Developing an in vivo adherence intervention for adolescents with asthma

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DESCRIPTION (provided by applicant): Asthma represents substantial morbidity and, worse, continues to kill disproportionately so for adolescents and for non-Hispanic Blacks. Adherence is key to asthma control, but is challenging, particularly for teens. While behavioral interventions to improve asthma adherence and outcomes have been studied in adult and pediatric populations, relatively few have addressed adolescents, none have explicitly combined problem- solving and motivational interviewing, and none have made use of mobile phones as a platform for bridging didactics to real life situations. There is a critical need to develop and test asthma self-management interventions incorporating efficacious components and tailored to adolescent needs in real life situations. Until this need is met, progress in reducing asthma morbidity and mortality will be slowed. The objective of this application is to develop and pilot test a tailored multimodal behavioral intervention, delivered using mobile-phone technology and incorporating motivation, knowledge, and problem-solving skills to overcome barriers to adherence in adolescents with moderate and severe persistent asthma. We will recruit participants from an academic adolescent medicine clinic serving a largely poor, urban, African-American population. Successful completion of this project will produce data that will serve as a foundation for a larger clinical trial. The application's objective will be pursued via the following three specific aims: 1) Examine the acceptability, for adolescents with moderate or severe asthma, of an intervention based on existing efficacious problem-solving and motivational interventions; 2) Develop and beta-test a mobile-phone based platform for the intervention; and 3) Feasibility test and pilot test the intervention to determine short-term efficacy in adolescents with moderate or severe asthma. This research will yield intervention materials and a feasible, field-tested mobile phone platform, pilot data on intervention acceptability, feasibility, fidelity, recruitment and retention, and potential effect sizes, and an R01 application to examine the intervention's efficacy and long-term effects through a larger clinical trial. This has great potential significance: Evidence for the efficacy and effectiveness of such an intervention could have a substantial impact on the health outcomes of adolescents with asthma throughout the United States. Moreover, as the intervention is not condition-specific, it could have broad application across populations and diseases. Public Health Relevance Paragraph: The proposed research is relevant to public health: Evidence for the efficacy of an intervention to reduce barriers to adherence and improve outcomes could have a substantial impact on the health outcomes of adolescents with asthma throughout the U.S.. Moreover, as this intervention is not condition-specific, it could have broad application across populations and diseases.