4 | DISCUSSION
In this research, the authors determine that mindfulness has a partial mediator effect in the relationship between perceived stress and the quality of life, in the relationship between perceived stress and activity limitation and the relationship between perceived stress and emotional function. However, there is no correlational relationship between mindfulness and symptoms which is subscale of the quality of life.
There are studies investigating the relationship between stress and the quality of life in asthmatics7, between stress and mindfulness14, 15 and between mindfulness and quality of life21 there are studies investigating the relationship. These studies have similar results with our study. They found significant correlative relationships between perceived stress, mindfulness and quality of life in people with asthma. According to the literature, it is been shown that when mindfulness increases, health and psychological well-being also increase.14 In chronic diseases when stress reduces due to mindfulness, psychological well-being increases.15 Mindfulness practises improve the quality of life in asthmatic people.17 Mindfulness increases asthma-based quality of life and asthma-based stress has a small part in this relationship.21
Even though there are research that shows the significant relationship between mindfulness and activity limitation17, our finding showed that, there is no correlational relationship between mindfulness and activity limitation. When mindfulness training was applied to an asthma group for eight weeks, a relationship was found between mindfulness and activity limitation and controlled asthma rate increased from 7.3% to 19.4%.17 There is a difference between our study and the research in question in terms of distribution of asthma control levels. In our study, controlled asthma rate (51%) was higher than partially-controlled (36%) and uncontrolled asthma rate (13%); therefore, the result might be not significant. Furthermore, the seasonal activity rates of the participants might be a confusing factor that may differentiate. There are studies showing that asthma control levels improve due to the low activity rates of people with asthma in winter. For example, adults with asthma may think that their asthma control levels are better in winter because they restrict their activities in winter compared to the summer seasons.29 The data collection process of our study coincided with the months of January, February and March, our participant group attends to school during the winter months, coincides with most daily activities.
In literature, the symptoms of the disease positively correlate with the stress level of asthmatic people.30 Asthma symptoms decrease with the increase of mindfulness.16 In our study, it was understood that mindfulness in pediatric asthma had a partial effect on the relationship between perceived stress and symptoms.
People with asthma decrease their emotional functionality due to inefficient coping with stress.31 Conversely, it has been observed that the increase of mindfulness levels affects emotional functionality.32 In our study, it was determined that mindfulness has a partial effect on the relationship between perceived stress and emotional function.
In this study, it was discovered that the perceived stress does not differ according to the asthma control levels, but the perceived stress level decreases hierarchically with the increase of the asthma control level. Literature has shown that the level of stress varies according to asthma control and consistent with our research, low asthma control and excessive stress are associated.21, 33 In a study, perceived stress increased in direct proportion with both the incidence of asthma and asthma severity.34
Mindfulness level did not change according to asthma control level. Similarly, it has been observed that asthma control has no effect on mindfulness scores in adolescents.21
Quality of life, activity limitation, symptoms and emotional function differed according to asthma control. When the level of asthma control increase; the quality of life and emotional function also increase; however, activity limitation, symptoms scores decreased. A similar study found that as asthma control decreases, quality of life decreases.35 Uncontrolled asthma had a higher activity limitation.36 According to GINA criteria, there is a negative correlation between asthma control and symptoms.37 Moreover, aggression, which is one of the emotional factors known to influence emotional functionality, has been found to decrease with increasing asthma control.38
When the previous studies were investigated, it might be said that our research has limitations. Compared to other studies, the number of participants was limited and study design was cross-sectional. Therefore, mindfulness may not have full mediator effect on the relationships in question. Although perceived stress decreases when asthma control increases, this model was not significant. It also may be related to the low number of participants. Thus, further research might investigate the same relationships with higher number of participants and design might be longitudinal. Moreover, in further studies, studying activity limitation via equally asthma control group division might occur crucial consequences. It may also be advisable to add a control group in the study to make the results more reliable on a scientific scale.
In conclusion, our study found that there is a relationship between perceived stress, mindfulness and the quality of life in pediatric asthma. Our results suggest mindfulness has a partial mediator impact on the relationship between perceived stress and quality of life, on the relationship between perceived stress and activity limitation which is the subscale of quality of life with on the relationship between perceived stress emotional function which is the quality of life’s subscale. Adding mindfulness-based practices to the current medical treatments might reduce perceived stress and increase the quality of life via reducing activity limitation, increasing emotional function. Moreover, health professionals working with asthmatic children, it may be advisable to consider the quality of life including the activities limitation, symptoms of the disease and emotional function in order to control asthma.
ACKNOWLEDGEMENTS
We would like to thank all the collaboration by the medical doctors in İstanbul University İstanbul Medical Faculty Hospital’s “Child Allergy Policlinic” and the participants.
ORCHID
Ayşe Sena Ayhan https://orcid.org/0000-0002-1192-2575
Zekeriya Deniz Aktan https://orcid.org/0000-0003-1757-2024
Zeynep Ülker Tamay https://orcid.org/0000-0002-3200-5493
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