A web-based, tailored asthma management program for urban African-American high school students
A web-based, tailored asthma management program for urban African-American high school students
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DOI：
10.1164/rccm.200608-1244oc
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发表时间：
2007-05-01
影响因子：
24.7
通讯作者：
Strecher, Victor
中科院分区：
文献类型：
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作者：
Joseph, Christine L. M.;Peterson, Edward;Strecher, Victor
理由：15-19 岁的城市非裔美国青少年的哮喘死亡率高于白人和年龄较小的儿童，但很少有项目针对这一人群。传统上，城市青年被认为很难参与与健康相关的项目，无论是在联系性还是说服力方面。目标：开发和评估专门针对城市高中生的多媒体、基于网络的哮喘管理计划。该计划使用“定制”与基于理论的模型相结合，根据用户的信仰、态度和个人改变障碍，通过个性化的健康信息来改变行为。方法：报告哮喘症状的高中生被随机分配接受量身定制的计划（治疗）或访问通用哮喘网站（对照）。该程序可在学校计算机上使用。测量和主要结果：在研究开始时和基线后 12 个月测量功能状态和医疗护理使用情况，以及选定的管理行为。干预期为180天（从基线计算）。共有 314 名学生被随机分配（98% 为非裔美国人，49% 为医疗补助参与者；平均年龄为 15.2 岁）。 12 个月时，与对照组学生相比，接受治疗的学生报告出现症状的天数、出现症状的夜晚、旷课的天数、限制活动的天数以及因哮喘住院的情况均较少；调整后的相对风险和 95% 置信区间如下：0.5 (0.4-0.8)，p = 0.003； 0.4（0.2-0.8），p = 0.009； 0.3（0.1-0.7），p = 0.006； 0.5（0.3-0.8），p = 0.02；和 0.2 (0.2-0.9)，p = 0.01。与对照组学生相比，接受治疗的学生更容易出现积极行为。项目实施的成本估计为每位参与治疗组学生 6.66 美元。结论：基于网络的、定制的方法来改变消极的哮喘管理行为是经济、可行的，并且可以有效地改善传统上难以接触到的人群的哮喘结果。
Rationale: Urban African-American Youth, aged 15-19 years, have asthma fatality rates that are higher than in whites and younger children, yet few programs target this population. Traditionally, urban youth are believed to be difficult to engage in health-related programs, both in terms of connecting and convincing. Objectives: Develop and evaluate a multimedia, web-based asthma management program to specifically target urban high school students. The program uses "tailoring," in conjunction with theory-based models, to alter behavior through individualized health messages based on the user's beliefs, attitudes, and personal barriers to change. Methods: High school students reporting asthma symptoms were randomized to receive the tailored program (treatment) or to access generic asthma websites (control). The program was made available on school computers. Measurements and Main Results: Functional status and medical care use were measured at study initiation and 12 months postbaseline, as were selected management behaviors. The intervention period was 180 days (calculated from baseline). A total of 314 students were randomized (98% African American, 49% Medicaid enrollees; mean age, 15.2yr). At 12months, treatment students reported fewer symptom-days, symptom-nights, school days missed, restricted-activity days, and hospitalizations for asthma when compared with control students; adjusted relative risk and 95% confidence intervals were as follows: 0.5 (0.4-0.8), p = 0.003; 0.4 (0.2-0.8), p = 0.009; 0.3 (0.1-0.7), p = 0.006; 0.5 (0.3-0.8), p = 0.02; and 0.2 (0.2-0.9), p = 0.01, respectively. Positive behaviors were more frequently noted among treatment students compared with control students. Cost estimates for program delivery were $6.66 per participating treatment group student. Conclusions: A web-based, tailored approach to changing negative asthma management behaviors is economical, feasible, and effective in improving asthma outcomes in a traditionally hard-to-reach population.