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（由适用提供）：儿童哮喘症状的感知不足是急诊就诊，住院和近乎致命/致命的哮喘发作的主要危险因素。波多黎各人和黑人儿童的哮喘发病率和死亡率比所有其他种族/族裔群体都要高。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哮喘健康差异差距。迄今为止，尚无RCT研究旨在改善少数民族儿童的哮喘症状感知。这项R01研究基于这项新研究者PI的先前赠款。我们证明了未接受峰值呼气流量流量（PEF）反馈不足的哮喘症状的儿童为42％的时间，而PEF反馈组的哮喘症状为15％，并且控制器药物的依从性较低（27.5％vs. 48.8％）。提出的随机对照试验由两个臂组成：PEF反馈（n = 130）与控制反馈（n = 130）。有10-17岁哮喘的拉丁裔和黑人青少年将从纽约州布朗克斯市的诊所招募10-17岁的护理人员。主要目的是检查PEF预测的效率，反馈与控制反馈对1）哮喘症状的感受不足2）控制器药物依从性和3）哮喘控制和紧急医疗保健使用。这些目标将在1年的随访中进行检查。探索性目的研究了假设的途径，即PEF干预减少了症状不足，将疾病表征转移到专业模型，并增加了青少年的“和父母”的哮喘管理自我效能感，从而导致更大的药物依从性并改善了哮喘控制。所有家庭的基线访问包括标准化的哮喘教育，然后进行3周的PEF预测，而无需使用可编程的电子螺旋计反馈。然后，参与者将被随机分配到干预组及其肺活量计重编程，显示实际的PEF和每日哮喘管理消息（PEF反馈组）或简短的积极信息（控制反馈组）。在接下来的6周内，所有青少年将预测其PEF，这将在吹入设备之前被锁定。家庭将在干预后和干预后返回，以接收有关症状感知和解决问题技能培训（PEF反馈小组）或支持咨询（控制反馈组）的口头个性化反馈。所有青少年都会扮演“寻求代码”，以加强基线哮喘教育。在干预后访问中，将对所有青少年的肺活量计进行重新编程，以便在接下来的4周内不提供任何反馈。这些症状感知数据将在干预后1个月下载。控制器药物的依从性将由电子设备监控。干预后会议将在3、6、9和12个月进行。 依从性数据并进行肺活量测定法。医生将使用国家准则对哮喘控制和哮喘控制造成看法。一个12个月的回顾性医疗记录抽象将比较群体之间哮喘的紧急医疗保健用途。