Peer-Administered Asthma Self-Management Intervention in Urban Middle Schools

城市中学同伴管理的哮喘自我管理干预

基本信息

批准号：
10166614
负责人：
GLORISA J CANINO
金额：
$ 70.47万
依托单位：
RHODE ISLAND HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-25 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10166614
关键词：
Address Administrator Adoption Affect Asthma Caregivers Caring Child Child Health Childhood Asthma Clinical effectiveness Collaborations Communities Control Groups Cultural Backgrounds Data Development Dimensions Dominican Education Enrollment Ensure Evaluation Future Geographic Locations Guidelines Health Health behavior Health education High Prevalence Human Resources Hybrids Institution Intervention Interview Knowledge Language Latino Maintenance Measures Mediating Methods Middle School Student Modeling Morbidity - disease rate Outcome Participant Penetration Play Process Puerto Rican Puerto Rico Quality Control Randomized Randomized Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Records Rhode Island Role Sample Size Sampling School Nursing Schools Self Efficacy Self Management Site Stress Students Surveys Symptoms Testing Training Translating Work age group asthma inhaler attentional control base clinical implementation control trial design disadvantaged population effectiveness evaluation effectiveness testing eighth grade eleventh grade health belief health disparity high risk implementation process implementation strategy improved intervention effect junior high school mortality novel peer pilot trial post intervention primary caregiver primary outcome programs pulmonary function reduce symptoms school district secondary outcome skills standard of care success symptomatic improvement treatment effect urban children urban school urban setting

项目摘要

Project Summary/Abstract: Health disparities in pediatric asthma persist, with Latino children demonstrating increased asthma morbidity. Middle school children have greater morbidity than children from any other age group, yet there are no school- based asthma management programs developed for this group. To address these gaps, we have developed and piloted a novel group-based intervention: ASMAS (Asthma Self-MAnagement in Schools) in two geographic areas with a high proportion of urban, Latino children with asthma: Providence, Rhode Island, and San Juan, Puerto Rico. ASMAS is a 4-session, peer-facilitated asthma self-management intervention specific to the school setting for Latino middle school (6th-8th graders) children. It is delivered by trained Latino High School Juniors and Seniors with asthma, adapts guidelines-based self-management to the urban school setting, and is consistent with Latino children's cultural backgrounds. In our pilot RCT, ASMAS improved asthma outcomes and self-management for the targeted groups. Our proposed approach involves a hybrid design including a large-scale randomized, controlled trial investigating the effect of ASMAS, and an evaluation of the implementation process to inform future plans to test ASMAS in additional urban settings. Our first aim is to evaluate the effects of ASMAS on asthma health outcomes (e.g., control, symptom free days, absences, lung function) and asthma self-management (skills, knowledge and self-efficacy, availability of rescue inhaler and action plan at school) in a sample of 432 Latino middle school children with asthma in Providence, RI and San Juan, PR (216 per site; 72 per condition). 6th to 8th grade middle schoolers will be enrolled then randomly assigned to 1) ASMAS, or 2) Asthma Education plus Child Health control condition, or 3) a no treatment control condition (9 groups of each condition per site; 8 children per group). Student and primary caregiver assessments will occur at baseline, end of treatment (directly following the intervention), and at three, 4-month post intervention follow-ups. Our second aim is to conduct a mixed-methods, multi-stakeholder process evaluation using the RE-AIM framework,48-50 with students, caregivers, HS Peers, school administrators and additional community stakeholders invested in supporting students' asthma care. We will begin to develop implementation strategies with key stakeholders to better prepare for future large-scale evaluation of the effectiveness of ASMAS and its implementation in additional urban centers. Relative to controls, over 1 year, we expect that ASMAS participants will have improved asthma outcomes and self- management. We also expect treatment effects on asthma outcomes will be mediated through changes in self- management in all children, and moderated by acculturative stress and language proficiency in RI children. The proposed work offers a critical opportunity to evaluate ASMAS for improving asthma outcomes for children at high risk on a larger-scale and to develop avenues for sustainability and future dissemination with state and community stakeholders.

项目摘要/摘要：小儿哮喘的健康差异仍然存在，拉丁裔儿童的哮喘发病率有所增加。中学生的发病率高于任何其他年龄段的儿童，但学校没有为该群体制定了基于哮喘管理计划。为了解决这些差距，我们开发了并在两个地区试点了一种新颖的基于团体的干预措施：ASMAS（学校哮喘自我管理）城市、拉丁裔哮喘儿童比例较高的地理区域：普罗维登斯、罗德岛州和波多黎各圣胡安。 ASMAS 是一项为期 4 个疗程、同伴协助的哮喘自我管理干预措施拉丁裔中学（6 至 8 年级学生）儿童的学校环境。它由训练有素的拉丁裔高中提供患有哮喘的学校三年级和四年级学生，将基于指南的自我管理融入城市学校设定，并且符合拉丁裔儿童的文化背景。在我们的试点随机对照试验中，ASMAS 得到了改善目标群体的哮喘结果和自我管理。我们提出的方法涉及混合设计包括调查 ASMAS 效果的大规模随机对照试验以及评估的实施过程，为未来在其他城市环境中测试 ASMAS 的计划提供信息。我们的首要目标是评估 ASMAS 对哮喘健康结果的影响（例如控制、无症状天数、缺勤、肺功能）和哮喘自我管理（技能、知识和自我效能、救援吸入器的可用性以及学校的行动计划），以罗德岛州普罗维登斯市 432 名患有哮喘的拉丁裔中学生为样本圣胡安，波多黎各（每个站点 216 个；每个条件 72 个）。 6至8年级中学生将随机入学分配给 1) ASMAS，或 2) 哮喘教育加儿童健康控制条件，或 3) 无治疗对照状况（每个地点每种状况 9 组；每组 8 名儿童）。学生和主要照顾者评估将在基线、治疗结束（干预后立即）以及三个月、四个月时进行干预后随访。我们的第二个目标是进行混合方法、多利益相关者流程使用 RE-AIM 框架进行评估，48-50 包括学生、看护者、高中同学、学校管理人员以及其他社区利益相关者投资支持学生的哮喘护理。我们将开始与主要利益相关者一起制定实施战略，以便更好地为未来的大规模评估 ASMAS 的有效性及其在其他城市中心的实施。相对于控制，在一年多的时间里，我们预计 ASMAS 参与者将改善哮喘结果和自我改善管理。我们还预计对哮喘结果的治疗效果将通过自我改变来调节对所有儿童进行管理，并通过 RI 儿童的文化压力和语言能力来调节。拟议的工作为评估 ASMAS 改善儿童哮喘结果提供了重要机会面临更大范围的高风险，并与国家和政府共同开发可持续发展和未来传播的途径社区利益相关者。