Quality of Life Research

, Volume 21, Issue 5, pp 747–764 | Cite as

The effectiveness of psychosocial interventions designed to improve health-related quality of life (HRQOL) amongst asthmatic children and their families: a systematic review

  • Sally-Ann ClarkeEmail author
  • Rachel Calam



Asthmatic children are at risk of compromised health-related quality of life (HRQOL) compared with their healthy peers. This systematic review reports the range and effectiveness of psychosocial interventions designed to improve HRQOL amongst asthmatic children, adolescents, and their families.


Data sources included The Cochrane Airways Group Trials Register of trials, PubMed database, and reference lists from review articles.


Eighteen studies of psychosocial interventions were identified. Interventions were designed to improve HRQOL amongst a range of psychosocial, health care, school-related and clinical outcomes, and were delivered in numerous settings and formats. Four studies reported that interventions were effective for significant improvements in child overall HRQOL scores. These include asthma education (n = 2), asthma education plus problem solving (n = 1), and art therapy (n = 1).


Most interventions focussed on the delivery of asthma education to children, with the purpose of improving knowledge about asthma and disease management. There is limited evidence to suggest that interventions currently available are effective for significantly improving HRQOL amongst asthmatic children, adolescents, and their families. Most interventions lacked a theoretical basis and did not focus on family functioning variables. Multi-component interventions that incorporate asthma education along with strategies to assist families with implementing behaviour change towards improved asthma management are required. Future interventions should also attempt to address the wider context of family functioning likely to contribute to the family’s ability to engage in successful asthma management in order to improve HRQOL.


Health-related quality of life (HRQOL) Paediatric Asthma Psychosocial intervention Systematic review 



Health-related quality of life


Randomised controlled trials


The ‘Roaring adventures of Puff’ Asthma Education Programme


The juniper paediatric asthma quality of life questionnaire


The juniper paediatric asthma caregiver quality of life questionnaire


The childhood asthma questionnaires


Pediatric quality of life inventory TM


School care and asthma management project


Social cognitive theory


Pre-disposing, reinforcing, and enabling causes in educational diagnosis and evaluation


Australian indigenous health care workers


Adapted paediatric asthma guidelines


Asthma education workshops


Open airways’ for pre-teens


Peer asthma action


Care coordination


Problem solving skills training


Interactive multi-media program for asthma control and tracking


Follow-up data collection


Socio-economic status


General practitioner


  1. 1.
    Asthma UK. (2010). Where do we stand? Asthma in the UK today. Accessed 19 Nov 2010.
  2. 2.
    Milgrom, H., Bender, B., Ackerson, L., Bowry, P., Smith, B., & Rand, C. (1996). Non-compliance and treatment failure in children with asthma. Journal of Allergy and Clinical Immunology, 98, 1051–1057.PubMedCrossRefGoogle Scholar
  3. 3.
    Gibson, N. A., Ferguson, A. E., Aitchison, T. C., & Paton, J. Y. (1995). Compliance with inhaled asthma medication in pre-school children. Thorax, 50, 1274–1279.PubMedCrossRefGoogle Scholar
  4. 4.
    National Center for Health Statistics. (2007). Summary of health statistics for U.S children: National health interview survey. Hyattsville, MD: U.S. Department of Health and Human Services.Google Scholar
  5. 5.
    Bender, B. (1995). Are asthmatic children educationally handicapped? School Psychology Q, 10, 274–291.CrossRefGoogle Scholar
  6. 6.
    Graetz, B., & Shute, R. (1995). Assessment of peer relationships in children with asthma. Journal of Paediatric Psychology, 20, 205–216.CrossRefGoogle Scholar
  7. 7.
    Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 generic core scales. Health and Quality of Life Outcomes, 5, 43.PubMedCrossRefGoogle Scholar
  8. 8.
    Merikallio, V. J., Mustalahti, K., Remes, S. T., Valovirta, E. J., & Kaila, M. (2005). Comparison of quality of life between asthmatic and healthy school children. Pediatric Allergy & Immunology, 16, 332–340.CrossRefGoogle Scholar
  9. 9.
    Gill, T., & Feinstein, A. (1994). A critical appraisal of the quality of life measurements. JAMA, 27, 619–626.CrossRefGoogle Scholar
  10. 10.
    World Health Organisation. (1948). Constitution of the World Health Organization basic document. Geneva, Switzerland: World Health Organization.Google Scholar
  11. 11.
    Price, M. R., Bratton, D. L., & Klinnert, M. D. (2002). Caregiver negative affect is a primary determinant of caregiver report of pediatric asthma quality of life. Annals of Allergy, Asthma & Immunology, 89, 572–577.CrossRefGoogle Scholar
  12. 12.
    Sawyer, M. G., Spurrier, N., & Kennedy, D. (2001). The relationship between the quality of life of children with asthma and family functioning. Journal of Asthma, 38, 279–284.PubMedCrossRefGoogle Scholar
  13. 13.
    Morawska, A., Stelzer, J., & Burgess, S. (2008). Parenting asthmatic children: Identification of parenting challenges. Journal of Asthma, 45, 465–472.PubMedCrossRefGoogle Scholar
  14. 14.
    Bartlett, S. J., Krishnan, J. A., Riekert, K. A., Butz, A. M., Malveaux, F. J., & Rand, C. S. (2004). Maternal depressive symptoms and adherence to therapy in inner-city children with asthma. Pediatrics, 113, 229–237.PubMedCrossRefGoogle Scholar
  15. 15.
    National Heart Lung and Blood Institute, National Asthma Educations and Prevention Program. Expert Panel Report 3. (2007). Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Institutes of Health. Publication 07–4051.Google Scholar
  16. 16.
    Juniper, E. F., Guyatt, G. H., Feeny, D. H., Ferie, P. J., Griffith, L. E., & Townsend, M. (1996). Measuring quality of life in parents of children with asthma. Quality of Life Research, 5, 27–34.PubMedCrossRefGoogle Scholar
  17. 17.
    Juniper, E. F., Guyatt, G. H., Feeny, D. H., Ferie, P. J., Griffith, L. E., & Townsend, M. (1996). Measuring quality of life in children with asthma. Quality of Life Research, 5, 35–46.PubMedCrossRefGoogle Scholar
  18. 18.
    Juniper, E. F., Guyatt, G. H., Epstein, R. S., Ferrie, P. J., Jaeschke, R., & Hiller, T. K. (1992). Evaluation of impairment of health-related quality of life in asthma: Development of a questionnaire for use in clinical trials. Thorax, 47, 76–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Boyd, L., Lasserson, T. J., McKean, M. C., Gibson, P. G., Ducharme, F. M., & Haby, M. (2009). Interventions for educating children who are at risk of asthma-related emergency department attendance (Review). The Cochrane collaboration. Wiley. []. Accessed 19 Oct 2010.
  20. 20.
    Coffman, J. M., Cabana, M. D., & Yelin, E. H. (2009). Do school based asthma education programmes improve self-management and health outcomes? Pediatrics, 124, 729–742.PubMedCrossRefGoogle Scholar
  21. 21.
    NHS CRD Report No. 5. (2009). [!SSL!/WebHelp/SysRev3.htm] Accessed 1 Oct 2010.
  22. 22.
    Gray, M. (1997). Evidence based healthcare. London: Churchill, Livingstone.Google Scholar
  23. 23.
    Eiser, C., & Morse, R. (2001). Quality-of-life measure in chronic diseases in childhood. Health Technology Assessments, 5, 1–157.Google Scholar
  24. 24.
    Chalmers, I., Adams, M., Dickersin, K., Hetherington, J., Tarnow-Mordi, W., Meinert, C., et al. (1990). A cohort study of summary reports of controlled trials. JAMA, 9(263), 1401–1405.CrossRefGoogle Scholar
  25. 25.
    McGhan, S., Wong, E., Sharpe, H., Hessel, P., Mandhane, P., Boechler, V., et al. (2010). A children’s asthma education program: Roaring adventures of puff (RAP), improves quality of life. Canadian Respiratory Journal, 17, 67–73.PubMedGoogle Scholar
  26. 26.
    McGhan, S. L., Wong, E., Wells, H. M., Jhangri, G. S., Michaelchuk, D. R., Boechler, V. L., et al. (2003). Evaluation of an education program for elementary school children with asthma. Journal of Asthma, 40, 523–533.CrossRefGoogle Scholar
  27. 27.
    Cicutto, L., Murphy, S., Coutts, D., O’Rourke, J., Lang, G., Chapman, C., et al. (2005). Breaking the access barrier. Evaluating an asthma centres efforts to provide education to children with asthma in schools. Chest, 128, 1928–1935.PubMedCrossRefGoogle Scholar
  28. 28.
    Yang, B. H., Chen, Y. C., Chiang, B. L., & Chang, Y. C. (2005). Effects of nursing instruction on asthma knowledge and quality of life in schoolchildren with asthma. Journal of Nursing Research, 13, 174–183.PubMedCrossRefGoogle Scholar
  29. 29.
    Valery, P. C., Masters, B., Taylor, B., Laifoo, Y., O’Rourke, P. K., & Chang, A. B. (2010). An education intervention for childhood asthma by Aboriginal and Torres Strait Islander health workers: A randomised controlled trial. The Medical Journal of Australia, 192, 574–579.PubMedGoogle Scholar
  30. 30.
    Sulaiman, N. D., Barton, C. A., Liaw, S. T., Harris, C. A., Sawyer, S. M., Abramson, M. J., et al. (2010). Do small group workshops and locally adapted guidelines improve asthma patients’ health outcomes? A cluster randomised controlled trial. Family Practice, 27, 246–254.PubMedCrossRefGoogle Scholar
  31. 31.
    Krishna, S., Francisco, B. D., Balas, E. A., König, P., Graff, G. R., & Madsen, R. W. (2003). Internet-enabled interactive multi-media asthma education program: A randomised trial. Pediatrics, 111, 503–510.PubMedCrossRefGoogle Scholar
  32. 32.
    McCann, D. C., McWhirter, J., Coleman, H., Calvert, M., & Warner, J. O. (2006). A controlled trial of a school-based intervention to improve asthma management. European Respiratory Journal, 27, 921–928.PubMedGoogle Scholar
  33. 33.
    Butz, A., Pham, L., Lewis, L., Lewis, C., Hill, K., Walker, J., et al. (2005). Rural children with asthma: impact of a parent and child asthma program. Journal of Asthma, 42, 813–821.PubMedCrossRefGoogle Scholar
  34. 34.
    Cano-Garcinuno, A., Diaz-Vazquez, C., Carvajal-Uruena, I., Praena-Crespo, M., Gatti-Vinoly, A., & Garcia-Guerra, I. (2007). Group education on asthma for children and caregivers: A randomised, controlled trial addressing effects on morbidity and quality of life. Journal of Investigational Allergology and Clinical Immunology, 17, 216–226.PubMedGoogle Scholar
  35. 35.
    McWhirter, J., McCann, D., Coleman, H., Calvert, M., & Warner, J. (2008). Can Schools promote the health of children with asthma? Health Education Research, 23, 917–930.PubMedCrossRefGoogle Scholar
  36. 36.
    Jan, R. L., Wang, J. Y., Huang, M. C., Tseng, S. M., Su, H. J., & Liu, L. F. (2007). An internet-based interactive telemonitoring system for improving childhood asthma outcomes in Taiwan. Telemedicine Journal and E-Health, 13, 257–268.PubMedCrossRefGoogle Scholar
  37. 37.
    Shames, R. S., Sharek, P., Mayer, M., Robinson, T. N., Hoyte, E. G., Gonzalez-Hensley, F., et al. (2004). Effectiveness of a mulitcomponent self-management program in at-risk, school-aged children with asthma. Annals of Allergy, Asthma & Immunology, 92, 611–618.CrossRefGoogle Scholar
  38. 38.
    Walders, N., Kercsmar, C., Schluchter, M., Redline, S., Kirchner, L. H., & Drotar, D. (2006). An interdisciplinary intervention for undertreated pediatirc asthma. Chest, 129, 292–299.PubMedCrossRefGoogle Scholar
  39. 39.
    Clark, N. M., Shah, S., Dodge, J. A., Thomas, L. J., Andridge, R. R., & Little, R. J. (2010). An evaluation of asthma interventions for preteen students. Journal of School Health, 80, 80–87.PubMedCrossRefGoogle Scholar
  40. 40.
    Seid, M., Varni, J. W., Gidwani, P., Gelhard, L. R., & Slyman, D. J. (2010). Problem-solving skills training for vulnerable families with persistent asthma: Report of a randomised trial of health-related quality of life outcomes. Journal of Pediatric Psychology, 35, 113–143.CrossRefGoogle Scholar
  41. 41.
    Beebe, A., Gelfand, E. W., & Bender, B. (2010). A randomised trial to test the effectiveness of at therapy for children with asthma. Journal of Allergy and Clinical Immunology, 126, 263–266.PubMedCrossRefGoogle Scholar
  42. 42.
    Patterson, E. E., Brennan, M. P., Linskey, K. M., Webb, D. C., Shields, M. D., & Patterson, C. C. (2005). A cluster randomised intervention trial of asthma clubs to improve quality of life in primary school children: The school care and asthma management project (SCAMP). Archives of Disease in Childhood, 90, 786–791.PubMedCrossRefGoogle Scholar
  43. 43.
    Garbutt, J. M., Banister, C., Highstein, G., Sterkel, R., Epstein, J., & Bruns, J. (2010). Telephone coaching for parents of children with asthma: Impact and lesson learned. Archives of Pediatric and Adolescent Medicine, 164, 625–630.CrossRefGoogle Scholar
  44. 44.
    D’Zurilla, T. J. (1986). Problem-solving therapy: A social competence approach to clinical intervention. New York: Springer.Google Scholar
  45. 45.
    D’Zurilla, T. J., & Goldfried, M. (1971). Problem-solving and behaviour modification. Journal of Abnormal Psychology, 78, 107–126.PubMedCrossRefGoogle Scholar
  46. 46.
    Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  47. 47.
    Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking. Journal of Consulting and Clinical Psychology, 51, 390–395.PubMedCrossRefGoogle Scholar
  48. 48.
    Green, L. W., & Frankish, C. J. (1994). Theories and principles of health education applied to asthma. Chest, 106(Suppl 4), 219S–230S.PubMedGoogle Scholar
  49. 49.
    Peterson-Sweeney, K., McMullen, A., Yoos, H. L., & Kitzman, H. (2003). Parental perceptions of their child’s asthma: Management and medication use. Journal of Pediatric Health Care, 17, 118–125.PubMedCrossRefGoogle Scholar
  50. 50.
    Halterman, J. S., Yoos, H. L., Conn, K. M., Callahan, P. M., Montes, G., Neely, T. L., et al. (2004). The impact of childhood asthma on parental quality of life. Journal of Asthma, 41, 645–653.PubMedCrossRefGoogle Scholar
  51. 51.
    Kaugars, A. S., Klinnert, M. D., & Bender, B. G. (2004). Family influences on pediatric asthma. Journal of Pediatric Psychology, 29, 475–491.PubMedCrossRefGoogle Scholar
  52. 52.
    Blackman, J. A., & Gurka, M. J. (2007). Developmental and behavioral comorbidities of asthma in children. Journal of Developmental and Behavioural Pediatrics, 28, 92–99.CrossRefGoogle Scholar
  53. 53.
    Calam, R., Gregg, L., & Goodman, R. (2005). Psychological adjustment and asthma in children adolescents: The UK nationwide mental health survey. Psychosomatic Medicine, 67, 105–110.PubMedCrossRefGoogle Scholar
  54. 54.
    McQuaid, E., Kopel, S., & Nasasu, J. (2001). Behavioral adjustment in children with asthma: A meta-analysis. Journal of Developmental and Behavioural Pediatrics, 22, 430–439.CrossRefGoogle Scholar
  55. 55.
    Weil, C. M., Wade, S. L., Bauman, L. J., Lynn, H., Mitchell, H., & Lavigne, J. (1999). The relationship between psychosocial factors and asthma morbidity in innercity children with asthma. Pediatrics, 104, 1274–1280.PubMedCrossRefGoogle Scholar
  56. 56.
    Wade, S. L., Islam, S., Holden, G., Kruszon-Moran, D., & Mitchell, H. (1999). Division of responsibility for asthma management tasks between caregivers and children in the inner city. Journal of Developmental and Behavioural Pediatrics, 20, 93–98.CrossRefGoogle Scholar
  57. 57.
    Creer, T. L. (1987). Self-management in the treatment of childhood asthma. Journal of Allergy and Clinical Immunology, 80, 500–505.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Division of Clinical PsychologyUniversity of ManchesterManchesterUK

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