AIM2ACT: A Mobile Health Tool to Facilitate Asthma Self-Management during Early Adolescence

项目摘要 哮喘是最常见的儿童慢性疾病，影响9.7%的青少年。国家指导方针 强调坚持自我管理行为对控制哮喘和预防 健康和生活质量受损。青少年对哮喘自我管理的依从性不佳 行为，使他们面临发病和生活质量下降的风险。哮喘自我管理困难 出现在青春期早期，因为青年开始过渡到更多地控制他们的治疗 这是一个关键的干预时期。有帮助的照顾者支持的存在是关键， 确定早期青少年是否最终发展和掌握哮喘自我管理行为。我们 跨学科团队获得了NIH的资助（PI：Fedele; R21 HD 083830），以应对 制定一项干预措施，以促进对患有以下疾病的早期青少年（12-15岁）提供有益的照顾者支持： 哮喘控制不佳AIM 2ACT是一种二元智能手机干预，由儿科自我- 专门为增加有益的护理人员支持和青少年哮喘而量身定制的管理模式 自我效能，从而改善哮喘控制。AIM 2ACT包含三个组成部分：1）生态 确定哮喘自我管理的个性化优势和劣势的瞬时评估 行为; 2）协作识别和跟踪帮助早期青少年成为 越来越独立地管理他们的哮喘;和3）一套引人入胜的技能培训视频，以帮助 二人组了解如何使用AIM 2ACT，并共同制定哮喘自我管理目标， 实现目标，并参与解决问题的沟通。我们的试点试验结果显示了高度的可行性 我们的方案的可接受性和AIM 2ACT在改善哮喘控制方面的初步疗效。的 拟议的研究将测试AIM 2ACT的疗效和治疗效果的长期维持， 在160例控制不佳的持续性哮喘的早期青少年中进行的有把握的随机对照试验，年龄 12-15岁，和一个照顾者。家庭将被随机分配接受AIM 2ACT（n=80）或mHealth 注意力控制条件（n=80），占员工的注意力和新奇的技术为基础的 干预6个月。对照条件下的双胞胎将不接受个性化哮喘管理 反馈，将不会通过协作识别和跟踪哮喘自我管理目标来指导， 也无法观看技能培训视频。相反，他们将收到静态的教育信息， 他们的智能手机上有关于行为管理技术的信息，他们可以用这些信息来改善哮喘自我， 管理控制条件旨在优化招聘和维持兴趣，同时 对哮喘管理的影响很小。评估将在基线、干预后和 3个月、6个月和12个月随访时间点。患者报告（例如，哮喘控制试验），客观地 被监视（例如，肺功能测定、药物依从性）结果。

PROJECT SUMMARY Asthma is the most prevalent childhood chronic illness, affecting 9.7% of adolescents. National guidelines emphasize the importance of adherence to self-management behaviors for controlling asthma and preventing impaired health and quality of life. Adolescents have suboptimal adherence to asthma self-management behaviors, placing them at risk for morbidity and reduced quality of life. Asthma self-management difficulties emerge in early adolescence as youth begin to transition towards taking more control of their treatment regimen, making it a critical intervention period. The presence of helpful caregiver support is pivotal in determining whether early adolescents ultimately develop and master asthma self-management behaviors. Our interdisciplinary team received NIH funding (PI: Fedele; R21 HD083830) to respond to the critical need for the development of an intervention to facilitate helpful caregiver support in early adolescents (12-15 year-olds) with poorly controlled asthma. AIM2ACT is a dyadic smartphone intervention, informed by the Pediatric Self- Management Model that is specifically tailored to increase helpful caregiver support and adolescent asthma self-efficacy, thereby improving asthma control. AIM2ACT contains three components: 1) ecological momentary assessment to identify personalized strengths and weaknesses in asthma self-management behaviors; 2) collaborative identification and tracking of goals that help early adolescents to become increasingly independent in managing their asthma; and 3) a suite of engaging skills training videos to help dyads understand how to use AIM2ACT and work together to set asthma self-management goals, develop and achieve goals, and engage in problem-solving communication. Results of our pilot trial revealed high feasibility and acceptability of our protocol and preliminary efficacy for AIM2ACT in improving asthma control. The proposed study will test the efficacy of AIM2ACT and long-term maintenance of treatment effects in a fully- powered randomized controlled trial with 160 early adolescents with poorly controlled persistent asthma, ages 12-15 years, and a caregiver. Families will be randomly assigned to receive AIM2ACT (n=80) or a mHealth attention control condition (n=80) that accounts for staff attention and novelty of a technology-based intervention for 6 months. Dyads in the control condition will not receive personalized asthma management feedback, will not be guided through collaborative identification and tracking of asthma self-management goals, and will not have access to skills training videos. Instead, they will receive static educational information on their smartphones about behavioral management techniques they can use to target improving asthma self- management. The control condition is designed to optimize recruitment and sustain interest while concurrently having a minimal impact on asthma management. Assessments will occur at baseline, post-intervention, and 3-, 6-, and 12-month follow-up time points. Patient-reported (e.g., Asthma Control Test) and objectively monitored (e.g., spirometry, medication adherence) outcomes will be collected.