Asthma symptom perception feedback intervention for ethnic minority adolescents

少数民族青少年哮喘症状感知反馈干预

• 批准号: 9051139
• 负责人: JONATHAN M. FELDMAN
• 金额: --
• 依托单位: YESHIVA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-15 至 2015-12-16
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9051139
• 关键词: 17 year old; Address; Adherence; Adolescent; Adrenal Cortex Hormones; African American; Age; Asthma; Blinded; Breathing; Bronchoconstriction; Bronchodilator Agents; Caregivers; Caribbean region; Child; Chronic; Clinic; Code; Counseling; Cuban; Cystic Fibrosis; Data; Devices; Diabetes Mellitus; Dominican; Education; Electronics; Emergency Care; Emergency department visit; Ethnic group; Family; Feedback; Fostering; Grant; Guidelines; Health; High Prevalence; Hospitalization; Impairment; Intervention; Language; Latino; Learning; Measures; Medical Records; Mexican; Minority Groups; Modeling; Monitor; Morbidity - disease rate; Outcome; Parents; Participant; Pathway interactions; Patients; Peak Expiratory Flow; Perception; Pharmaceutical Preparations; Physicians; Play; Prevalence; Problem Solving; Public Health; Puerto Rican; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Personnel; Respiratory physiology; Risk; Risk Factors; Schools; Self Efficacy; Self Management; Spirometry; Staging; Symptoms; Time; Visit; Vital capacity; Work; arm; asthmatic patient; base; behavior change; control trial; design; disorder control; ethnic disparity; ethnic minority population; follow-up; group intervention; health disparity; improved; individualized feedback; intervention effect; medication compliance; meter; minority children; mortality; post intervention; prevent; pulmonary function; racial and ethnic; racial and ethnic disparities; skills training

 DESCRIPTION (provided by applicant): Under-perception of asthma symptoms in children is a major risk factor for emergency department visits, hospitalizations, and near-fatal/fatal asthma attacks. Puerto Rican and Black children have greater asthma morbidity and mortality rates than all other racial/ethnic groups. Interventions targeting asthma symptom perception and medication adherence may help close this asthma health disparities gap. There are no RCT studies to date designed to improve asthma symptom perception in ethnic minority children. This R01 study builds upon this new investigator PI's prior grants. We demonstrated that children who did not receive peak expiratory flow (PEF) feedback under-perceived asthma symptoms 42% of the time vs. 15% for the PEF feedback group and had lower controller medication adherence (27.5% vs. 48.8%). The proposed randomized controlled trial consists of two arms: PEF feedback (N = 130) versus control feedback (N = 130). Latino and Black adolescents with asthma ages 10-17 years old and their caregivers will be recruited from clinics in the Bronx, NY. The primary aims are to examine the efficacy of PEF prediction with feedback versus control feedback on 1) under-perception of asthma symptoms 2) controller medication adherence and 3) asthma control and emergency health care use. These aims will be examined across a 1- year follow-up. An exploratory aim examines the hypothesized pathway that the PEF intervention reduces under-perception of symptoms, shifts illness representations toward the professional model and increases adolescents' and parents' asthma management self-efficacy, resulting in greater medication adherence and improved asthma control. The baseline visit for all families consists of standardized asthma education followed by 3 weeks of PEF prediction without feedback using a programmable, electronic spirometer. Participants then will be randomized to intervention group and their spirometer reprogrammed, showing either the actual PEF and daily asthma management messages (PEF feedback group) or a brief, positive message (control feedback group). For the next 6 weeks, all adolescents will predict their PEF, which will be locked in before blowing into the device. Families will return at mid-intervention and post-intervention to receive verbal individualized feedback on symptom perception and problem-solving skills training (PEF feedback group) or supportive counseling (control feedback group). All adolescents will play "Quest for the Code" to reinforce the baseline asthma education. At the post-intervention visit, the spirometer will be reprogrammed for all adolescents to provide no feedback for the next 4 weeks. These symptom perception data will be downloaded at 1-month post-intervention. Controller medication adherence will be monitored by electronic devices. Post-intervention sessions will take place at 3, 6, 9, and 12 months to collect adherence data and conduct spirometry. Physicians will be blinded to group assignment and rate asthma control using national guidelines. A 12-month retrospective medical record abstraction will compare emergency health care use for asthma between groups.

 描述（由申请人提供）：对儿童哮喘症状的认识不足是急诊就诊、住院治疗以及濒临死亡/致命的哮喘发作的主要危险因素。波多黎各和黑人儿童的哮喘发病率和死亡率高于所有儿童。针对哮喘症状感知和药物依从性的干预措施可能有助于缩小这种哮喘健康差异差距。迄今为止，尚无旨在改善少数族裔儿童哮喘症状感知的随机对照研究。我们证明，没有收到呼气峰流量 (PEF) 反馈的儿童在 42% 的时间内未能充分感知到哮喘症状，而接受 PEF 反馈组的这一比例为 15%，并且控制药物依从性较低（27.5%）。拟议的随机对照试验包括两个组：PEF 反馈（N = 130）与对照反馈（N = 130）。将从纽约州布朗克斯的诊所招募 10-17 岁的儿童及其护理人员，主要目的是检查 PEF 预测反馈与控制反馈在 1) 哮喘症状感知不足 2) 控制药物依从性和3) 哮喘控制和紧急医疗保健的使用。这些目标将在一年的随访中进行检查，探索性目的是检查 PEF 干预减少对症状的感知不足、将疾病表征转向实际情况的途径。专业模型并提高青少年和家长的哮喘管理自我效能，从而提高药物依从性并改善哮喘控制。所有家庭的基线访问包括标准化哮喘教育，然后使用可编程电子设备进行 3 周的 PEF 预测。然后，参与者将被随机分配到干预组，并重新编程他们的肺量计，显示实际的 PEF 和日常哮喘管理信息（PEF 反馈组）或简短的积极信息（控制反馈组）。青少年将预测他们的 PEF，该值将在干预期间和干预后返回以接收有关症状感知和问题解决技能培训（PEF 反馈小组）或支持性咨询的口头个性化反馈。 （控制反馈组）。所有青少年将玩“探索代码”以强化基线哮喘教育。在干预后访视时，将为所有青少年重新编程肺活量计，以在接下来的 4 周内不提供这些症状。感知数据将在干预后 1 个月下载。控制者用药依从性将在干预后 3、6、9 和 12 个月进行监测。 医生将根据国家指南对分组情况和哮喘控制率不知情，并通过 12 个月的回顾性病历摘要来比较各组之间哮喘的紧急医疗保健使用情况。