Children and Asthma: Communication and Outcomes

描述（由申请人提供）：该项目专注于儿童健康服务研究中一个被忽视的领域，即儿童哮喘就诊期间提供者与儿童照顾者之间的沟通与治疗依从性之间的关系。治疗依从性包括药物依从性、症状监测和环境触发控制。识别有效的沟通策略对未来的干预研究至关重要。将在8个儿科诊所招募35名医生及其护士和360对讲英语的儿童护理人员。如果儿童年龄在8至15岁之间，患有轻度、中度或重度持续性哮喘，并且之前至少因哮喘来过这家诊所一次，他们将符合资格。如果护理人员年满18岁，并且与患有哮喘的儿童住在一起，那么他们将符合资格。将分别获得照顾者和儿童的同意和同意。医生和护士将在研究开始时填写一份人口调查问卷。参加研究后，将对儿童的医疗访问进行录音。儿童在就诊后将接受访谈，要求他们演示吸入器和峰值流量技术，并使用肺活量测定法评估他们的肺功能。孩子们的看护人将在这些医疗访问后填写调查问卷。在录音探访后一个月将进行家访。在家访期间，将对儿童进行访谈，要求他们再次展示吸入器和峰值流量技术，并使用肺活量测定法检查他们的肺功能。护理人员将填写调查问卷。广义估计方程将用于检查医生和护士关于哮喘管理的沟通，哮喘护理行为的建模，以及儿童和护理人员在就诊期间的参与如何与治疗依从性相关。

DESCRIPTION (provided by applicant): The project is focused on a neglected area within children's health services research, the relationship between provider-child-caregiver communication during pediatric asthma visits and treatment adherence. Treatment adherence comprises medication adherence, symptom monitoring, and environmental trigger control. Identification of effective communication strategies is important for future intervention research. Thirty-five physicians and their nurses and 360 English-speaking child-caregiver pairs will be recruited at eight pediatric clinics. Children will be eligible if they are between 8 and 15 years of age, have mild, moderate, or severe persistent asthma and have previously visited this clinic at least once before for asthma. Caregivers will be eligible if they are at least 18 years of age and live with the child with asthma. Consent and assent to participate will be obtained from the caregivers and children respectively. Physicians and nurses will fill out a demographic questionnaire at the start of the study. Following enrollment into the study, the children will have their medical visits audio-taped. The children will be interviewed after their medical visits, asked to demonstrate inhaler and peak flow technique, and assessment of their lung function will occur using spirometry. The children's caregivers will fill out questionnaires after these medical visits. A home visit will occur one month after the audio-taped visit. Children will be interviewed during the home visits, asked to demonstrate inhaler and peak flow technique a second time, and have their lung function examined using spirometry. Caregivers will fill out questionnaires. Generalized estimating equations will be used to examine how physician and nurse communication about asthma management, modeling of asthma care behaviors, and engagement of the child and caregiver during medical visits, are related to treatment adherence.