Project ASPIRE: Improving Pediatric Asthma Management for Urban Families

ASPIRE 项目：改善城市家庭的小儿哮喘管理

• 批准号: 7244079
• 负责人: MARIANNE CELANO
• 金额: $ 20.24万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-01 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7244079
• 关键词: Accounting; Adherence; Adopted; American Lung Association; Asthma; Behavior; Biological Markers; Caregiver Burden; Caregivers; Child; Childhood; Childhood Asthma; Chronic Disease; Collaborations; Communication; Communities; Community Practice; Control Groups; Cotinine; Development; Diabetes Mellitus; Disease; Education; Educational Intervention; Effectiveness; Effectiveness of Interventions; Environment; Environmental Tobacco Smoke; Exposure to; Family; Family Caregiver; Focus Groups; Health; Health Sciences; Health Services; Home environment; Individual; Intervention; Life; Link; Low income; Measures; Mental Health; Modeling; Morbidity - disease rate; Numbers; Outcome; Parent-Child Relations; Parents; Patient Self-Report; Pilot Projects; Poverty; Psychopathology; Randomized Clinical Trials; Rate; Reporting; Research; Research Personnel; Resources; Schools; Self Management; Stigmata; Stress; Symptoms; Techniques; Testing; Training; Treatment outcome; Variant; Wood material; Writing; base; child depression; cohesion; cost effectiveness; day; design; experience; family management; follow-up; health belief; health care delivery; health care service utilization; improved; low socioeconomic status; member; model design; mortality; programs; psychologic; social stigma; therapy development; urinary

DESCRIPTION (provided by applicant): Family stress has been identified as a mechanism by which low socioeconomic status may be linked to adverse asthma outcomes. Family and caregiver stress have a negative impact on children's asthma management behaviors and asthma outcomes, yet few asthma education interventions include a psychological component to assess and modify the impact of stress on asthma self-management. Given cultural variation in the experience of stress and the stigma associated with mental health problems, educational interventions with psychological components are best designed in collaboration with members of the target community, who can insure that program content and format will be responsive to their specific needs and culturally-influenced health beliefs. In collaboration with the American Lung Association - Southeast and our Community Advisory Board, we will design and pilot-test a home-based family intervention that integrates individually tailored asthma education with strategies to reduce the impact of caregiver and family stress on asthma management. The aims of this treatment development proposal are to: (1) conduct focus groups with children with persistent asthma and their parents to refine the content of the family intervention, and (2) conduct a pilot study of the family intervention, evaluating its initial efficacy, feasibility, and acceptability for 25 families receiving the family intervention as compared to 25 families receiving enhanced treatment as usual (trigger control resources and a written asthma action plan). Primary treatment outcomes include measures of asthma self-management (self-reported management, observed MDI/spacer technique, urinary cotinine to assess exposure to environmental tobacco smoke) and morbidity (number of symptom days, school days missed for asthma, and urgent health care utilization for asthma). Secondary outcomes include parent-child relationship quality, family cohesion, and caregiver stress. A secondary aim of the study is to assess the cost effectiveness of the intervention from the perspective of a health services payer. If successful, the home-based family intervention can improve the asthma management of caregivers under stress and their children. We hope that this research will result in a replicable and sustainable model that can be adopted by community-based organizations to reduce the high asthma morbidity reported for low-income children with asthma living in urban, stressful environments.

描述（由申请人提供）：家庭压力已被确定为一种机制，通过这种机制，低社会经济地位可能与不良哮喘结局有关。家庭和照顾者的压力对儿童的哮喘管理行为和哮喘结果有负面影响，但很少有哮喘教育干预措施包括心理因素来评估和修改压力对哮喘自我管理的影响。鉴于文化差异的经验，压力和耻辱与心理健康问题，教育干预与心理成分的最佳设计与目标社区的成员合作，谁可以确保节目的内容和格式将响应他们的具体需求和文化影响的健康信念。在与美国肺脏协会-东南和我们的社区咨询委员会合作，我们将设计和试点测试一个以家庭为基础的家庭干预，将个性化的哮喘教育与战略相结合，以减少照顾者和家庭压力对哮喘管理的影响。这项治疗发展建议的目的是：（1）对持续性哮喘儿童及其父母进行焦点小组，以完善家庭干预的内容，（2）进行家庭干预的试点研究，评估其初步疗效、可行性，接受家庭干预的25个家庭与接受常规强化治疗的25个家庭相比，（触发控制资源和书面哮喘行动计划）。主要治疗结局包括哮喘自我管理（自我报告管理、观察MDI/间隔器技术、尿可替宁以评估环境烟草烟雾暴露）和发病率（症状天数、哮喘缺课天数和哮喘紧急医疗保健利用）。次要结果包括亲子关系质量，家庭凝聚力和照顾者压力。该研究的第二个目的是从卫生服务支付者的角度评估干预措施的成本效益。如果成功，以家庭为基础的家庭干预可以改善哮喘管理的照顾者在压力和他们的孩子。我们希望这项研究将产生一个可复制和可持续的模式，可以通过社区组织，以减少高哮喘发病率报告的低收入儿童哮喘生活在城市，紧张的环境。