Motivating Asthma Adherence in Urban Teens

激励城市青少年坚持哮喘治疗

• 批准号: 7121518
• 负责人: CYNTHIA S RAND
• 金额: $ 48.18万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-13 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7121518
• 关键词: African American; adolescence (12-20); asthma; behavioral /social science research tag; caucasian American; clinical research; clinical trials; counseling; emergency health services; health disparity; health services research tag; human subject; human therapy evaluation; interview; middle childhood (6-11); motivation; outcomes research; patient monitoring device; patient oriented research; quality of life; racial /ethnic difference; respiratory disorder chemotherapy; therapy compliance; urban poverty area

Low-income, minority teenagers have disproportionately high rates of asthma morbidity, including excess risk of emergency department (ED) care, hospitalization and death from asthma, compared to white adolescents. Research by this group and others has documented that non-adherence with asthma treatment regimens is common among high-risk, inner city families with asthma, and that this poor adherence with prescribed therapies plays a significant contributing role in asthma morbidity. Inner-city adolescents with asthma are at particular risk of non-adherence, yet this population remains understudied. While asthma self-management training has shown promise in achieving some improvement in adherence with asthma, there are few intervention studies explicitly targeting adolescents, particularly those in the inner-city. Urban children typically assume primary control over their asthma management during late childhood/early adolescence. At the same time, adolescents' efforts to achieve autonomy and peer-acceptance may result in increase health risk behaviors, including poor asthma self-management. Developmentally-appropriate asthma self-management interventions are needed that target the unique challenges of adolescence. Motivational Interviewing (Ml) is a promising interventional approach that uses a client-centered, nondirective approach for enhancing motivation to change health behaviors. Ml techniques are developmentally consistent with the needs of early adolescents. Ml does not assume that health will be the most important factor motivating the teen, but rather acknowledges and incorporates other motivators that are within the context of the teen's life, thus this intervention strategy has the flexibility to adapt to the unique life circumstances and stressors faced by urban adolescents. We propose to evaluate the relative effectiveness of a Mi-focused self-management intervention (MI+SM) compared to a self-management (SM) intervention containing asthma education and self-monitoring strategies in a sample of 226 children age 10-15 years treated for asthma in the ED. Our primary hypothesis is that the MI+SM, as compared to SM alone, will result in greater improvement in medication adherence at 3- and 6-months post-randomization, as measured by electronic medication monitoring. Secondary outcomes include self-reported medication adherence, symptoms free days, urgent health care utilization for asthma, and caregiver/adolescent quality of life.

与白人青少年相比，低收入，少数青少年的哮喘发病率不成比例高，包括急诊科（ED）护理，住院和哮喘死亡的过多风险。该群体和其他人的研究表明，哮喘治疗方案的不遵守性在患有哮喘的高风险内城家庭中很常见，并且这种对处方疗法的依从性较差在哮喘发病率中起着显着的作用。患有哮喘的城市青少年特别有不遵守的风险，但该人群仍在研究中。尽管哮喘自我管理训练在哮喘的依从性方面有希望，但很少有干预研究明确针对青少年，尤其是在市区中的青少年。城市儿童通常会在儿童早期/青春期初期对其哮喘管理进行主要控制。同时，青少年为实现自主权和同伴接受的努力可能导致健康风险行为增加，包括哮喘的自我管理不良。需要针对青春期独特的挑战，需要采取适合发育的抚养性抚摸自我管理干预措施。动机访谈（ML）是一种有前途的介入方法，它使用以客户为中心的非定向方法来增强改变健康行为的动力。 ML技术在发展上与早期青少年的需求一致。 ML并不认为健康将是激励青少年的最重要因素，而是承认并结合了青少年生活中的其他动力，因此，这种干预策略具有适应城市青少年所面临的独特生活环境和压力源的灵活性。与自我管理（SM）干预措施相比，我们建议评估以MI为中心的自我管理干预（MI+SM）的相对有效性，该干预措施在226名儿童中包含哮喘教育和自我监控策略的两名年龄在10-15岁的儿童中接受了ED中的哮喘。我们的主要假设是，与单独使用SM相比，MI+SM将在三个月后三分之一和6个月的药物依从性上得到更大的改善，这是通过电子药物监测衡量的。次要结果包括自我报告的药物依从性，无症状的日子，哮喘的紧急医疗保健利用以及照料者/青少年生活质量。