Integrating gratitude-based interventions with peer education improves outcomes in school-aged children with asthma: A two-phase clinical study

Childhood asthma remains poorly controlled globally. We aimed to identify social, behavioral, and comorbid factors affecting asthma control and evaluate a novel management strategy combining gratitude-based positive psychology interventions with peer interaction education for asthma self-management. This study employed a sequential two-phase design. Phase 1 comprised a retrospective analysis of clinical data from 152 children with asthma (aged 6-14 years) treated from June 2022 to June 2023 to identify social, behavioral, and comorbid risk factors for poor control. Phase 2 consisted of a prospective non-randomized controlled trial evaluating 120 children allocated to either a control group (CG, n = 60) or research group (RG, n = 60) from December 2023 to December 2024. Allocation occurred through a time-based enrollment process. The RG received an integrated program combining gratitude-based psychological interventions with structured peer interaction components (facilitated child-only small groups with skills rehearsal and mutual symptom monitoring) targeting asthma self-management in addition to standard care. Outcomes included self-management abilities (primary outcome), asthma control, quality of life, family functioning, caregiver psychological parameters, and clinical outcomes. Multivariable analysis from Phase 1 identified key risk factors for poor asthma control including comorbid allergic rhinitis (odds ratio (OR) = 1.23, 95% confidence interval (CI): 0.98-1.67), guardian smoking (OR = 1.36, 95% CI: 1.02-2.17), medication non-adherence (OR = 1.44, 95% CI: 1.12-2.37), low family functioning (OR = 4.59, 95% CI: 1.12-9.33), and absence of health education (OR = 5.13, 95% CI: 1.54-7.80). In Phase 2, the RG demonstrated significantly higher treatment adherence (90% vs 76.7%, P = .033), improved asthma control scores (adjusted mean difference: 2.3 points, 95% CI: 1.1-3.5, P = .049), enhanced quality of life (adjusted mean difference: 0.6 points, 95% CI: 0.3-0.9, P = .018), and better family functioning (P = .004) compared to the CG. The RG experienced fewer clinical events with incidence rate ratio of 0.33 (95% CI: 0.12-0.91, P = .032) for relapses over 12 months of follow-up. Integrating gratitude-based interventions with peer education is associated with clinically meaningful improvements in self-management, asthma control, and quality of life in school-aged children with asthma.