 2008). Others believe they do not need to use medication during times when they do not have symptoms (Goeman, O’Hehir, Jenkins, Scharf, & Douglass, 2007). The cost of treatment (Douglass, Goeman, Yu, & Abramson, 2005) and quality of communication with health care providers (Moffat, Cleland, van der Molen, & Price, 2007) can also be barriers to medication use. In semistruc- tured interviews, patients with poor asthma control reported that they would be reluctant to inform their health care pro- vider that they were not using their preventive asthma med- ication as prescribed, and had negative perceptions of interactions with health care providers (Moffat et al., 2007). A number of interventions to improve asthma self-care have been developed. There is evidence to suggest that such interventions can reduce asthma symptoms and unsched- uled health care use and result in improved patient-reported quality of life (Gibson et al., 2002; Smith, Mugford, Holland, Noble, & Harrison, 2007; Tapp, Lasserson, & Rowe, 2007; Yorke, Flemming, & Shuldham, 2006). However, these interventions have varied widely in their theoretical underpinnings, the psychological processes 507376QHR XX X 10.1177/1049732313507376Qualitative Health ResearchDenford et al. research-article 2013 1 University of Exeter, Exeter, Devon, United Kingdom Corresponding Author: Sarah Denford, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, Devon, United Kingdom. Email: Sarah.denford@pms.ac.uk Processes of Change in an Asthma Self-Care Intervention Sarah Denford 1 , John L. Campbell 1 , Julia Frost 1 , and Colin J. Greaves 1 Abstract In this article, we present a qualitative exploration of the psychological and communication processes that occur within an intervention to improve self-care for people with asthma. In the context of a primary-care-based trial of the intervention, we collected data at three time points for 21 patients, comprising 2 audiotaped consultations (nurse and patient together) and individual semistructured interviews 3 months after the second consultation. Using framework analysis, we identified both psychological processes (illness understanding, affective response to asthma, and reasoned motivation) and patient–provider interactions (active patient involvement and individual tailoring). We use these findings to extend and refine the pre-existing theoretical model of behavior change underpinning the intervention, in particular with relation to patient–provider interaction processes. We conclude that it is important for developers and providers of asthma self-care interventions to attend to the style of delivery as well as the behavior change techniques involved. Keywords asthma; behavior change; education, patient; qualitative analysis, self-care; theory development