Asthma symptom perception feedback intervention for ethnic minority adolescents

 描述（由申请人提供）：对儿童哮喘症状的感知不足是急诊室就诊、住院和近乎致命/致命哮喘发作的主要风险因素。波多黎各和黑人儿童的哮喘发病率和死亡率高于所有其他种族/族裔群体。针对哮喘症状感知和药物依从性的干预可能有助于缩小哮喘健康差距。迄今为止，尚无旨在改善少数民族儿童哮喘症状感知的RCT研究。这项R 01研究建立在这位新研究者PI先前的赠款基础上。我们发现，没有接受呼气峰流量（PEF）反馈的儿童在42%的时间内对哮喘症状的感知不足，而PEF反馈组为15%，并且控制药物的依从性较低（27.5%对48.8%）。 拟议的随机对照试验包括两组：PEF反馈（N = 130）与对照反馈（N = 130）。将从纽约布朗克斯的诊所招募10-17岁的拉丁裔和黑人哮喘青少年及其护理人员。主要目的是检查反馈与对照反馈的PEF预测在1）哮喘症状感知不足，2）控制药物依从性和3）哮喘控制和紧急医疗保健使用方面的有效性。这些目标将在1年随访期间进行检查。一个探索性的目的是检查假设的途径，即PEF干预减少了对症状的感知不足，将疾病表征向专业模式转变，并提高了青少年和父母的哮喘管理自我效能，从而提高了药物依从性并改善了哮喘控制。所有家庭的基线访视包括标准化哮喘教育，随后使用可编程电子肺量计进行3周无反馈的PEF预测。然后，参与者将被随机分配到干预组，他们的肺量计重新编程，显示实际的PEF和每日哮喘管理信息（PEF反馈组）或简短的积极信息（对照反馈组）。在接下来的6周内，所有青少年都将预测他们的PEF，在吹入设备之前将被锁定。家庭将在干预中期和干预后返回，接受关于症状感知和解决问题技能培训的口头个性化反馈（PEF反馈组）或支持性咨询（控制反馈组）。所有青少年将播放“寻找代码”，以加强基线哮喘教育。在干预后访视时，将对所有青少年的肺量计进行重新编程，以便在接下来的4周内不提供反馈。这些症状感知数据将在干预后1个月下载。将通过电子设备监测控制药物的依从性。干预后会议将在3、6、9和12个月时进行，以收集 依从性数据并进行肺量测定。医生将不知道组分配和使用国家指南对哮喘控制进行评级。一项为期12个月的回顾性病历摘要将比较两组间哮喘的急诊医疗服务使用情况。

 DESCRIPTION (provided by applicant): Under-perception of asthma symptoms in children is a major risk factor for emergency department visits, hospitalizations, and near-fatal/fatal asthma attacks. Puerto Rican and Black children have greater asthma morbidity and mortality rates than all other racial/ethnic groups. Interventions targeting asthma symptom perception and medication adherence may help close this asthma health disparities gap. There are no RCT studies to date designed to improve asthma symptom perception in ethnic minority children. This R01 study builds upon this new investigator PI's prior grants. We demonstrated that children who did not receive peak expiratory flow (PEF) feedback under-perceived asthma symptoms 42% of the time vs. 15% for the PEF feedback group and had lower controller medication adherence (27.5% vs. 48.8%). The proposed randomized controlled trial consists of two arms: PEF feedback (N = 130) versus control feedback (N = 130). Latino and Black adolescents with asthma ages 10-17 years old and their caregivers will be recruited from clinics in the Bronx, NY. The primary aims are to examine the efficacy of PEF prediction with feedback versus control feedback on 1) under-perception of asthma symptoms 2) controller medication adherence and 3) asthma control and emergency health care use. These aims will be examined across a 1- year follow-up. An exploratory aim examines the hypothesized pathway that the PEF intervention reduces under-perception of symptoms, shifts illness representations toward the professional model and increases adolescents' and parents' asthma management self-efficacy, resulting in greater medication adherence and improved asthma control. The baseline visit for all families consists of standardized asthma education followed by 3 weeks of PEF prediction without feedback using a programmable, electronic spirometer. Participants then will be randomized to intervention group and their spirometer reprogrammed, showing either the actual PEF and daily asthma management messages (PEF feedback group) or a brief, positive message (control feedback group). For the next 6 weeks, all adolescents will predict their PEF, which will be locked in before blowing into the device. Families will return at mid-intervention and post-intervention to receive verbal individualized feedback on symptom perception and problem-solving skills training (PEF feedback group) or supportive counseling (control feedback group). All adolescents will play "Quest for the Code" to reinforce the baseline asthma education. At the post-intervention visit, the spirometer will be reprogrammed for all adolescents to provide no feedback for the next 4 weeks. These symptom perception data will be downloaded at 1-month post-intervention. Controller medication adherence will be monitored by electronic devices. Post-intervention sessions will take place at 3, 6, 9, and 12 months to collect adherence data and conduct spirometry. Physicians will be blinded to group assignment and rate asthma control using national guidelines. A 12-month retrospective medical record abstraction will compare emergency health care use for asthma between groups.