This research was carried out in a tertiary Hospital at Jimma University Comprehensive Specialized Hospital, Oromia, Ethiopia. Jimma city is the capital of the Jimma zone found at 356 Km from Addis Ababa, the capital city of Ethiopia, in the Southwestern part of the country. Jimma University Comprehensive Specialized Hospital is one of the oldest public hospitals in the country and it is the only teaching and referral hospital in the south-western part of the country. It provides services for approximately 19,000 inpatients, 160,000 outpatient attendances, 5,000 delivery, and 11,000 emergency cases annually. It has a bed capacity of 800 and an estimated total number of 14,000 adult patients admitted annually. The hospital has 1,600 staff members, 23 service delivery units, 698 Staff nurses, 125 pharmacy staff and different working units like medical, surgical, maternity, Gynecology, oncology, ophthalmology, psychiatry, and the like. Approximately, 19,000 patients attend the follow-up clinic for NCDs, in a year (82).

The study was conducted from May 1 to June 1 2023.

A cross-sectional institutional research approach was employed.

All adult patients with chronic asthma diseases at Jimma University Comprehensive Specialized Hospital.

All selected adult patients with chronic asthma diseases were regularly followed up at Jimma University Comprehensive Specialized Hospital during the data collection period.

All adult patients aged ≥18 years who were regularly followed up for at least six months with chronic asthma diseases were able to respond.

Patients who were critically ill.

The research used a single-population proportion formula to determine the appropriate sample size, considering the level of perceived autonomy in chronic disease in Ethiopia at Mettu was 60.5% (17), with a 95% confidence interval, and a 5% margin of error. The sample size for primary potential predictors was also calculated using Epi Info Version 7.2.0.1. Subsequently, the largest sample size was selected from both methods. Later on 5% nonresponse rate was added, and the ultimate sample size was 349. Participants were recruited over two months until the allotted number was reached.

All adult patients aged ≥18 years with chronic asthma diseases on regular follow-ups at Jimma University Comprehensive Specialized Hospital were selected during the data collection period. The study participants were consecutively recruited from April 1 to July 1, 2023.

Perceived level of autonomy in decision-making.

Sociodemographic Variables (age, sex, monthly family income, area where they live, educational level, marital status, occupation, and source of information), clinically related variables (type and stage of the disease, family history, informal caregiver, duration of disease, type of treatment, and presence of comorbidity), health-related factors (smoking cigarettes, alcohol users, physical inactivity), patient health literacy, healthcare provider-related factors (healthcare professional role and types of healthcare profession and their role), and health information and communication (language barriers, jargon medical words, and decisional aid materials).

The study used a Patient Autonomy Preference Index questionnaire, which has been proven to be effective in determining the level of patient autonomy in self-management. The questionnaire consists of four sections and 59 items, including socio-demographic, illness-related, health literacy, and Patient Autonomy Preference Index questionnaires (19). The Patient Autonomy Preference Index questionnaires were rated on a five-point Likert scale, with participants rating their agreement with each statement. The results were then categorized as high or low based on the mean score of each question. The instrument has improved in validity and reliability over time, making it the most effective tool for gauging patient participation in healthcare decision-making.

Patients with brachial asthma who had been monitored for at least six months following their service completion during the data collection period were interviewed face-to-face. Two BSc nurses from Shenan Gibe Hospital were chosen based on their prior expertise in gathering data. Patient cards were used to collect clinical factor data on the patients.

A total of 175 participants were recruited. Among them, 127 (72.6%) were female, the mean age was 47.51 with a standard deviation of 13.96, 92(52.6%) were Muslim followers, 101(57.7%) lived in urban areas, 54 (30.9%) had no formal education, 56(32%) of their occupation was housewife, 140 (80%) were married, 100(57.1%) had monthly income <2,500 Ethiopian Birr, 112 (64%) had health insurance, 102(83.3%) obtained health information about their condition from healthcare workers, 134(76.6%) got information from Doctors and nurses, and around 12(6.9%) not differentiate types of health care provided they receive the care and information (Table 1).

Regarding risky health behavior, 172(98.3%) were non-cigarette smokers, 18(10.3%) were non-alcohol users, from those who used alcohol 23 (8.6%) drank alcohol for more than five years, 39(22.3%) engaged in regular physical exercise and from those 37(21.1%) was doing physical exercise less than 30 min, and 99(56.6%) not done regular exercise due to not have interest with doing exercise (Table 2).

From the total recruited participants 72(41.1%) had comorbid disease with asthma, 80(45.7%) had health information material for decision for disease on follow-up and 20(11.4%) for comorbid disease with asthma, 17(9.7%) had family history of the same illness, 43(24.6%) of their caregiver was family, 41(23.4%) has peer network with the same disease on follow-up, 108 (61.7%) diagnosed below five years after diagnosis, and 146 (83.4%) had a history of hospitalization for the disease on follow-up (Table 3).

Items related to health literacy, which were rated from one to five on a five-point Likert scale, were totaled and handled as continuous variables. The study participants’ health literacy mean and standard deviation was 20.923 (SD ± 5.31).

The participants’ preference for autonomy in managing their asthma exacerbation was found to have a mean score and standard deviation of 43.87 (SD ± 10.49) with a range of 23–72. By dichotomizing based on their mean, 73(41.7%) [95% CI: 34.34, 49.09] Of study participants reported having autonomy in their self-management of asthma exacerbation.

By adjusting for confounding factors, binary and multivariable logistic regression models were used to evaluate the relationship between independent variables and patient autonomy in self-management. Age, residence, educational status, marital status, occupation, health insurance, source of health information, types of health care provider in information sharing, alcohol, exercise, comorbidity, having decisional aid for disease on follow-up, Family history with the disease on follow up, peer network, duration since diagnosed, hospitalization, and patient health literacy were a candidate for multivariate logistic regression analysis. In the multivariate logistic regression analysis, only six variables (residence, health insurance, regular exercise, family history, duration of the disease since diagnosis, and patient health literacy became statistically significant (p < 0.05) (Table 4).

Participants who live in the urban area has three times more likely autonomous in self-management of asthma exacerbation than those from rural areas (AOR = 3.24; 95% CI: 1.40–7.49), those participants had health insurance has four times more likely autonomous in self-management of asthma exacerbation than those has no health insurance (AOR = 4.30; 95% CI: 1.76–10.51), those doing regular physical exercise has around four point seven more likely autonomous in self-management of asthma exacerbation than those not doing regular physical exercise (AOR = 4.79; 95% CI: 1.69–13.64).

Participants those has family history of bronchial asthma seven ctimes more likely autonomous in self-management of asthma exacerbation than those has no family history of asthma (AOR = 7.47; 95% CI: 1.61–34.60), those participants diagnosed with bronchial asthma below five year duration was 56% less likely autonomous in self-management of asthma exacerbation than those five years and above since diagnosed with asthma (AOR = 0.44; 95% CI: 1.04–1.26).

This study also indicated, for every one-point increase in a participant's health literacy score, the Log odds that the participants will have autonomous in self-management of asthma exacerbation increases by 1.1(β = 0.093, AOR = 1.1, 95% CI: 1.00–1.20) on average (Table 4).

The study used a cross-sectional institutional research design to examine patient autonomy in self-management, specifically in asthma patients. The research was conducted in a tertiary hospital, allowing for a diverse patient population. The Patient Autonomy Preference Index was used to understand decision-making and self-management preferences. The study included patients with at least six months of regular follow-up, ensuring reliability and exploring the relationship between autonomy and asthma management. However the exclusion of critically ill patients may limit the applicability of the findings to a broader patient population, the cross-sectional design does not allow for causal inferences, as it captures data at a single point in time, and Potential biases in self-reported data could affect the accuracy of the results, as patients may overestimate their autonomy.

The study's limitation is the use of the Patient Autonomy Preference Index, which may not be specific to bronchial asthma management. The tool does not account for unique aspects of asthma care, such as adherence to individualized action plans or specific guidelines. The study also did not evaluate adherence behaviors, such as medication use or proper inhaler technique. Future research should adapt Patient Autonomy Preference Index to better reflect asthma care and recruit a larger cohort to further validate these findings and enhance their generalizability.

Nurses should be aware of the factors influencing patient autonomy, such as health literacy and access to healthcare, to better support patients in self-management and also Training programs focusing on enhancing communication skills can empower nurses to facilitate shared decision-making with patients, particularly in rural settings where barriers exist.