Children and Asthma: Communication and Outcomes

描述(由申请人提供)：该项目侧重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-儿童-照顾者之间的沟通与治疗依从性之间的关系。治疗依从性包括用药依从性、症状监测和环境触发控制。确定有效的沟通策略对未来的干预研究具有重要意义。将在8家儿科诊所招聘35名医生和他们的护士以及360对讲英语的儿童保育员。如果儿童年龄在8岁到15岁之间，患有轻度、中度或重度持续性哮喘，并且以前至少曾因哮喘来过本诊所一次，则符合条件。如果照顾者至少年满18岁，并与患有哮喘的孩子一起生活，他们就有资格。参加活动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统计调查问卷。在登记参加这项研究后，孩子们的就医过程将被录音。这些儿童将在就诊后接受采访，被要求演示吸入器和峰值流动法，并将使用肺活量测定仪评估他们的肺功能。孩子们的照顾者将在这些医疗访问后填写问卷。家访将在录音访问一个月后进行。儿童将在家访期间接受采访，要求再次演示吸入器和峰值流动法，并使用肺活量测定法检查他们的肺功能。照顾者将填写调查问卷。广义估计方程将被用来检验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在就诊期间儿童和照顾者的参与度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.