Asthma and Technology in Emerging African American Adults (The ATHENA Project)

在美国，尤其是在非洲裔美国人中，哮喘导致了大量的发病率和死亡率 新兴成人（AAEA;年龄18-30），但很少有哮喘项目针对这一人群。 提供教育和解决管理哮喘的潜在动机的干预措施可能是最重要的 有效然而，面对面的干预措施往往难以实施，特别是在新兴市场国家， 成年人了本提案的目的是开发一种有效的移动的哮喘管理干预措施， 改进AAEA控制。我们将评估多个技术组件的能力，以帮助和改善 传统哮喘教育干预包括4个潜在组成部分：1）MES。激励 哮喘管理增强系统（MES）是一种移动的4阶段干预，利用支持的 自我调节和动机面试（MI）。个性化内容基于每个参与者的活动 水平、日常体验和目标。2)SA.支持责任制（SA）由哮喘护士管理 利用有针对性的移动的支持（Skype/语音通话）提供教育，提高自我效能，并克服 通过基于MI的框架来消除障碍。3)短信。短信（SMS）提供哮喘提醒 管理教育、药物依从性和身体活动。4)专利身体活动追踪（PAT） 使用可穿戴技术来鼓励哮喘控制，以满足用户定义的身体活动目标。 使用多阶段优化策略（MOST），我们将完善和测试这4个干预组件， 组件的组合，以确定最有效的移动的干预。MOST是一种创新的、成本低廉的 时间有效的实验设计，利用工程原理来测试行为干预。 参与者（N=180）将被随机分配到6个干预组中的1个，这些干预组由以下药物的各种组合组成： 干预措施。采用析因设计，本实验相当于进行多个试点 随机临床试验，以评估每一个干预措施的有效性，但只使用一个 样本量和资源的一部分。在研究完成后，我们将有一个经验- 支持移动的哮喘管理干预，以改善AAEA的哮喘控制。参与者将被 从美国肺脏协会气道临床研究中心网络的多个站点招募， 底特律医疗中心的门诊护理诊所。将在基线、4个月和6个月时收集数据。 我们假设干预后（4和6个月），哮喘不受控制的参与者将显示 哮喘控制方面的临床显著改善。我们假设哮喘的改善 管理行为（包括体力活动）、生活质量、症状、依从性和加重 （次要结果）也将被观察。

Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEA; ages 18-30), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be most effective. However, face-to-face interventions are often difficult to implement, especially among emerging adults. The purpose of this proposal is to develop an effective mobile asthma management intervention to improve control in AAEA. We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The intervention includes 4 potential components: 1) MES. The Motivational Enhancement System (MES) for Asthma Management is a mobile 4-session intervention utilizing supported self-regulation and Motivational Interviewing (MI). Personalized content is based on each participant’s activity level, daily experiences, and goals. 2) SA. Supportive accountability (SA) is administered by asthma nurses utilizing targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through an MI-based framework. 3) SMS. Text messaging (SMS) provides reminders for asthma management education, medication adherence, and physical activity. 4) PAT. Physical activity tracking (PAT) uses wearable technology to encourage asthma control in order to meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST), we will refine and test these 4 intervention components and combination of components to identify the most effective mobile intervention. MOST is an innovative, cost- and time-effective experimental design that utilizes engineering principles to test behavioral interventions. Participants (N=180) will be randomized to 1 of 6 intervention arms consisting of various combinations of the intervention components. Using factorial design, this experiment is equivalent to conducting multiple pilot randomized clinical trials to evaluate the efficacy of each of the intervention components, yet uses only a fraction of the sample size and resources. At the completion of the study, we will have an empirically- supported mobile asthma management intervention to improve asthma control for AAEA. Participants will be recruited from multiple sites of the American Lung Association Airway Clinical Research Center network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, 4, and 6 months. We hypothesize that post-intervention (4 and 6 months), participants with uncontrolled asthma will show clinically-significant improvement in asthma control. We hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbations (secondary outcomes) will also be observed.