Using technology-assisted stepped-care interventions to improve adherence in adolescents with asthma

项目总结/文摘

PROJECT SUMMARY/ABSTRACT Candidate: I am a practicing pediatric psychologist whose overarching career goal is to improve health outcomes for adolescents with asthma by targeting adherence through technology-assisted interventions. I am an Assistant Professor of Pediatrics in the Division of Behavioral Medicine and Clinical Psychology (BMCP) at Cincinnati Children's Hospital Medical Center (CCHMC). I completed my doctoral training at Oklahoma State University and a T32 fellowship in pediatric adherence at CCHMC. Training Objectives: The proposed K23 will allow me to fill my current training gaps and enable me to: 1) Obtain advanced training in dissemination and implementation science, 2) Develop knowledge of clinical care models of asthma for adolescents with a specific focus on community health, 3) Obtain advanced training in clinical research design and biostatistics, and 4) Enhance my professional development through grant writing skills and publications of research findings. Mentors: My primary mentor, Kevin Hommel, PhD, is a NIH-funded researcher with expertise in clinical research design and technology-enabled behavioral adherence-promotion interventions for adolescents. Under Dr. Hommel's mentorship, I have assembled an expert team of leaders in asthma and pulmonary care (Drs. Guilbert, Kahn), dissemination and implementation science (Dr. Epstein), and Statistics (Dr. Peugh) who complement Dr. Hommel's expertise and will provide valuable mentorship. Environment: CCHMC and the University of Cincinnati (UC) are uniquely equipped to facilitate the career development of junior researchers. Through UC's Clinical and Translational Science Award and the Asthma Center, I have local resources to achieve my training objectives and complete the proposed research. The Asthma Center within the Division of Pulmonary Medicine provides access to a large patient population and I will capitalize on my existing relationships with Asthma Center faculty. Research: My proposed research will test the preliminary efficacy of a technology-assisted stepped-care (TASC) adherence-promotion intervention for 12-18 year old adolescents with asthma in a pilot RCT. TASC was developed using dissemination and implementation strategies to facilitate translation to practice and has the potential to address the limitations of available adherence interventions for adolescents with asthma by overcoming barriers to access, providing individualized care, and expanding the reach and impact of adherence intervention to improve the health of adolescents with asthma. Preliminary efficacy will be demonstrated by improved adherence to daily inhaled corticosteroids as measured by electronic monitoring devices compared to a treatment as usual (TAU) control group. Secondary outcomes include disease severity as measured by the Composite Asthma Severity Index combining symptoms, treatment, and exacerbations compared to TAU and an assessment of TASC implementation through a process evaluation assessing reach, usability, and sustainability. This research will provide the basis for a fully powered RCT to be proposed in an R01 grant application prior to the end of this K award.