Motivating Asthma Adherence in Urban Teens

激励城市青少年坚持哮喘治疗

• 批准号: 6980310
• 负责人: CYNTHIA S RAND
• 金额: $ 45.31万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-13 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6980310
• 关键词: African American; adolescence (12-20); asthma; behavioral /social science research tag; caucasian American; clinical research; clinical trials; counseling; emergency health services; health disparity; health services research tag; human subject; human therapy evaluation; interview; middle childhood (6-11); motivation; outcomes research; patient monitoring device; patient oriented research; quality of life; racial /ethnic difference; respiratory disorder chemotherapy; therapy compliance; urban poverty area

Low-income, minority teenagers have disproportionately high rates of asthma morbidity, including excess risk of emergency department (ED) care, hospitalization and death from asthma, compared to white adolescents. Research by this group and others has documented that non-adherence with asthma treatment regimens is common among high-risk, inner city families with asthma, and that this poor adherence with prescribed therapies plays a significant contributing role in asthma morbidity. Inner-city adolescents with asthma are at particular risk of non-adherence, yet this population remains understudied. While asthma self-management training has shown promise in achieving some improvement in adherence with asthma, there are few intervention studies explicitly targeting adolescents, particularly those in the inner-city. Urban children typically assume primary control over their asthma management during late childhood/early adolescence. At the same time, adolescents' efforts to achieve autonomy and peer-acceptance may result in increase health risk behaviors, including poor asthma self-management. Developmentally-appropriate asthma self-management interventions are needed that target the unique challenges of adolescence. Motivational Interviewing (Ml) is a promising interventional approach that uses a client-centered, nondirective approach for enhancing motivation to change health behaviors. Ml techniques are developmentally consistent with the needs of early adolescents. Ml does not assume that health will be the most important factor motivating the teen, but rather acknowledges and incorporates other motivators that are within the context of the teen's life, thus this intervention strategy has the flexibility to adapt to the unique life circumstances and stressors faced by urban adolescents. We propose to evaluate the relative effectiveness of a Mi-focused self-management intervention (MI+SM) compared to a self-management (SM) intervention containing asthma education and self-monitoring strategies in a sample of 226 children age 10-15 years treated for asthma in the ED. Our primary hypothesis is that the MI+SM, as compared to SM alone, will result in greater improvement in medication adherence at 3- and 6-months post-randomization, as measured by electronic medication monitoring. Secondary outcomes include self-reported medication adherence, symptoms free days, urgent health care utilization for asthma, and caregiver/adolescent quality of life.

与白人青少年相比，低收入、少数族裔青少年的哮喘发病率过高，包括急诊室 (ED) 护理、住院治疗和因哮喘死亡的风险过高。该小组和其他人的研究表明，不遵守哮喘治疗方案在患有哮喘的高风险内城区家庭中很常见，而这种对处方疗法的依从性差在哮喘发病率中起着重要作用。内城区患有哮喘的青少年尤其面临不遵守规定的风险，但这一人群的研究仍未充分。虽然哮喘自我管理培训已显示出在改善哮喘依从性方面的前景，但很少有明确针对青少年的干预研究，尤其是内城区的青少年。城市儿童通常在童年晚期/青春期早期承担对哮喘管理的主要控制权。与此同时，青少年努力实现自主和同伴接受可能会导致健康风险行为增加，包括哮喘自我管理不佳。需要针对青春期独特挑战的适合发育的哮喘自我管理干预措施。动机访谈（Ml）是一种很有前景的干预方法，它采用以客户为中心的非指导性方法来增强改变健康行为的动机。机器学习技术在发展上符合青少年早期的需求。 Ml并不认为健康将是激励青少年的最重要因素，而是承认并纳入青少年生活背景中的其他激励因素，因此这种干预策略具有灵活性，可以适应独特的生活环境和面临的压力。由城市青少年。我们建议以 226 名 10-15 岁儿童为样本，评估以 Mi 为中心的自我管理干预 (MI+SM) 与包含哮喘教育和自我监测策略的自我管理 (SM) 干预的相对有效性在急诊室接受哮喘治疗。我们的主要假设是，与单独的 SM 相比，MI+SM 将在随机化后 3 个月和 6 个月的药物依从性方面带来更大的改善（通过电子药物监测测量）。次要结局包括自我报告的药物依从性、无症状天数、针对哮喘的紧急医疗保健利用以及护理人员/青少年的生活质量。