Evaluation of a Web-Based Asthma Management Intervention Program for Urban Teenagers: Reaching the Hard to Reach
Evaluation of a Web-Based Asthma Management Intervention Program for Urban Teenagers: Reaching the Hard to Reach
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DOI：
10.1016/j.jadohealth.2012.07.009
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发表时间：
2013-04-01
影响因子：
7.6
通讯作者：
Johnson, Christine Cole
中科院分区：
文献类型：
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作者：
Joseph, Christine L. M.;Ownby, Dennis R.;Johnson, Christine Cole
目的：针对城市青少年的哮喘干预措施很少，尽管有很大的需求。激励青少年实现更好的哮喘自我管理是具有挑战性的，文献表明某些亚群比其他亚群更具抵抗力。我们进行了一项基于学校的随机对照试验(RCT)来评估泡芙城市，这是一种基于网络的量身定做的哮喘干预措施，包括一名转介协调员，并纳入了基于理论的策略，目标是具有先前发现与缺乏行为改变相关的特征的城市青少年。方法：为了确定符合条件的青少年，我们在预定的英语课上向参与学校的九到十二年级的学生发放了关于哮喘诊断和症状的问卷。结果：我们随机选择了422名学生(98%是非洲裔美国人，平均年龄为15.6岁)。在12个月的随访中，调整后的优势比(AORS)(95%可信区间)表明，在症状日和限制活动日(分析为分类变量)中，青少年的干预受益分别为AOR=0.49(0.24-0.79)，p=0.006和.53(.32-.86)，p=0.010。在符合叛逆基线标准的青少年中，接受治疗的青少年报告的症状日、症状夜、缺课和限制活动天数较少：AOR=.30(.11-.80)、.29(.14-.64)、.40(.20-.78)和.23(.10-.55)；均为P<；0.05。在报告低感受到情绪支持的青少年中，接受治疗的学生报告的症状天数只比对照组少：AOR-.23(0.06-.88)，p=.031。我们没有观察到在医疗护理使用方面的统计学差异。结论：结果表明，基于理论的、量身定做的方法，加上转诊协调员，可以改善城市青少年哮喘的管理。帕夫市是向高危和难以接触的人群传播有效干预措施的可行战略。(C)2013年青少年健康和医学学会。版权所有。
Purpose: Asthma interventions targeting urban adolescents are rare, despite a great need. Motivating adolescents to achieve better self-management of asthma is challenging, and the literature suggests that certain subgroups are more resistant than others. We conducted a school-based, randomized controlled trial (RCT) to evaluate Puff City, a Web-based, tailored asthma intervention, which included a referral coordinator, and incorporated theory-based strategies to target urban teens with characteristics previously found to be associated with lack of behavior change.Methods: To identify eligible teens, we administered questionnaires on asthma diagnoses and symptoms to ninth through 12th graders of participating schools during a scheduled English class. We randomized eligible, consenting students to Puff City (treatment) or generic asthma education (control).Results: We randomized 422 students (98% African-American, mean age = 15.6 years). At 12-month follow-up, adjusted odds ratios (aORs) (95% confidence intervals) indicated intervention benefit for treatment teens for symptom-days and restricted activity days (analyzed as categorical variables) as aOR = .49 (.24-.79), p = .006 and .53 (.32-.86), p = .010, respectively. Among teens meeting baseline criteria for rebelliousness, treatment teens reported fewer symptom-days, symptom-nights, school absences, and restricted activity days: aOR = .30 (.11-.80), .29 (.14-.64), .40 (.20-.78), and .23 (.10-.55); all p < .05. Among teens reporting low perceived emotional support, treatment students reported only fewer symptom-days than controls: aOR -.23 (.06-.88), p = .031. We did not observe statistically significant differences in medical care use.Conclusions: Results suggest that a theory-based, tailored approach, with a referral coordinator, can improve asthma management in urban teens. Puff City represents a viable strategy for disseminating an effective intervention to high-risk and hard-to-reach populations. (C) 2013 Society for Adolescent Health and Medicine. All rights reserved.