The role of parental psychological flexibility in childhood asthma management: An analysis of cross-lagged panel models

Objective: This is a secondary analysis of a previously reported randomized controlled trial, aimed at examining the mediating role of parental psychological flexibility (PF) in an Acceptance and Commitment Therapy (ACT)-based childhood asthma management program for parents. Methods: The participants were 168 parents (mean age (SD) = 38.40 (5.90) years; 88.1% mothers) and their children who had been diagnosed with asthma (mean age (SD) = 6.81 (2.50) years; 62% boys). They were randomly allocated to either the program composed of a four-session, group-based ACT plus asthma education (ACT Group) or to a group-based asthma education talk plus three telephone follow-ups (Control Group). The parents underwent assessments at baseline, and immediately, 3-months, and 6-months after the intervention for the following outcomes: PF (Acceptance and Action Questionnaire-II), psychological distress of the parents (Depression Anxiety Stress Scale-21); and the asthma symptoms and use of inhaled bronchodilators of their children. Results: Cross-lagged panel models showed that the improvement in parental PF at post-intervention mediated the effect of ACT on reducing parental psychological distress (all beta coefficients (βs) ranged from −2.20 to - 2.30, all Ps < 0.01) and childhood asthma symptoms in terms of daytime symptoms (β = −0.22, 95% CI [−0.52, −0.02], P = 0.04), nighttime symptoms (β = −0.17, 95% CI [−0.33, −0.02], P = 0.04), and the use of bronchodilators (β = −0.22, 95% CI [−0.48, −0.02], P = 0.03) at 6-months post-intervention. Conclusion: ACT makes a unique contribution to improving the health outcomes of parents and their children diagnosed with asthma through fostering parental PF.