Educational diagnosis of self-management behaviors of parents with asthmatic children by triangulation based on PRECEDE±PROCEED model in Taiwan Li-Chi Chiang a,* , Jing-Long Huang b , Chang-Ming Lu c a Department of Nursing, Hung-Kuang Institute of Technology, Taichung, Taiwan, ROC b Division of Allergy, Asthma and Rheumatology, Chang-Gung Children's Hospital, Taipei, Taiwan, ROC c Department of Health Education, National Taiwan Normal University, Taipei, Taiwan, ROC Received 4 September 2001; received in revised form 8 January 2002; accepted 11 January 2002 Abstract This assessment study is an educational and behavioral diagnosis based on the PRECEDE±PROCEED model which identi®es factors (predisposing, enabling, and reinforcing) that must be changed to initiate and sustain the self-management behaviors of parents with asthmatic children (aged 3±14 years) in the largest children's hospital in northern Taiwan. In the ®rst step, 21 self-management behaviors were induced from the content analysis of qualitative interviews of 16 successful parents. The construct validity of 21 self-management behaviors was established by principal component factor analysis, followed by the rotation method with Varimax and Kaiser normalization. Three extracted components were named: preventing behaviors, managing behaviors, and assessing behaviors. The cumulative percentage of variance of the three factors was 48.2%. In order to identify the determinate factors of self-management behaviors, 133 parents with asthmatic children were recruited and investigated at the outpatient department of the hospital, in the second step. All the instruments were developed based on the results of content analysis from an in-depth interview. The results indicated that the self-management behaviors of this group were middle level. Stepwise multiple regression was used to analyze the predicted rate of self-management behaviors by 12 educational factors. The results indicate that self-ef®cacy, perceived effectiveness, and children's cooperation can explain 50.2% of the variance in the self-management behaviors. The determinate factors of preventive behaviors were self-ef®cacy, perceived effectiveness, and children's cooperation with R 2  0:448. The determinate factor of managing behaviors was perceived effectiveness with R 2  0:262. The determinate factors of assessing behaviors were perceived severity, knowledge, self-ef®cacy, and perceived effectiveness with R 2  0:311. These results suggest the direction of a self-management education program for different parents of asthmatic children with poor management skills. Future research should be conducted to evaluate the effectiveness of treatment by a more speci®c self-management education program, which focuses on increasing self- ef®cacy and perceived effectiveness. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Self-management; Parents with asthmatic children; PRECEDE±PROCEED; Self-ef®cacy; Perceived effectiveness 1. Introduction Asthma is one of the most common chronic health problems of children in Taiwan. Due to the prevalence of this disease, hospital admissions rates have risen worldwide in the recent years [1,2]. A longitudinal study has indicated that the incidence of school-age asthma cases has increased eight times during the past 20 years in Taiwan [3,4]. The percentage of severe asthma cases has also increased from 8 to 20%, according to one recent hospital-based study [3,5]. The abrupt and recurrent signs/symptoms of asthma are child absenteeism from school, poor academic performance, and psychosocial adaptation problems [6,7]. According to the ®ndings of one survey in Taiwan, one-third of school- aged asthma children have some psychosocial disturbances [8]. The treatment of asthma is not only a pharmacological control problem, but also a self-management through health education problem [9±11]. Successful self-management can reduce asthma attacks and the mortality rate [12]. Miller and Wood emphasized that an effective educational program must include families [14]. The onset of asthma in most children occurs under the age of 5 years, so the parents take the majority of responsibility for managing all of the health Patient Education and Counseling 49 (2003) 19±25 * Corresponding author. Present address: 34 Chung-Chie Road, Sha-Lu, Taichung Hsien 433, Taiwan, ROC. Tel.: 886-4-26318652x3032; fax: 886-4-26310776. E-mail address: lichi514@seed.net.tw (L.-C. Chiang). 0738-3991/02/$ ± see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0738-3991(02)00037-X