Developing an in vivo adherence intervention for adolescents with asthma

描述（由申请人提供）：哮喘发病率很高，更糟糕的是，青少年和非西班牙裔黑人的死亡率仍然不成比例。坚持是控制哮喘的关键，但却具有挑战性，尤其是对青少年而言。虽然已经在成人和儿科人群中研究了改善哮喘依从性和结果的行为干预措施，但针对青少年的研究相对较少，没有人明确地将问题解决和动机访谈结合起来，也没有人利用手机作为连接教学与现实生活情况的平台。迫切需要开发和测试哮喘自我管理干预措施，包括有效的成分，并根据青少年在现实生活中的需求量身定制。在满足这一需求之前，降低哮喘发病率和死亡率的进展将会减慢。本应用程序的目的是开发和试点测试量身定制的多模式行为干预，使用移动电话技术提供，并结合动机，知识和解决问题的技能，以克服患有中度和重度持续性哮喘的青少年的坚持障碍。我们将从一个学术青少年医学诊所招募参与者，该诊所主要服务于贫困的城市非裔美国人。该项目的成功完成将产生数据，为更大规模的临床试验奠定基础。该应用程序的目标将通过以下三个具体目标来实现：1)根据现有的有效解决问题和动机干预措施，检查患有中度或重度哮喘的青少年的可接受性；2)开发并测试基于手机的干预平台；3)可行性试验和试点试验，确定干预措施对青少年中重度哮喘的短期疗效。本研究将产生干预材料和一个可行的、实地测试的手机平台，干预可接受性、可行性、保真度、招募和保留以及潜在效应大小的试点数据，并通过更大规模的临床试验来检验干预的疗效和长期效果的R01申请。这具有巨大的潜在意义：这种干预措施的有效性和有效性的证据可能对整个美国患有哮喘的青少年的健康结果产生重大影响。此外，由于干预措施不是针对特定条件的，它可以广泛应用于人群和疾病。

DESCRIPTION (provided by applicant): Asthma represents substantial morbidity and, worse, continues to kill disproportionately so for adolescents and for non-Hispanic Blacks. Adherence is key to asthma control, but is challenging, particularly for teens. While behavioral interventions to improve asthma adherence and outcomes have been studied in adult and pediatric populations, relatively few have addressed adolescents, none have explicitly combined problem- solving and motivational interviewing, and none have made use of mobile phones as a platform for bridging didactics to real life situations. There is a critical need to develop and test asthma self-management interventions incorporating efficacious components and tailored to adolescent needs in real life situations. Until this need is met, progress in reducing asthma morbidity and mortality will be slowed. The objective of this application is to develop and pilot test a tailored multimodal behavioral intervention, delivered using mobile-phone technology and incorporating motivation, knowledge, and problem-solving skills to overcome barriers to adherence in adolescents with moderate and severe persistent asthma. We will recruit participants from an academic adolescent medicine clinic serving a largely poor, urban, African-American population. Successful completion of this project will produce data that will serve as a foundation for a larger clinical trial. The application's objective will be pursued via the following three specific aims: 1) Examine the acceptability, for adolescents with moderate or severe asthma, of an intervention based on existing efficacious problem-solving and motivational interventions; 2) Develop and beta-test a mobile-phone based platform for the intervention; and 3) Feasibility test and pilot test the intervention to determine short-term efficacy in adolescents with moderate or severe asthma. This research will yield intervention materials and a feasible, field-tested mobile phone platform, pilot data on intervention acceptability, feasibility, fidelity, recruitment and retention, and potential effect sizes, and an R01 application to examine the intervention's efficacy and long-term effects through a larger clinical trial. This has great potential significance: Evidence for the efficacy and effectiveness of such an intervention could have a substantial impact on the health outcomes of adolescents with asthma throughout the United States. Moreover, as the intervention is not condition-specific, it could have broad application across populations and diseases. Public Health Relevance Paragraph: The proposed research is relevant to public health: Evidence for the efficacy of an intervention to reduce barriers to adherence and improve outcomes could have a substantial impact on the health outcomes of adolescents with asthma throughout the U.S.. Moreover, as this intervention is not condition-specific, it could have broad application across populations and diseases.