Multi-component technology intervention for minority emerging adults with asthma

描述(由申请人提供)： 即使在控制了社会经济变量后，有色人种青年的哮喘状况也比高加索青年更差。正确使用哮喘控制药物对于降低哮喘死亡率和发病率至关重要。哮喘管理不善的临床后果包括增加疾病并发症、过度功能性发病率和致命性哮喘发作。在改善少数群体、特别是少数群体青少年和年轻人哮喘管理的干预措施方面，研究存在很大局限性，尽管疾病管理往往在青春期之后的初成年期恶化，这是青春期之后但成年期之前的独特发展阶段。由于很少有专门针对这一年龄段的干预措施，我们目前正在进行几项小型可行性研究，为这一提议提供信息。基于从可行性研究中获得的知识，这项试点研究的目标是开发并初步测试一种基于技术的干预措施，以提高城市非裔美国人新兴成年人(18-25岁)的哮喘药物依从性。这项拟议的研究将收集从临床环境中招募的80名患有哮喘的非裔美国新发成年人的试点数据，这些人的服药依从性不佳。样本的一半将随机接受多组分的基于技术的干预(MCTI)，目标是遵守每日控制者的药物治疗。MCTI由两部分组成：1)针对服药依从性的计算机传递的激励性访谈的2次会议，以及2)会议之间专注于服药依从性的个性化短信。短信将根据生态瞬时评估(EMA)进行个性化。剩下的一半参与者将完成一系列由计算机提供的哮喘教育模块，这些模块与干预课程的长度、地点和交付方法相匹配。对照参与者还将在干预会话之间收到文本消息。所有对照参与者的信息内容将是相同的，并包含有关哮喘的一般事实(不是量身定制的)。青年将从底特律医学中心招募，底特律医学中心是唯一一所 密歇根州底特律的附属医疗中心，以及同样位于底特律的韦恩州立大学校园健康中心。该项目的目标是通过评估可行性、确定技术问题、确定总体未来研究方向以及为R01级随机对照试验的预算提供反馈，初步确定MCTI的概念。尽管科学文献可能为开展更大规模的区域工作队提供了理由，但这一试点将提供有关实施干预和招募战略的关键信息，这些战略是设计成功的区域工作队所必需的。假设在1个月和3个月的随访中，与对照条件相比，接受MCTI坚持治疗的年轻人在坚持哮喘药物的动机和自我报告的坚持方面将有所改善。

DESCRIPTION (provided by applicant): Youth of color have poorer asthma status than Caucasian youth, even after controlling for socioeconomic variables. Proper use of asthma controller medications is critical in reducing asthma mortality and morbidity. The clinical consequences of poor asthma management include increased illness complications, excessive functional morbidity, and fatal asthma attacks. There are significant limitations in research on interventions to improve asthma management in minority populations, particularly minority adolescents and young adults, though illness management tends to deteriorate after adolescence during emerging adulthood, the unique developmental period beyond adolescence but before adulthood. Because few interventions have specifically targeted this age group, we are currently conducting several small feasibility studies to inform this proposal. Building on the knowledge gained from the feasibility studies, this pilot study's goal is to develop and preliminarily test a technology-based intervention to improve asthma medication adherence in urban African American emerging adults (ages 18-25). The proposed study will collect pilot data with a sample of 80 African American emerging adults with asthma with suboptimal medication adherence recruited from clinic settings. Half of the sample will be randomized to receive a multi-component technology-based intervention (MCTI) targeting adherence to daily controller medication. The MCTI consists of two components: 1) 2 sessions of computer-delivered motivational interviewing targeting medication adherence, and 2) individualized text messaging focused on medication adherence between the sessions. Text messages will be individualized based on Ecological Momentary Assessment (EMA). The remaining half of participants will complete a series of computer-delivered asthma education modules matched for length, location, and method of delivery of the intervention session. Control participants will also receive text messages between intervention sessions. Message content will be the same for all control participants and contain general facts about asthma (not tailored). Youth will be recruited from the Detroit Medical Center, the only university affiliated medical center in Detroit, Michigan, as well as the Campus Health Center at Wayne State University also in Detroit. The goal of this project is to establish initial proof of conceptof MCTI through assessing viability, identifying technical issues, and establishing overall future research direction, as well as providing feedback for budgeting for a R01-level RCT. Although the scientific literature may provide the rationale for conducting a larger RCT, this pilot will provide critical information about the implementation of the intervention and recruitment strategies necessary to design a successful RCT. It is hypothesized that youth randomized to MCTI for adherence will show improvements in motivation to adhere to asthma medications and self-reported adherence compared to the comparison condition at 1- and 3- month follow up.