Individualized Interventions to Improve Asthma Adherence

提高哮喘依从性的个体化干预措施

• 批准号: 7577425
• 负责人: ANDREA J. APTER
• 金额: $ 67.99万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-05-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7577425
• 关键词: Address; Adherence; Adrenal Cortex Hormones; Adult; African American; Asthma; Attention; Attitude; Benefits and Risks; Breathing; Caring; Characteristics; Clinic; Clinical; Clinical Research; Cohort Studies; Communication; Data; Drug Formulations; Effectiveness of Interventions; Electronics; Ethnic group; Focus Groups; Goals; Inhalators; Intervention; Knowledge; Latino; Life; Link; Low income; Mediating; Mentors; Minority; Monitor; Morbidity - disease rate; Motivation; Outpatients; Participant; Patients; Population; Powder dose form; Problem Solving; Protocols documentation; Provider; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Self Efficacy; Self Management; Severities; Site; Social Environment; Social Interaction; Social support; Solutions; Testing; Theoretical model; Time; Trust; Visit; base; behavior change; contextual factors; cost; cost effectiveness; depression; ethnic minority population; experience; improved; prospective; pulmonary function; satisfaction; skills

DESCRIPTION (provided by applicant): Low-income minority adults have excessively high rates of morbidity from asthma. Poor adherence has been documented in these patients and contributes to this high morbidity. We will conduct a randomized controlled trial of Problem Solving (PS) compared with Attention Control (AC) to improve and sustain asthma self-management deliverable in a clinical setting that includes strategies to address contextual factors related to adherence. PS is based on findings from our prospective cohort study of African Americans, which identified influences of adherence in the social context. We have extracted the context from our experiences with African Americans and applied it to Latinos, another group with significant asthma morbidity. In order to accomplish this, we explored such influences in focus groups of African American and Latino patients and ultimately piloted PS extensively in both patient groups. PS addresses and integrates solutions to a problem of the participants' choosing, tailoring problem-solving to participants' needs with ways to maintain or improve adherence using a simple four-step protocol. Specific aims are to test whether: 1) PS improves adherence to ICS over AC among adults with moderate or severe persistent asthma receiving care from urban clinics serving low-income minority populations, 2) PS improves asthma control over AC, and 3) PS improves asthma-related quality of life over AC. We will recruit 450 adults from five clinics and randomize these participants to PS or A C, stratifying by site and type of ICS. Because there are no electronic monitors providing date-time adherence data with the most frequently used dry powder inhalers, we have developed and tested one and will be able to obtain date-time data on all participants. The intervention will take place over three months. Participants will be followed for an additional three months. In our cohort study, attitude (the weighing of risks and benefits of ICS), trust of and satisfaction with communication with the provider were associated with adherence. We will explore whether motivation variables such as improved knowledge of ICS, attitudes about ICS benefits, and self-efficacy provided by the intervention mediate the relationship between PS and adherence. We also will explore whether personal characteristics and contextual influences (e.g. ethnic group, educational attainment, asthma severity, etc), social interactions (e.g. trust of and satisfaction with communication with the provider, social support) and generative capabilities such as innate problem-solving ability and absence of depression moderate this relationship. We will estimate the incremental cost-effectiveness of PS.

描述（由申请人提供）：低收入少数民族成年人的发病率过高。这些患者的依从性不佳，并导致这种高发病率。与注意力控制（AC）相比，我们将对解决问题的随机对照试验（PS）进行，以改善和维持哮喘自我管理在临床环境中可交付的，其中包括解决与依从性相关的上下文因素的策略。 PS基于我们对非洲裔美国人的前瞻性队列研究的发现，该研究确定了在社会环境中依从性的影响。我们已经从非裔美国人的经验中提取了背景，并将其应用于拉丁美洲人，拉丁裔是另一个具有重大哮喘发病率的群体。为了实现这一目标，我们探讨了非裔美国人和拉丁裔患者焦点小组的这种影响，并最终在两个患者组中广泛驾驶PS。 PS解决并集成解决方案，以解决参与者选择，将问题解决的问题定制为参与者的需求的问题，并使用简单的四步协议来维持或提高依从性。具体目的是测试：1）PS是否提高了在为低收入少数群体的城市诊所接受中度或严重持续性哮喘接受护理的成年人中AC的依从性，2）PS可以改善对AC的哮喘控制，3）PS提高了与AC相关的哮喘与AC相关的哮喘相关质量。我们将从五个诊所招募450名成年人，并将这些参与者随机为PS或A，按场地和类型的IC进行分层。由于没有电子监视器可提供最常用的干粉吸入器的日期依从性数据，因此我们已经开发并测试了一个，并且能够获取所有参与者的日期时间数据。干预将在三个月内进行。参与者将额外遵循三个月。在我们的队列研究中，态度（权衡了IC的风险和利益），与提供者的沟通的信任和满意与依从性有关。我们将探讨动机变量，例如改善IC的知识，对IC的福利的态度以及干预提供的自我效能感会介导PS与依从性之间的关系。我们还将探讨个人特征和上下文影响（例如种族群体，教育程度，哮喘严重性等），社会互动（例如，与提供者的沟通，社会支持的信任和满意）以及诸如先天问题解决能力以及抑郁症之间的抑郁症之间的无关能力等生成能力。我们将估计PS的增量成本效益。