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

哮喘在美国造成相当大的发病率和死亡率，特别是在非裔美国人中 新兴成人(AAEA；18-30岁)，但很少有哮喘项目针对这一人群。 提供教育并解决治疗哮喘的潜在动机的干预措施可能是最 有效。然而，面对面的干预往往很难实施，特别是在新兴国家中 成年人。这项建议的目的是开发一种有效的流动哮喘管理干预措施，以 加强对AAEA的控制。我们将评估多个技术组件的协助和改进能力 传统的哮喘教育。干预包括4个潜在组成部分：1)MES。激励因素 用于哮喘管理的增强系统(MES)是一种移动4会话干预，利用支持 自我调节和激励性访谈(MI)。个性化内容基于每个参与者的活动 水平、日常经验和目标。2)SA。支持性责任(SA)由哮喘护士实施 利用有针对性的移动支持(Skype/语音呼叫)提供教育，提高自我效能，并克服 通过基于MI的框架设置障碍。3)短信。短信(短信)为哮喘患者提供提醒 管理教育、服药依从性和体力活动。4)PAT.体力活动跟踪(PAT) 使用可穿戴技术鼓励哮喘控制，以满足用户定义的体力活动目标。 使用多阶段优化策略(MOST)，我们将细化和测试这4个干预组件，并 组件组合，以确定最有效的移动干预。MOST是一种创新、成本和 利用工程原理测试行为干预的时效性实验设计。 参与者(N=180)将被随机分配到6个干预组中的1个，这些干预组由不同的 干预组件。采用析因设计，本试验相当于进行多个试验 用于评估每个干预成分的有效性的随机临床试验，但仅使用 样本数量和资源的一小部分。在研究完成后，我们将有一个经验上的- 支持流动哮喘管理干预，以改善AAEA的哮喘控制。参与者将是 从美国肺脏协会呼吸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。数据收集将在基线、4个月和6个月进行。 我们假设在干预后(4个月和6个月)，患有失控哮喘的参与者将表现出 临床-哮喘控制方面的显著改善。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、坚持和恶化 (次要结果)也将观察到。

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.