Impact of Parental Illness Uncertainty on Asthma Control in Children: The Chain Mediation of Resilience and Fear of Progression.

BACKGROUND

Parental illness uncertainty may affect pediatric asthma management, yet the psychological pathways linking parental uncertainty to child asthma control remain unclear. This study aimed to examine the chain mediating roles of resilience and fear of progression (FoP) in the association between parental illness uncertainty and childhood asthma control.

METHODS

A cross-sectional survey was conducted among 288 child-mother dyads attending follow-up visits at the pediatric outpatient clinic of a tertiary hospital in Fujian Province, China, between January 2025 and April 2026. Parental perceived illness uncertainty (PPUS), resilience, fear of progression (FoP), and childhood asthma control were measured. Chain mediation analysis was conducted using the PROCESS macro (Model 6) with 5000 bootstrap resamples.

RESULTS

Parental illness uncertainty was negatively correlated with asthma control (r = -0.575, p < 0.001). The chain mediation model showed acceptable fit (CFI = 0.952, TLI = 0.952, RMSEA = 0.074, SRMR = 0.032). The direct effect of illness uncertainty on C-ACT scores was significant (β = -0.361, 95% CI [-0.464, -0.259]), accounting for 62.8% of the total effect. Three significant indirect pathways were identified: through resilience alone (β = -0.158, 95% CI [-0.223, -0.092]; 27.4% of the total effect), through FoP alone (β = -0.036, 95% CI [-0.070, -0.003]; 6.3%), and the chain pathway through resilience and FoP (β = -0.020, 95% CI [-0.038, -0.001]; 3.4%). The total indirect effect was -0.214 (95% CI [-0.292, -0.136]), accounting for 37.2% of the total effect.

CONCLUSION

Parental illness uncertainty was directly associated with poorer childhood asthma control and was indirectly associated with it through resilience and fear of progression. Strengthening parental resilience and reducing excessive fear of progression may be promising targets for family-centered interventions supporting pediatric asthma management.