Children and Asthma: Communication and Outcomes

该项目的重点是儿童健康服务研究中一个被忽视的领域，即关系 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。 治疗依从性包括药物依从性、症状监测和环境触发 控制力。确定有效的沟通策略对未来的干预研究具有重要意义。 将在以下地点招聘35名医生及其护士和360名说英语的儿童保育员 八家儿科诊所。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，以前至少因哮喘来过本诊所一次。 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。同意书 并将分别获得照顾者和儿童的同意参加。医生和 护士将在研究开始时填写一份人口统计学调查问卷。在加入这项研究后， 孩子们将对他们的医疗访问进行录音。孩子们将在体检后接受采访 探视，要求展示吸入器和峰流技术，并评估他们的肺功能将 使用肺活量测定法发生。孩子们的照顾者将在这些医疗访问后填写问卷。一个 家访将在录音访问一个月后进行。孩子们将在家中接受采访 来访，要求再次演示吸入器和峰值流量技术，并进行肺功能检查 用肺活量测定法检查。照顾者将填写调查问卷。广义估计方程将是 用于检查医生和护士如何就哮喘管理、哮喘模型 护理行为，以及儿童和照顾者在就医期间的参与，与治疗有关 坚持不懈。

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.