Table 1 Concept and Indicator Definitions, Guiding Principles, and Qualitative Study Referents

Participation in Life Activities

A child's or adolescent's unrestricted involvement in chosen pursuits, such as sports, clubs, interests, and hobbies.

Subjects self-select up to five or more of their most favorite or desirable activities.

Whereas some participants were not interested in sports, others competed at state, national, and international levels.

• Activities are allowed to change over time as children grow and develop.

* I didn't grow up with sports and wasn't around sports so I am not as interested in sports. I'm student director of our youth group. My asthma is no big deal. I only take medication as needed.

• The activities are not as important as the level of restriction from participation believed to motivate changes in self management.

* Everybody needs to succeed at something: chess, academics, art or sports. Success is what makes you. I'm good at swimming.

Indicators

1. Planning for Participation

The amount of thinking about the condition required before engaging in desired activities.

With proper treatment and management, children with asthma should be able to participate in the same activities and at the same level as children without asthma.

Participation sometimes required planning.

• Children may sometimes need to consider their asthma when planning for activities.

* Now that I'm going to be starting cheerleading, I have to start taking asthma medication every day. I will also need to carry my inhaler with me.

* When leaving to play basketball, my friends ask me if I have my inhaler because they don't want to have to come back if I have breathing problems.

2. Interference with Participation

The amount of temporary disruption with engaging in desired activities due to the condition.

• Children should rarely allow asthma to interfere with or disrupt participation.

Participants shared thoughts and feelings of times asthma interfered with participation.

* I went on a hayride with my friends and started having asthma problems around the campfire that evening.

* I hate having to sit out and watch because of my asthma.

3. Prevention from Participation

The amount of complete limitation from engaging in desired activities due to the condition.

• Children should almost never allow asthma to prevent participation.

Where some participants were prevented from caring for pets, others followed medical treatment plans and used management techniques so that participation was possible.

* I want to have a pet to care for, but can't because of my asthma.

* Living on a farm, I have to take my medication everyday so I can care for my horse and play with the dogs.