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，有色人种的哮喘状况也比白人差。正确使用哮喘控制药物对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疾病并发症增加、功能性发病率过高和致命性哮喘发作。在改善少数群体哮喘管理的干预研究方面存在重大局限性，特别是少数群体青少年和年轻人，尽管疾病管理往往在青春期后的成年期出现恶化，这是一个独特的发展时期，超过青春期，但在成年期之前。由于很少有专门针对这一年龄组的干预措施，我们目前正在进行几项小型可行性研究，为这一建议提供信息。基于从可行性研究中获得的知识，该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，以改善城市非洲裔美国新兴成年人（18-25岁）的哮喘药物依从性。拟议的研究将收集试点数据与样本的80个非洲裔美国新兴成人哮喘与次优的药物依从性招募从诊所设置。一半的样本将随机接受多组分技术干预（MCTI），目标是坚持每日控制药物。MCTI由两部分组成：1）针对药物依从性的2个计算机提供的动机访谈会话，以及2）会话之间侧重于药物依从性的个性化文本消息。短信将根据生态瞬时评估（EMA）进行个性化处理。其余一半的参与者将完成一系列计算机提供的哮喘教育模块，这些模块与干预会议的时间、地点和方法相匹配。对照组参与者也将在干预会话之间接收文本消息。所有对照组受试者的消息内容相同，并包含有关哮喘的一般事实（未定制）。青年将从底特律医疗中心招募，这是唯一一所大学 密歇根州底特律的附属医疗中心，以及底特律韦恩州立大学的校园健康中心。本项目的目标是通过评估可行性、识别技术问题和确定未来的总体研究方向，以及为R 01级RCT的预算提供反馈，建立MCTI概念的初步证明。尽管科学文献可能为开展更大规模的随机对照试验提供了依据，但该试点将提供有关实施干预和招募策略的关键信息，这些策略是设计成功的随机对照试验所必需的。假设在1个月和3个月随访时，与对照组相比，随机分配至MCTI治疗依从性的青少年在坚持哮喘药物治疗的动机和自我报告的依从性方面会有所改善。

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.