Previous Article in Journal
Toxocara spp. Infection Influences on Eosinophil Levels: An Immunological Indicator of Severe Asthma and Allergy
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Allergies
Volume 5
Issue 3
10.3390/allergies5030025
allergies-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Teacher Self-Efficacy in Asthma Management in Elementary and Middle Schools

by
Ethan Schilling
1,
Stacey Neuharth-Pritchett
2,*,
Sofia H. Davie
2 and
Yvette Q. Getch
3
1
Children’s Hospital of Richmond, Richmond, VA 23235, USA
2
Department of Educational Psychology, Mary Frances Early College of Education, University of Georgia, Athens, GA 30602, USA
3
Department of Counseling and Instructional Sciences, College of Education and Professional Studies, University of South Alabama, Mobile, AL 36688, USA
*
Author to whom correspondence should be addressed.
Allergies 2025, 5(3), 25; https://doi.org/10.3390/allergies5030025
Submission received: 17 March 2025 / Revised: 22 June 2025 / Accepted: 30 June 2025 / Published: 3 July 2025
(This article belongs to the Section Asthma/Respiratory)
Versions Notes

Abstract

Background/Objectives: This study assessed teacher self-efficacy in school-based asthma management in two southern states in the United States. Current literature focuses primarily on supporting school-based asthma management, but few studies have focused on teacher self-efficacy in the asthma management process. Methods: With data collected from a two-state survey of a randomly selected group of teachers in grades kindergarten to grade eight (n = 379), teachers’ demographic variables, general opinions about asthma management practices, and their self-perceptions on the Teacher Asthma Management and Information Seeking Scale, which assesses self-efficacy, were examined. Results: Teachers’ self-efficacy in managing asthma and seeking information was significantly higher among teachers who had completed in-service professional learning sessions and those who had access to community resources or links to community agencies. Additionally, teachers with personal experience of chronic illness, asthma, or allergies and those who had students with chronic illnesses in their classrooms reported higher self-efficacy scores. Conclusions: Findings suggest that providing professional learning about asthma for teachers, offering access to asthma action plans and community resources, and increasing awareness of chronic conditions and training for handling medical emergencies can enhance teachers’ self-efficacy and improve outcomes for students with chronic illnesses.

1. Introduction

In 2021, the national estimate of lifetime asthma prevalence among youth in the United States aged 5–14 was 11.9% [1]. Given that youth spend a significant portion of their day in structured settings such as schools [2,3,4], it is crucial for teachers to support asthma management in these environments [5,6]. These supports include evaluating symptoms, monitoring health status, enacting asthma action plans, and helping to facilitate the use of appropriate medications [7,8]. Such interventions help youth manage their conditions effectively [9] and develop self-efficacy in following their asthma action plans [10,11]. As Lavoie et al. [12] note, confidence in asthma control is related to better asthma control and quality of life. These supports also align with the Global Initiative for Asthma 2008 guidelines, which emphasize the importance of caregiver backing for youth asthma control [13] from caregivers such as peers, parents, teachers, and health professionals. With all 50 states in the U.S. having inhaler self-carry and self-administration laws, teachers have more opportunities to support effective asthma management in classrooms [14,15] through multidimensional interventions [16]. Moving beyond mere asthma knowledge, it is essential to enhance teachers’ self-efficacy in the delivery of interventions [17], which can further support youth asthma management in schools.
Numerous studies have highlighted the significant outcomes for youth who participate in asthma education programs [18]. These programs aim to enhance youth skills in monitoring their condition, self-management, and developing self-efficacy in controlling their asthma [19]. In one study with adolescents, self-efficacy improved following an asthma education intervention that used developmentally appropriate and humorous interactive learning modules that ranged in length from 30 to 45 min. The authors created a curriculum that focused on prevention, monitoring, management, communication, and psychosocial understandings of chronic illness. Outcomes led to increased knowledge of medications and their usage, contextual awareness, the ability to minimize asthma exacerbations, remaining calm during asthma exacerbations, and knowing when to seek emergency support [20]. Kaul [21] noted that self-efficacy is a crucial component of self-management for youth. Other scholars have observed that self-management skills are associated with symptom reduction and decreased morbidity [22,23,24].
Asthma education programs can also be designed to include various stakeholders, such as parents, school nurses and other medical personnel, and community organization members [18]. These stakeholders can assist with educational activities and demonstrate to youth how to administer lung function tests or perform periodic peak flow monitoring to assess asthma severity or compliance [17,25]. Findings from studies that have examined parental perspectives on school-based asthma management are mixed. Some studies have found that parents expressed concerns over teachers’ abilities to manage acute asthma episodes, communication between home and school, and school policies that did not support comprehensive school-based management of their child’s condition [26]. However, Horner and Brown [27] found that individualized parent asthma education programs were helpful in incorporating neighborhood and home environmental variables to support the plan’s implementation.
Other research suggests that parental knowledge can influence efficacy, but efficacy varies for certain variables, such as anxiety in intervening with medical procedures for the condition [16,28,29]. In a study by Brown and colleagues [2], it was found that parents had lower efficacy for exacerbation management than for exacerbation prevention. Additionally, simple tasks, those performed frequently, and skill-based tasks (e.g., medication administration) resulted in high levels of self-efficacy.
For school nurses and other healthcare providers, asthma education programs have been shown to increase self-efficacy in managing the chronic health condition [30,31]. Medical providers also can assist with asthma education for school teachers, supporting children’s asthma self-management. Studies have noted that when medical providers support school personnel in asthma education, school personnel gain higher levels of knowledge about the condition and also develop a greater trust in their own efficacy in helping children and youth manage asthma [32,33]. Another outcome of asthma education programs is increased knowledge about the chronic illness [9,34,35]. Although studies continue to document challenges with teachers’ knowledge about asthma [36,37,38,39], other studies note that once teachers have access to asthma knowledge, they experience increased comfort [40] and self-efficacy in managing asthma [41,42,43]. In a study by Langton and colleagues [41], over half of the teachers surveyed (52%) expressed confidence in their ability to recognize asthma exacerbations once they were knowledgeable about the condition. Drawing from the positive results from families and other key stakeholders in asthma management, understanding how teachers perceive their self-efficacy in supporting youth with asthma is a crucial contribution to effective disease management [44,45].
Self-efficacy is defined as one’s belief in their ability to accomplish tasks and achieve specific goals [46,47]. Numerous studies have examined self-efficacy in asthma management for youth, families, and school nurses. For youth, Holley and colleagues [48] noted that developing self-efficacy in asthma management was related to better asthma outcomes, including reduced hospitalizations and improved quality of life. Naman et al. [49] found that asthma education for youth supported self-efficacy and self-care abilities, increased comfort in managing asthma, and reduced the stigma sometimes associated with the chronic condition. However, one study found that self-efficacy in teens was not associated with self-management and asthma morbidity [50]. Interventions with families targeting self-efficacy and asthma management have focused on the challenges of coordinating care teams necessary to ensure appropriate care for their children in school settings [51].
Interventions designed for school nurses have resulted in mixed outcomes. For example, Quarnata et al. [52] found that nurses with increased self-efficacy were more likely to endorse and support asthma management behaviors. Chiang et al. [53] noted that self-efficacy can enhance motivation to engage in care plans. Gau and colleagues [54] observed that nurses with experience in specific asthma management activities had higher self-efficacy in elements of asthma management such as using inhalers or peak flow meters. In a study conducted in Taiwan, Chao et al. [55] determined that a one-time, four-hour training improved nurses’ asthma case management efficacy. However, concerns with self-efficacy are also documented in the literature. For example, Goei et al. [56] ascertained that many school employees perceived that they knew how to support youth with asthma exacerbations but had a false sense of disease response efficacy. Response efficacy was operationalized by Goei et al. as the “perceived likelihood that the recommended response will avert the threat (p. 259)”.
Studies documenting teacher self-efficacy in asthma management have been conducted globally. In Taiwan, a study of 460 kindergarten teachers found that teachers’ knowledge correlated with self-efficacy (r = 0.23, p < 0.001), and the authors concluded that self-efficacy could predict more thorough engagement in asthma management [57]. In the Bronx, New York, a 45 min workshop for teachers resulted in increased self-efficacy scores [58]. Another American study concluded that teachers’ self-efficacy in asthma management contributed as much to managing the chronic illness as their knowledge [59]. In a study completed in Connecticut, it was found that providing teachers with educational sessions and continued access to children’s asthma action plans improved their self-efficacy [60].
Self-efficacy can also be enhanced by making chronic illness management a core component of educator preparation programs [61,62]. Gau and Hung [62] emphasized that “the asthma care self-efficacy of teachers is crucial to the health-related behaviors and outcomes of children with asthma” (p. 97). Schools and teachers are key partners in asthma care and play a critical role in helping children with asthma succeed academically [51]. Again, most studies on school-based asthma management have primarily focused on teacher knowledge. More research is needed to examine teacher characteristics associated with self-efficacy in supporting school-based asthma management. Furthermore, additional evidence is needed to demonstrate that self-efficacy can be a focal point of asthma intervention for teachers from elementary through middle school. Because schools in the United States have variable policies with regard to teacher administration of emergency medications, teacher efficacy in understanding the condition and seeking appropriate medical support for youth with an asthma exacerbation is a variable that needs exploration.

2. Materials and Methods

Data Collection and Instrumentation. Teachers were recruited for this study in Fall 2015 from a sample of 3223 elementary and middle school teachers in Georgia and Kentucky in the United States. In addition to demographic information and general opinions about asthma management practices in schools, teachers also completed items on the Teacher Asthma Management and Information Seeking Scale [63]. This two-factor scale yields information on an Asthma Management Factor and an Information Seeking Factor. Items were rated on a 1–10 scale (1 = not sure; 10 = very sure). Sample items on the Teacher Asthma Management factor included ‘recognizing the early warning signs of an asthma episode’ and ‘recognizing when asthma medications are not working for the child with asthma.’ A sample item from the Information Seeking factor is ‘discussing with school administrators (principal, school board members, etc.) concerns you have about your school policies regarding the administration of asthma medications’. Cronbach alphas from the development of the scale were reported to be 0.90 and 0.71, respectively. For the current study, Cronbach’s alphas were 0.945 for the Asthma Management factor and 0.771 for the Information Seeking factor, indicating high levels of internal consistency.
School Policies. Teachers responded to two questions about asthma management and formal documentation about youths’ conditions. Specifically, teachers were asked if their schools had 504 plans for youth with asthma. A 504 plan is a plan of action that allows for accommodations and supports for youth with disabilities that prohibits discrimination based on a child’s disability or medical condition [64].

3. Results

Participants. Teachers (n = 379) in this study were drawn from a two-state study conducted in Georgia and Kentucky in the United States. Teachers reported their years of teaching experience with an average number of years of 15.86 (SD = 8.17; range 1–39 years). Within the sample, there were 301 elementary school teachers (79.4%) who taught grades kindergarten through grade five and 78 middle school teachers (20.6%) who taught grades six through eighth grade. The majority of teachers had advanced degrees in education, with 80.5% having earned a master’s, specialist, or doctoral degree and the remainder of the sample having completed a bachelor’s degree (n = 74; 19.5%). Teachers also taught in communities that were predominantly non-rural and that represented populations of 15,000 residents or more (66.8%). The distribution of gender across the participants was 16 (4.2%) male and 363 (95.8%) female. The age distribution of the sample was 7.1% aged 20–29 years, 30.3% aged 30–39 years, 29.3% aged 40–49 years, and 33.2% aged 50 years or more. Self-reported race/ethnicity was 87.9% European-American, 12.1% African American, and 1.1% Hispanic/Latino, with four participants identifying as Indigenous (Native American)/Other. Teachers were also polled about their own health status, with 12.1% reporting a chronic illness other than asthma, 14.2% with diagnosed asthma, and 63.9% with diagnosed allergies.
Of the 379 teachers, 71 (18.7%) indicated that youth with asthma had 504 plans that documented their condition and provided access to needed services or accommodations. Of the remaining 308 teachers, 166 (43.8%) noted that 504 plans were not used in their schools to support youth with asthma, and 142 (37.5%) were unsure. Regarding action plans for asthma, 38.8% of teachers (n = 147) indicated that youth in their schools who were diagnosed with asthma had an asthma action plan. Of the remaining 232 teachers, 51 (13.5%) stated that their schools did not use asthma action plans, and 181 (47.8%) were unsure. In general, teachers who completed the survey noted that the youth they teach in their schools who were diagnosed with asthma had conditions that were well controlled, with only 1.8% indicating that youths’ asthma was not well controlled, and another 11.1% indicating that they were unsure about youths’ level of asthma control.
We analyzed teachers’ self-efficacy scores and their relationship to having taught youth diagnosed with chronic illness and youth diagnosed with asthma. Significant differences were observed regarding teachers’ self-efficacy in asthma management skills and their experiences with youth diagnosed with chronic disease. Teachers who scored higher on the information seeking self-efficacy subscale also reported having children in their classroom who were diagnosed with a chronic disease. Post-hoc analyses indicated that the teachers who scored the highest on self-efficacy significantly differed from teachers who were unsure of the chronic medical conditions of the youth in their classrooms. Significant differences in information seeking self-efficacy were also found for teachers who reported that they had or did not have a child in their classroom with a chronic illness. Post-hoc analyses regarding information seeking self-efficacy indicated that both of those groups differed from teachers who were unsure of their students’ chronic disease conditions. Data from these analyses are presented in Table 1 below.
Among in-service teachers, for both the asthma management and the information seeking self-efficacy subscales, higher rates of efficacy were associated with teachers who had completed coursework through in-service professional learning sessions. For teachers who participated in such professional learning sessions, the mean score for the asthma management subscale was 6.37 (SD = 2.36). For those who had not participated in professional learning sessions, the mean score was 5.68 (SD = 2.50). A statistically significant difference was found between the two groups (F (1, 378) = 7.02, p = 0.008). A parallel finding for the information seeking self-efficacy subscale was also observed, favoring those who had participated in in-service professional learning sessions, with the mean for those who participated being 7.98 (SD = 2.12) and for those who had not participated being 7.37 (SD = 2.28). This difference was again statistically significant (F (1, 378) = 6.60, p = 0.011). Another question posed to teachers was related to specific in-service professional learning received on asthma. A significant difference was found for teachers who had engaged in such professional learning on the information seeking self-efficacy subscale (F (1, 378) = 3.80, p = 0.05). The mean score for those who had engaged in professional learning on asthma was 8.03 (SD = 1.96), while for those who replied that they had not engaged in professional learning, it was 7.48 (SD = 2.29). No significant differences were observed for the asthma management self-efficacy subscale.
Teachers also responded to a question about teacher training for addressing medical emergencies in the classroom. A statistically significant difference was found on the information seeking self-efficacy (F (1, 378) = 7.69, p = 0.006) favoring those teachers who had medical emergency training. Means and standard deviations for that analysis are presented in Table 2. When polled about whether or not they knew what symptoms or signs of an asthma attack looked like, teachers who responded yes had higher self-efficacy scores on asthma management and information seeking subscales.
Other resources that could support youth school-based asthma management are found in a child’s access to either a 504 plan or an asthma action plan [64]. We examined teacher-reported school use of 504 plans and asthma action plans. No statistically significant differences were found in teacher self-efficacy based on whether or not their school used 504 plans for supporting students with asthma. On the information seeking self-efficacy scale, teachers who reported that their schools used asthma action plans significantly differed in their self-efficacy from those teachers whose schools did not use asthma action plans. A similar trend was found in self-efficacy for teachers who reported that students with asthma receive the medical support they need in school. Again, on the information seeking self-efficacy scale, teachers who reported that students with asthma received the medical support that they needed significantly differed in their self-efficacy from those teachers who did not perceive that their students with asthma received the medical support that they needed. Means and standard deviations for the statistical tests for all of these analyses are presented in Table 2 below.
Teachers were also asked if their schools provide general resources or links to community agencies or physicians that might assist the teacher with information or referral services for youth with asthma. For both asthma management and information seeking self-efficacy scales, teachers who had been provided links and referral information had greater self-efficacy scores. Post-hoc analyses indicated that on asthma management self-efficacy subscale, a difference was found among teachers who had access and those who were unsure. On the information seeking subscale, post-hoc analyses revealed differences between those teachers who had access and both groups of teachers who did not have access or who were unsure about their access. Means, standard deviations, and statistical test outcomes are displayed in Table 3.
Finally, we examined teachers’ own health characteristics and whether the absence or presence of those characteristics was related to their self-efficacy. We found that teachers who reported that they themselves had a chronic illness diagnosis, had asthma, or had allergies significantly differed from teachers without those diagnoses on their reported self-efficacy on the asthma management self-efficacy subscale but not on the information seeking self-efficacy subscale. Means, standard deviations, and statistical test outcomes are displayed in Table 4.

4. Discussion

Results from this study provide valuable insight into the relationship between teachers’ self-efficacy and their experiences in supporting students diagnosed with asthma. First, we found that teachers who had prior experiences teaching youth who have been diagnosed with a chronic illness reported higher self-efficacy in both asthma management and information seeking about the condition. This finding is consistent with other work suggesting that professional experience might help promote advocacy in supporting youth with chronic illnesses such as asthma [51]. This finding is also promising in that front-line school staff members can serve in this important health management role. This finding has also been supported by other scholars who note the power of increasing teachers’ confidence and information seeking behaviors [65]. Our findings also revealed a high number of teachers who were unaware of their students’ chronic medical conditions and, specifically, asthma diagnoses, which have also been highlighted as a concern in the literature [66].
Results also indicate that various forms of professional learning and use of health tools were connected to higher rates of self-efficacy. Among in-service teachers, for both the asthma management and the information seeking self-efficacy subscales, higher rates of efficacy were associated with teachers who had completed coursework through in-service professional learning sessions. Such in-service training opportunities have also been found to be effective in other disciplines, such as the general health care workforce [67] and nursing [68]. Teachers who knew what the signs and symptoms of an asthma attack looked like also had higher self-efficacy ratings. This finding is consistent with global work noting the importance of teacher recognition of an asthma exacerbation [69,70,71]. Teachers’ information-seeking self-efficacy in this dataset was also found to be higher when schools had 504 plans or asthma action plans in place to support students with asthma, which is consistent with findings from prior studies [60]. Information-seeking self-efficacy was also found to be higher when teachers perceived that students with asthma received the medical support they needed in school.
Teachers with access to community resources and referral information had greater self-efficacy scores for both asthma management and information seeking self-efficacy. This outcome speaks to the need for partnerships in constituting care teams in schools and engaging medical and other community partners in establishing a comprehensive approach to health care monitoring and interventions [72,73,74] in schools. Finally, on the asthma management self-efficacy scale, teachers who reported having their own chronic illness condition, who had asthma, or who had allergies had higher self-efficacy scores than teachers without those characteristics. This finding is consistent with work by Reznik and colleagues [59], who found that teachers with their own chronic illness conditions were more efficacious in helping students avoid exposure to triggers.
Although the results from this study add to the literature on teacher efficacy, our data were collected from just two states in the United States. The restricted sample limits the generalizability to other states within the United States or other countries around the world. We also relied on teacher reports of school records, such as the existence of asthma action plans or 504 plans, as we did not have access to school records. Our results also focus on individual teachers’ self-reports. A teacher demonstrating self-efficacy in supporting youth with asthma management does not necessarily equate to this support always being received well by youth, families, and other school personnel.

5. Implications

Results from this study have three primary implications. First, opportunities to provide professional learning for teachers about the characteristics of asthma, asthma exacerbation episodes, and how to partner with other school personnel in managing asthma continue to be areas of great need for schools. The data from the study clearly indicate that teachers’ self-efficacy, with a focus of professional learning experiences, could be a malleable factor in leading to better overall management of asthma for children in elementary and middle schools. Second, Providing teachers with access to asthma action plans, medical information supports, and community resources can boost teachers’ confidence and effectiveness potentially augmenting their self-efficacy in managing students’ health needs. Third, increasing teachers’ awareness of chronic conditions and training teachers to handle medical emergencies, such as asthma exacerbations, could ultimately lead to better outcomes for students with chronic illnesses, their abilities to be present in schools, and opportunities to de-stigmatize managing asthma at school.

Author Contributions

Conceptualization, Y.Q.G., E.S., S.N.-P. and S.H.D. Methodology: Y.Q.G., E.S., S.N.-P. and S.H.D. Formal Analysis: S.N.-P. Investigation: Y.Q.G. and S.N.-P. Resources: Y.Q.G., E.S., S.N.-P. and S.H.D. Data Curation: S.N.-P. Writing—Original Draft Preparation: Y.Q.G., E.S., S.N.-P. and S.H.D. Writing—Review and Editing: Y.Q.G., E.S., S.N.-P. and S.H.D. Visualization: Y.Q.G., E.S., S.N.-P. and S.H.D. Project Administration: Y.Q.G. and S.N.-P. Funding Acquisition: Y.Q.G. and S.N.-P. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by the University of Georgia.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the University of Georgia (Study00000650 and 1 October 2014).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The datasets presented in this article are not readily available because the data are part of an ongoing study. Requests to access the datasets should be directed to sneuhart@uga.edu.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Centers for Disease Control and Prevention. 2021 National Health Interview Survey (NHIS) Data: Table 2-1—Percentage of Persons with Lifetime Asthma by Age, United States: National Health Interview Survey, 2021. 2023. Available online: https://www.cdc.gov/asthma/nhis/2021/table2-1.htm (accessed on 22 February 2025).
  2. Brown, N.; Gallagher, R.; Fowler, C. Asthma management self-efficacy in parents of primary school-age children. J. Child. Health Care 2014, 18, 133–144. [Google Scholar] [CrossRef]
  3. Bruzzese, J.M.; Kattan, M. School-based interventions: Where do we go from here? J. Allergy Clin. Immunol. 2019, 143, 550–551. [Google Scholar] [CrossRef]
  4. Rehman, N.; Morais-Almeida, M.; Wu, A.C. Asthma across childhood: Improving adherence to asthma management from early childhood to adolescence. J. Allergy Clin. Immunol. Pract. 2020, 8, 1802–1807. [Google Scholar] [CrossRef] [PubMed]
  5. Kay Bartholomew, L.; Sockrider, M.M.; Abramson, S.L.; Swank, P.R.; Czyzewski, D.I.; Tortolero, S.R.; Markham, C.M.; Fernandez, M.E.; Shegog, R.; Tyrrell, S. Partners in school asthma management: Evaluation of a self-management program for children with asthma. J. Sch. Health 2006, 76, 283–290. [Google Scholar] [CrossRef]
  6. Price, J.; Dake, J.; Murnan, J.; Telljohann, S. Elementary school secretaries’ experiences and perceptions of administering prescription medication. J. Sch. Health 2003, 73, 373–379. [Google Scholar] [CrossRef] [PubMed]
  7. Kaugars, A.S.; Klinnert, M.D.; Bender, B.G. Family influences on pediatric asthma. J. Pediatr. Psychol. 2004, 29, 475–491. [Google Scholar] [CrossRef] [PubMed]
  8. National Institutes of Health. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma; National Heart, Lung, and Blood Institute: Bethesda, MD, USA, 2007. [Google Scholar]
  9. Ones, U.; Akcay, A.; Tamay, Z.; Guler, N.; Dogru, M. Asthma knowledge level of primary schoolteachers in Istanbul, Turkey. Asian Pac. J. Allergy Immunol. 2006, 24, 9–15. [Google Scholar]
  10. Chan, A.H.Y.; Stewart, A.W.; Foster, J.M.; Mitchell, E.A.; Camargo, C.A., Jr.; Harrison, J. Factors associated with medication adherence in school-aged children with asthma. ERJ Open Res. 2016, 2, 87. [Google Scholar] [CrossRef]
  11. Wissow, L.S.; Roter, D.; Bauman, L.J.; Crain, E.; Kercsmar, C.; Weiss, K.; Mitchell, H.; Mohr, B. Patient provider communication during the emergency department care of children with asthma. Med. Care 1998, 36, 1439–1450. [Google Scholar] [CrossRef]
  12. Lavoie, K.L.; Bouchard, A.; Joseph, M.; Campbell, T.S.; Favreau, H.; Bacon, S.L. Association of asthma self-efficacy to asthma control and quality of life. Ann. Behav. Med. 2008, 36, 100–106. [Google Scholar] [CrossRef]
  13. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention 2008 (Update). 2008. Available online: http://www.ginasthma.org (accessed on 4 July 2022).
  14. American Lung Association. Asthma Medication in Schools. 2020. Available online: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/health-professionals-educators/asthma-in-schools/asthma-medication-in-schools (accessed on 4 July 2022).
  15. Maa, S.-H.; Chang, Y.-C.; Chou, C.-L.; Ho, S.-C.; Sheng, T.-F.; MacDonald, K.; Wang, Y.; Shen, Y.-M.; Abraham, I. Evaluation of the feasibility of a school-based asthma management programme in Taiwan. J. Clin. Nurs. 2010, 19, 2415–2423. [Google Scholar] [CrossRef]
  16. Friend, M.; Morrison, A. Interventions to improve asthma management of the school-age child. Clin. Pediatr. 2015, 54, 534–542. [Google Scholar] [CrossRef]
  17. Clark, N.M.; Nothwehr, F. Self-management of asthma by adult patients. Patient Educ. Couns. 1997, 32, S5–S20. [Google Scholar] [CrossRef]
  18. Shaw, S.F.; Marshak, H.H.; Dyjack, D.T.; Neish, C.M. Effects of a classroom-based asthma education curriculum on asthma knowledge, attitudes, self-efficacy, quality of life, and self-management behaviors among adolescents. J. Health Educ. 2005, 36, 140–147. [Google Scholar] [CrossRef]
  19. Greenberg, C.; Luna, P.; Simmons, G.; Huhman, M.; Merkle, S.; Robin, L.; Keener, D. Follow-up of an elementary school intervention for asthma management: Do gains last into middle school? J. Asthma 2010, 47, 587–593. [Google Scholar] [CrossRef]
  20. Mammen, J.R.; Rhee, H.; Atis, S.; Grape, A. Changes in asthma self-management knowledge in inner city adolescents following developmentally sensitive self-management training. Patient Educ. Couns. 2018, 1010, 687–695. [Google Scholar] [CrossRef] [PubMed]
  21. Kaul, T. Helping African American children self-manage asthma: The importance of self-efficacy. J. Sch. Health 2011, 81, 29–33. [Google Scholar] [CrossRef] [PubMed]
  22. Bruhn, J.G. The application of theory in childhood asthma self-help programs. J. Allergy Clin. Immunol. 1983, 72, 561–577. [Google Scholar] [CrossRef]
  23. Clark, N.M. Fostering self-management among patients with asthma. Pediatrics 1989, 2, 200–206. [Google Scholar]
  24. McClure, N.; Seibert, M.; Johnson, T.; Kannenburg, L.; Brown, T.; Lutenbacher, M. Improving asthma management in the elementary school setting: An education and self-management pilot project. J. Pediatr. Nurs. 2018, 42, 16–20. [Google Scholar] [CrossRef]
  25. Carpenter, D.M.; Ayala, G.X.; Williams, D.M.; Yeatts, K.B.; Davis, S.; Sleath, B. The relationship between patient–provider communication and quality of life for children with asthma and their caregivers. J. Asthma 2013, 50, 791–798. [Google Scholar] [CrossRef] [PubMed]
  26. Al Aloola, N.A.; Nissen, L.; Alewairdhi, H.A.; Al Faryan, N.; Saini, B. Parents’ asthma information needs and preferences for school-based asthma support. J. Asthma 2017, 54, 946–956. [Google Scholar] [CrossRef] [PubMed]
  27. Horner, S.D.; Brown, A. Evaluating the effect of an asthma self-management intervention for rural families. J. Asthma 2014, 51, 168–177. [Google Scholar] [CrossRef]
  28. Bonner, S.; Zimmerman, B.J.; Evans, D.; Irigoyen, M.; Resnick, D.; Mellins, R.B. An individualized intervention to improve asthma management among urban Latino and African-American families. J. Asthma 2002, 39, 167–179. [Google Scholar] [CrossRef] [PubMed]
  29. Wood, M.R.; Price, J.H.; Dake, J.A.; Telljohann, S.K.; Khuder, S.A. African American parents’/guardians’ health literacy and self-efficacy and their child’s level of asthma control. J. Pediatr. Nurs. 2010, 25, 418–427. [Google Scholar] [CrossRef] [PubMed]
  30. Winkelstein, M.L.; Quartey, R.; Pham, L.; Lewis-Boyer, L.; Lewis, C.; Hill, K.; Butz, A. Asthma education for rural school nurses: Resources, barriers, and outcomes. J. Sch. Nurs. 2006, 22, 170–177. [Google Scholar] [CrossRef]
  31. Wisnivesky, J.P.; Lorenzo, J.; Lyn-Cook, R.; Newman, T.; Aponte, A.; Kiefer, E.; Halm, E.A. Barriers to adherence to asthma management guidelines among inner city primary care providers. Ann. Allergy Asthma Immunol. 2008, 101, 264–270. [Google Scholar] [CrossRef]
  32. Bruzzese, J.M.; Unikel, L.H.; Evans, D.; Bornstein, L.; Surrence, K.; Mellins, R.B. Asthma knowledge and asthma management behavior in urban elementary school teachers. J. Asthma 2010, 47, 185–191. [Google Scholar] [CrossRef]
  33. Soo, Y.Y.; Saini, B.; Moles, R.J. Can asthma education improve the treatment of acute asthma exacerbation in young children? J. Paediatr. Child Health 2013, 49, 353–360. [Google Scholar] [CrossRef]
  34. Canitez, Y.; Cekic, S.; Celik, U.; Kocak, A.; Sapan, N. Health-care conditions in elementary schools and teachers’ knowledge of childhood asthma. Paediatr. Int. Child Health 2016, 36, 64–71. [Google Scholar] [CrossRef]
  35. Ruvalcaba, E.; Chung, S.-E.; Rand, C.; Riekert, K.A.; Eakin, M. Evaluating the implementation of a multicomponent asthma education program for Head Start staff. J. Asthma 2022, 56, 218–226. [Google Scholar] [CrossRef] [PubMed]
  36. Cain, A.; Reznik, M. Asthma management in New York City schools: A classroom teacher perspective. J. Asthma 2016, 53, 744–750. [Google Scholar] [CrossRef] [PubMed]
  37. Getch, Y.Q.; Neuharth-Pritchett, S. Teacher characteristics and knowledge of asthma. Public. Health Nurs. 2009, 26, 124–133. [Google Scholar] [CrossRef] [PubMed]
  38. Hussey, J.; Cahill, A.; Henry, D.; King, A.M.; Gormley, J. National school teachers’ knowledge of asthma and its management. Ir. J. Med. Sci. 1999, 168, 174–179. [Google Scholar] [CrossRef]
  39. Neuharth-Pritchett, S.; Getch, Y.Q. Asthma and the school teacher: The status of teacher preparedness and training. J. Sch. Nurs. 2001, 17, 323–328. [Google Scholar] [CrossRef]
  40. Getch, Y.Q.; Schilling, E.; Neuharth-Pritchett, S.M.; Hirt, S. Teacher comfort in managing asthma: A two-state study. Allergies 2024, 4, 181–191. [Google Scholar] [CrossRef]
  41. Langton, C.R.; Hollenbach, J.P.; Simoneau, T.; Cloutier, M.M. Asthma management in school: Parents’ and school personnel perspectives. J. Asthma 2020, 57, 295–305. [Google Scholar] [CrossRef]
  42. Neuharth-Pritchett, S.; Getch, Y.Q. The effectiveness of a brief asthma education intervention for child care providers and primary school teachers. Early Child. Educ. J. 2016, 44, 555–561. [Google Scholar] [CrossRef]
  43. Pfitzner-Eden, F. Why do I feel more confident? Bandura’s sources predict preservice teachers’ latent changes in teacher self-efficacy. Front. Psychol. 2016, 7, 1486. [Google Scholar] [CrossRef]
  44. Marks, R.; Allegrante, J.P.; Lorig, K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (part II). Health Promot. Pract. 2005, 6, 148–156. [Google Scholar] [CrossRef]
  45. Montalbano, L.; Ferrante, G.; Alesi, M.; La Grutta, S. Integrating self-efficacy in the cyclical process of paediatric asthma management: A new perspective. Psychol. Health Med. 2022, 28, 1582–1590. [Google Scholar] [CrossRef]
  46. Bandura, A. Self-Efficacy: The Exercise of Control; W.H. Freeman: New York, NY, USA, 1997. [Google Scholar]
  47. Schunk, D.H.; Pajaras, F. The development of academic self-efficacy. In Development of Achievement Motivation; Wigfield, A., Eccles, J., Eds.; Academic Press: San Diego, CA, USA, 2002; pp. 16–31. [Google Scholar]
  48. Holley, S.; Knibb, R.; Latter, S.; Liossi, C.; Mitchell, F.; Radley, R.; Roberts, G. Development and validation of the Adolescent Asthma Self-Efficacy Questionnaire (AASEQ). Eur. Respir. J. 2019, 54, 1801375. [Google Scholar] [CrossRef]
  49. Naman, J.; Press, V.G.; Vaughn, D.; Hull, H.; Erwin, K.; Volerman, A. Student perspectives on asthma management in schools: A mixed-methods study examining experiences, facilitators, and barriers to care. J. Asthma 2019, 56, 1294–1305. [Google Scholar] [CrossRef] [PubMed]
  50. Zebracki, K.; Drotar, D. Outcome expectancy and self-efficacy In adolescent asthma self-management. Child. Health Care 2004, 33, 133–149. [Google Scholar] [CrossRef]
  51. Volerman, A.; Dennin, M.; Vela, M.; Ignoffo, S.; Press, V.G. A qualitative study of parent perspectives on barriers, facilitators and expectations for school asthma care among urban, African-American children. J. Asthma 2019, 56, 1099–1109. [Google Scholar] [CrossRef]
  52. Quaranta, J.E.; Spencer, G.A. Using the health belief model to understand school nurse asthma management. J. Sch. Nurs. 2015, 31, 430–440. [Google Scholar] [CrossRef]
  53. Chiang, L.-C.; Hsu, J.-Y.; Liang, W.-M.; Yeh, K.-W.; Huang, J.-L. Developing a scale to measure self-efficacy on asthma teaching for health care providers. J. Asthma 2009, 46, 113–117. [Google Scholar] [CrossRef] [PubMed]
  54. Gau, B.S.; Horner, S.D.; Chang, S.C.; Chen, Y.C. Asthma management efficacy of school nurses in Taiwan. Int. J. Nurs. Stud. 2002, 39, 279–285. [Google Scholar] [CrossRef] [PubMed]
  55. Chao, S.-Y.; Yan, D.-C.; Ou, L.S.; Tsao, C.-H.; Chen, C.-Y.; Lai, S.R.; Chiang, L.-C.; Huang, J.L. Primary school nurses’ knowledge/competence pertaining to childhood asthma and its management prior to and following a National Asthma Education Program in Taiwan. J. Asthma 2003, 40, 927–934. [Google Scholar] [CrossRef]
  56. Goei, R.; Boyson, A.R.; Lyon-Callo, S.K.; Schott, C.; Wasilevich, E.; Cannarile, S. Developing an asthma tool for schools: The formative evaluation of the Michigan Asthma School Packet. J. Sch. Health 2006, 76, 259–263. [Google Scholar] [CrossRef]
  57. Hung, C.-C.; Huang, G.-S.; Lin, C.H.; Gau, B.S. Asthma care issues in kindergarten teachers: An evaluation on knowledge, attitudes, and self-efficacy of asthma. J. Asthma 2008, 45, 539–544. [Google Scholar] [CrossRef]
  58. Reznik, M.; Greenberg, E.; Cain, A.; Halterman, J.S.; Avalos, M.I. Improving teacher comfort and self-efficacy in asthma management. J. Asthma 2020, 57, 1237–1243. [Google Scholar] [CrossRef]
  59. Appea, S.K. Teacher Management of Asthmatic Children: The Contributions of Knowledge and Self-Efficacy; City University of New York: New York, NY, USA, 1999. [Google Scholar]
  60. Arekapudi, K.L.; Norris, C.; Updegrove, S. Improving self-efficacy of student asthma management in elementary and preschool staff. J. Sch. Nurs. 2021, 37, 513–522. [Google Scholar] [CrossRef]
  61. Getch, Y.Q.; Neuharth-Pritchett, S.; Schilling, E.J. Asthma and the public school teacher: A two state study. Pediatr. Allergy Immunol. Pulmonol. 2019, 32, 109–116. [Google Scholar] [CrossRef] [PubMed]
  62. Gau, B.S.; Hung, C.C. The self-efficacy scale for preschool teachers regarding asthma care: Instrument development and validation. J. Sch. Health 2014, 84, 91–98. [Google Scholar] [CrossRef]
  63. Getch, Y.Q.; Neuharth-Pritchett, S. Teacher Asthma Management and Information Seeking Scale. J. Asthma 2007, 44, 497–500. [Google Scholar] [CrossRef] [PubMed]
  64. Burke, M.M.; Mercer, C.; Ramos-Torres, S.; Lindsay, R.; Burakov, I. Frequently asked questions and answers for supporting students with section 504 Plans. Interv. Sch. Clin. 2024, 60, 214–219. [Google Scholar] [CrossRef]
  65. Bruzzese, J.; Evans, D.; Wiesemann, S.; Pinkett-Heller, M.; Levison, M.J.; Du, Y.; Fitzpatrick, C.; Krigsman, G.; Ramos-Bonoan, C.; Turner, L.; et al. Using school staff to establish a preventive network of care to improve elementary school students’ control of asthma. J. Sch. Health 2006, 76, 307–312. [Google Scholar] [CrossRef]
  66. Silvia, G.G.; Motellón, M.C.; Gómez, C.A.; Santos, L.S.; Doval, F.M.G.; Núñez, A.R. Schoolchildren with chronic diseases; What are teachers worried about? An. Pediatría 2020, 93, 374–379. [Google Scholar] [CrossRef]
  67. Bluestone, J.; Johnson, P.; Fullerton, J.; Carr, C.; Alderman, J.; BonTempo, J. Effective in-service training design and delivery: Evidence from an integrative literature review. Hum. Resour. Health 2013, 11, 51. [Google Scholar] [CrossRef]
  68. King, R.; Taylor, B.; Talpur, A.; Jackson, C.; Manley, K.; Ashby, N.; Tod, A.; Ryan, T.; Wood, E.; Senek, M.; et al. Factors that optimise the impact of continuing professional development in nursing: A rapid evidence review. Nurse Educ. Today 2021, 98, 104652. [Google Scholar] [CrossRef]
  69. Elston, R. Recognising and managing an acute asthma attack. Br. J. Child. Health 2021, 2, 12–18. [Google Scholar] [CrossRef]
  70. Ibraheem, R.M.; Hamzah, A.O.; Ameen, H.A.; Katibi, O.S.; Johnson, A.R. Evaluation of the awareness and experiences of the primary and secondary school teachers on asthma: A cross-sectional study in Ilorin, Nigeria. J. Pan Afr. Thorac. Soc. 2022, 3, 140–150. [Google Scholar] [CrossRef]
  71. Salih, M.R.M.; Abd, A.Y.; Fawzi, H.A. Awareness of asthma and its management in primary school teachers in Baghdad, Iraq. F1000Research 2022, 11, 367. [Google Scholar] [CrossRef]
  72. Janevic, M.R.; Baptist, A.P.; Bryant-Stephens, T.; Lara, M.; Persky, V.; Ramos-Valencia, G.; Uyeda, K.; Hazan, R.; Garrity, A.; Malveaux, F.J. Effects of pediatric asthma care coordination in underserved communities on parent perceptions of care and asthma-management confidence. J. Asthma 2017, 54, 514–519. [Google Scholar] [CrossRef] [PubMed]
  73. Kilbourne, A.M.; Hynes, D.; O’Toole, T.; Atkins, D. A research agenda for care coordination for chronic conditions: Aligning implementation, technology, and policy strategies. Transl. Behav. Med. 2018, 8, 515–521. [Google Scholar] [CrossRef]
  74. Singer, C.; Porta, C. Improving patient well-being in the United States through care coordination interventions informed by social determinants of health. Health Social. Care Community 2022, 30, 2270–2281. [Google Scholar] [CrossRef]
Table 1. Asthma Management and Information Seeking Self-Efficacy by Child Chronic Illness/Asthma Status.
Table 1. Asthma Management and Information Seeking Self-Efficacy by Child Chronic Illness/Asthma Status.
YesNoUnsure
M (SD)M (SD)M (SD)F (p)Post Hoc
Differences
Asthma Management
Have you ever had a child in your classroom with a chronic disease?6.13 (2.45)5.41 (2.19)4.41 (2.57)6.91 (0.001)Yes and Unsure
Have you had a child in your classroom in the last year with asthma?6.02 (2.49)5.55
(2.36)		3.94 (1.70)1.78
(0.170)
Information Seeking
Have you ever had a child in your classroom with a chronic disease?7.65 (2.22)7.86 (1.99)6.46 (2.59)3.65 (0.027)Yes and Unsure
No and Unsure
Have you had a child in your classroom in the last year with asthma?7.58
(2.23)		1.71 (2.29)6.67
(1.53)		0.332
(0.717)
M = mean; SD = Standard Deviation; F (p) = test statistic and significance.
Table 2. Asthma Management and Information Seeking Self-Efficacy by In-Service Training for Medical Emergencies, Knowledge of Symptoms or Signs of an Asthma Attack, Use of 504 Plans, Use of Asthma Action Plans, and Medical Supports.
Table 2. Asthma Management and Information Seeking Self-Efficacy by In-Service Training for Medical Emergencies, Knowledge of Symptoms or Signs of an Asthma Attack, Use of 504 Plans, Use of Asthma Action Plans, and Medical Supports.
YesNo
M (SD)M (SD)F (p)
Asthma Management
Have you had specific in-service training in dealing with medical emergencies in the classroom?6.07 (2.37)5.65 (2.65)2.38
(0.124)
If a child in your class is having an asthma attack, do you know what the symptoms and signs of an attack look like?6.66
(2.12)		2.59
(1.59)		87.38
(<0.001)
Do children with asthma in your school have a 504 plan?6.69
(2.41)		6.24
(2.52)		1.60
(0.207)
Do children with asthma in your school have an asthma action plan? 6.56
(2.22)		6.22
(2.92)		0.781
(0.378)
In general, do you think that students with asthma receive the medical support they need in your school?6.13
(2.38)		5.55
(2.96)		0.876
(0.350)
Information Seeking
Have you had specific in-service training in dealing with medical emergencies in the classroom?7.81 (2.09)7.14 (2.47)7.69 (0.006)
If a child in your class is having an asthma attack, do you know what the symptoms and signs of an attack look like?7.91
(2.00)		6.58
(2.73)		9.63
(0.002)
Do children with asthma in your school have a 504 plan?8.14
(2.09)		7.73
(2.26)		1.67
(0.197)
Do children with asthma in your school have an asthma action plan? 8.28
(1.87)		7.06
(2.91)		11.84
(<0.001)
In general, do you think that students with asthma receive the medical support they need in your school?7.84
(2.12)		6.00
(2.98)		10.99
(0.001)
M = mean; SD = Standard Deviation; F (p) = test statistic and significance.
Table 3. Asthma Management and Information Seeking Self-Efficacy by Information and Referral Services.
Table 3. Asthma Management and Information Seeking Self-Efficacy by Information and Referral Services.
YesNoUnsure
M (SD)M (SD)M (SD)F (p)Post Hoc Analyses
Asthma Management
Does your school provide general resources or links to community agencies or physicians that might assist you with information or referral services for youth with asthma?6.66 (2.33)6.00 (2.51)5.31 (2.40)9.91 (<0.001)Yes and Unsure
Information Seeking
Does your school provide general resources or links to community agencies or physicians that might assist you with information or referral services for youth with asthma?8.20 (1.93)7.37 (2.39)7.31 (2.25)6.18 (0.002)Yes and Unsure;
Yes and No
M = mean; SD = Standard Deviation; F (p) = test statistic and significance.
Table 4. Asthma Management and Information Seeking Self-Efficacy by Teachers’ Reported Diagnoses of Chronic Illness, Asthma, and Allergies.
Table 4. Asthma Management and Information Seeking Self-Efficacy by Teachers’ Reported Diagnoses of Chronic Illness, Asthma, and Allergies.
YesNo
M (SD)M (SD)F (p)
Asthma Management
Do you have a chronic illness other than asthma?6.90
(2.26)		5.80
(2.47)		8.17
(0.005)
Do you have asthma?7.64
(2.22)		5.65
(2.40)		32.43
(<0.001)
Do you have allergies?6.35
(2.42)		5.20
(2.39)		20.15
(<0.001)
Information Seeking
Do you have a chronic illness other than asthma?8.04
(1.86)		7.53
(2.23)		2.23
(0.146)
Do you have asthma?7.95
(2.07)		7.53
(2.26)		1.64
(0.202)
Do you have allergies?7.73
(2.13)		7.35
(2.40)		2.48
(0.117)
M = mean; SD = Standard Deviation; F (p) = test statistic and significance.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Schilling, E.; Neuharth-Pritchett, S.; Davie, S.H.; Getch, Y.Q. Teacher Self-Efficacy in Asthma Management in Elementary and Middle Schools. Allergies 2025, 5, 25. https://doi.org/10.3390/allergies5030025

AMA Style

Schilling E, Neuharth-Pritchett S, Davie SH, Getch YQ. Teacher Self-Efficacy in Asthma Management in Elementary and Middle Schools. Allergies. 2025; 5(3):25. https://doi.org/10.3390/allergies5030025

Chicago/Turabian Style

Schilling, Ethan, Stacey Neuharth-Pritchett, Sofia H. Davie, and Yvette Q. Getch. 2025. "Teacher Self-Efficacy in Asthma Management in Elementary and Middle Schools" Allergies 5, no. 3: 25. https://doi.org/10.3390/allergies5030025

APA Style

Schilling, E., Neuharth-Pritchett, S., Davie, S. H., & Getch, Y. Q. (2025). Teacher Self-Efficacy in Asthma Management in Elementary and Middle Schools. Allergies, 5(3), 25. https://doi.org/10.3390/allergies5030025

Article Metrics

Back to TopTop