Developing an adapted parent-youth teamwork intervention to improve medication adherence among adolescents with asthma: a feasibility study

在英国，每11名儿童和青少年中就有一名患有哮喘，这对青少年的生活质量和他们的医疗保健使用有重大影响。每天使用哮喘预防吸入器是减少症状并让儿童和青少年过上正常生活的最有效方法。研究表明，青少年尤其难以定期服用吸入器药物。因此，父母对定期服药的支持非常重要。然而，在这个年龄段，同伴的支持变得越来越重要。因此，父母和同龄人的支持可以用来帮助青少年定期服药。目前，国家卫生服务体系没有任何方案帮助父母和青少年定期服用哮喘药物。我们已经确定了一个非常有前途的家长-青年团队合作方案，该方案是在美国制定和测试的，能够提供这种支持。该方案包括：（a）讨论学习材料和讲座，介绍定期服用哮喘药物的原因，以及家庭沟通对服药的重要性;（B）利用角色扮演和解决问题的技巧来界定问题，寻找替代方案和解决办法;（c）讨论与定期服用哮喘药物有关的家庭挑战;及（d）制订目标及切实可行的计划，以便定期服用哮喘药物。在该方案中，将电子监测器（所谓的智能吸入器）连接到实际的吸入器上，用于记录预防性吸入器是否按规定使用。在该方案中，父母和青少年利用这些数据制定目标和行动计划。我们建议调整这一方案，以英国国民保健服务的背景下，并通过应用最新的研究成果以及青少年，家长和护理提供者的投入加强它。重要的是，我们将开发和评估一个额外的新组件对同行的支持。为了使该计划在英国NHS范围内可持续发展，哮喘护士将提供该计划。因此，我们将制定一个手册，有效地培训哮喘护士。在此之后，我们将测试这一新方案的可行性，最多10名青少年和他们的父母，以评估它将如何在英国国民保健服务提供;以及青少年，父母和护理提供者对这一新方案的看法。我们的研究结果将为更大规模的干预铺平道路，鼓励青少年定期服用哮喘药物，帮助有效管理哮喘，提高生活质量。

Asthma affects one in 11 children and adolescents in the UK and can have a major impact on adolescents' quality of life and their health care use. Daily use of an asthma preventer inhaler is the most effective way to reduce symptoms and allow children and adolescents to lead a normal life. Research studies have shown that adolescents in particular struggle with taking their inhaler medication regularly. Therefore, parental support for taking medication regularly is important. However, in this age group peer support becomes more and more critical. Thus, support from parents and peers can be used to help adolescents to take their medication regularly. There is currently no programme in the NHS to help parents and adolescents to take asthma medication regularly. We have identified a very promising parent-youth teamwork programme, developed and tested in the United States, that provide such support. This programme includes: (a) discussing learning materials and worksheets about reasons for taking asthma medication regularly, and about how important family communication is for taking medication; (b) using role play and problem-solving techniques to define the problem, find alternatives and solutions; (c) discussing the family's challenges associated with taking asthma medication regularly; and (d) formulating goals and realistic plans how to take asthma medication regularly. In this programme, electronic monitors (so-called smart inhalers) to be attached to the actual inhaler, were used to record if the preventer inhaler was used as prescribed. For the programme, parents and adolescents used these data to formulate their goals and actions plans. We propose to adapt this programme to the UK NHS context, and strengthen it by applying the latest research findings as well as input from adolescents, parents, and care providers. Importantly, we will develop and evaluate an additional novel component on peer support. To make this program sustainable within the UK NHS context, an asthma nurse will be delivering this programme. Therefore, we will develop a manual to efficiently train asthma nurses. After that, we will test the feasibility of this new programme with up to 10 adolescents and their parents to evaluate how it would be delivered in the UK NHS; and what adolescents, parents and care providers think about this new programme. The results of our study will pave the way to a larger scale intervention that may encourage adolescents to take their asthma medications regularly, help manage their asthma effectively, and improve their quality of life.