Project ASPIRE: Improving Pediatric Asthma Management for Urban Families

描述(由申请人提供)：家庭压力已被确定为一种机制，通过这种机制，低社会经济地位可能与不利的哮喘结果有关。家庭和照顾者压力对儿童哮喘管理行为和哮喘结局有负面影响，但很少有哮喘教育干预包括评估和调整压力对哮喘自我管理的影响的心理部分。考虑到压力体验的文化差异和与心理健康问题相关的耻辱，带有心理成分的教育干预措施最好与目标社区成员合作设计，目标社区成员可以确保节目内容和形式符合他们的特定需求和受文化影响的健康信念。我们将与美国东南肺脏协会和我们的社区咨询委员会合作，设计并试行一种以家庭为基础的干预措施，将个人量身定制的哮喘教育与减少照顾者和家庭压力对哮喘管理的影响的策略相结合。这一治疗发展建议的目的是：(1)对持续性哮喘儿童及其父母进行重点小组，以完善家庭干预的内容；(2)对家庭干预进行试点研究，评估接受家庭干预的25个家庭的初步疗效、可行性和可接受性，并与通常接受强化治疗的25个家庭进行比较(触发控制资源和书面的哮喘行动计划)。主要治疗结果包括哮喘自我管理措施(自我报告管理、观察MDI/SPACE技术、尿可替宁以评估暴露于环境烟草烟雾)和发病率(症状天数、因哮喘缺课的天数和对哮喘的紧急卫生保健利用)。次要结果包括亲子关系质量、家庭凝聚力和照顾者压力。这项研究的第二个目的是从卫生服务支付者的角度评估干预措施的成本效益。如果成功，以家庭为基础的家庭干预可以改善处于压力下的照顾者及其子女的哮喘管理。我们希望这项研究将产生一种可复制和可持续的模式，可供社区组织采用，以降低生活在城市压力环境中的低收入哮喘儿童报告的高哮喘发病率。

DESCRIPTION (provided by applicant): Family stress has been identified as a mechanism by which low socioeconomic status may be linked to adverse asthma outcomes. Family and caregiver stress have a negative impact on children's asthma management behaviors and asthma outcomes, yet few asthma education interventions include a psychological component to assess and modify the impact of stress on asthma self-management. Given cultural variation in the experience of stress and the stigma associated with mental health problems, educational interventions with psychological components are best designed in collaboration with members of the target community, who can insure that program content and format will be responsive to their specific needs and culturally-influenced health beliefs. In collaboration with the American Lung Association - Southeast and our Community Advisory Board, we will design and pilot-test a home-based family intervention that integrates individually tailored asthma education with strategies to reduce the impact of caregiver and family stress on asthma management. The aims of this treatment development proposal are to: (1) conduct focus groups with children with persistent asthma and their parents to refine the content of the family intervention, and (2) conduct a pilot study of the family intervention, evaluating its initial efficacy, feasibility, and acceptability for 25 families receiving the family intervention as compared to 25 families receiving enhanced treatment as usual (trigger control resources and a written asthma action plan). Primary treatment outcomes include measures of asthma self-management (self-reported management, observed MDI/spacer technique, urinary cotinine to assess exposure to environmental tobacco smoke) and morbidity (number of symptom days, school days missed for asthma, and urgent health care utilization for asthma). Secondary outcomes include parent-child relationship quality, family cohesion, and caregiver stress. A secondary aim of the study is to assess the cost effectiveness of the intervention from the perspective of a health services payer. If successful, the home-based family intervention can improve the asthma management of caregivers under stress and their children. We hope that this research will result in a replicable and sustainable model that can be adopted by community-based organizations to reduce the high asthma morbidity reported for low-income children with asthma living in urban, stressful environments.