Project ASPIRE: Improving Pediatric Asthma Management for Urban Families

ASPIRE 项目：改善城市家庭的小儿哮喘管理

• 批准号: 7069253
• 负责人: MARIANNE CELANO
• 金额: $ 12.41万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-01 至 2008-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7069253
• 关键词: adolescence (12-20); asthma; behavioral /social science research tag; caregivers; child rearing; clinical research; early /brief intervention /therapy; education evaluation /planning; family structure /dynamics; family therapy; health education; human subject; low socioeconomic status; middle childhood (6-11); outcomes research; patient care management; patient oriented research; stress; therapy compliance; training; urban area

DESCRIPTION (provided by applicant): Family stress has been identified as a mechanism by which low socioeconomic status may be linked to adverse asthma outcomes. Family and caregiver stress have a negative impact on children's asthma management behaviors and asthma outcomes, yet few asthma education interventions include a psychological component to assess and modify the impact of stress on asthma self-management. Given cultural variation in the experience of stress and the stigma associated with mental health problems, educational interventions with psychological components are best designed in collaboration with members of the target community, who can insure that program content and format will be responsive to their specific needs and culturally-influenced health beliefs. In collaboration with the American Lung Association - Southeast and our Community Advisory Board, we will design and pilot-test a home-based family intervention that integrates individually tailored asthma education with strategies to reduce the impact of caregiver and family stress on asthma management. The aims of this treatment development proposal are to: (1) conduct focus groups with children with persistent asthma and their parents to refine the content of the family intervention, and (2) conduct a pilot study of the family intervention, evaluating its initial efficacy, feasibility, and acceptability for 25 families receiving the family intervention as compared to 25 families receiving enhanced treatment as usual (trigger control resources and a written asthma action plan). Primary treatment outcomes include measures of asthma self-management (self-reported management, observed MDI/spacer technique, urinary cotinine to assess exposure to environmental tobacco smoke) and morbidity (number of symptom days, school days missed for asthma, and urgent health care utilization for asthma). Secondary outcomes include parent-child relationship quality, family cohesion, and caregiver stress. A secondary aim of the study is to assess the cost effectiveness of the intervention from the perspective of a health services payer. If successful, the home-based family intervention can improve the asthma management of caregivers under stress and their children. We hope that this research will result in a replicable and sustainable model that can be adopted by community-based organizations to reduce the high asthma morbidity reported for low-income children with asthma living in urban, stressful environments.

描述（由申请人提供）：家庭压力已被确定为低社会经济地位可能与哮喘不良后果相关的一种机制。家庭和护理人员的压力对儿童的哮喘管理行为和哮喘结果有负面影响，但很少有哮喘教育干预措施包括心理成分来评估和改变压力对哮喘自我管理的影响。鉴于压力体验的文化差异以及与心理健康问题相关的耻辱感，包含心理成分的教育干预措施最好与目标社区成员合作设计，他们可以确保项目内容和形式能够满足他们的具体需求和受文化影响的健康信念。我们将与美国肺脏协会东南部和我们的社区咨询委员会合作，设计并试点测试一种以家庭为基础的家庭干预措施，该干预措施将个性化定制的哮喘教育与减少护理人员和家庭压力对哮喘管理影响的策略相结合。该治疗开发提案的目的是：（1）对持续性哮喘儿童及其父母进行焦点小组讨论，以完善家庭干预的内容，以及（2）进行家庭干预的试点研究，评估其初步疗效、可行性和接受家庭干预的25个家庭与照常接受强化治疗的25个家庭的可接受性（触发控制资源和书面哮喘行动计划）。主要治疗结果包括哮喘自我管理措施（自我报告的管理、观察到的 MDI/间隔技术、尿可替宁以评估环境烟草烟雾的暴露）和发病率（症状天数、哮喘缺课天数以及哮喘紧急医疗保健利用情况）。次要结果包括亲子关系质量、家庭凝聚力和照顾者压力。该研究的第二个目的是从卫生服务付款人的角度评估干预措施的成本效益。如果成功，以家庭为基础的家庭干预可以改善压力下的护理人员及其孩子的哮喘管理。我们希望这项研究将产生一个可复制且可持续的模型，可供社区组织采用，以降低生活在压力大的城市环境中的低收入哮喘儿童的高哮喘发病率。