Children and Asthma: Communication and Outcomes

描述（由申请人提供）：该项目的重点是在儿童的健康服务研究中被忽视的领域，在儿科哮喘访问和治疗依从性期间提供者-儿童-护理人员之间的关系。治疗依从性包括药物依从性、症状监测和环境触发控制。有效的沟通策略的识别是重要的，为未来的干预研究。将在8个儿科诊所招募35名医生及其护士和360名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，并且之前曾因哮喘去过该诊所至少一次，则符合条件。照顾者将有资格，如果他们至少18岁，并与患有哮喘的孩子住在一起。将分别从看护者和儿童处获得参与的同意书。医生和护士将在研究开始时填写人口统计学调查问卷。入组研究后，儿童的医疗访视将被录音。这些儿童将在医疗访视后接受采访，要求他们演示吸入器和峰值流量技术，并使用肺功能测定法评估他们的肺功能。儿童的照顾者将在这些医疗访问后填写问卷。将在录音访视后一个月进行家访。儿童将在家访期间接受采访，要求他们第二次演示吸入器和峰值流量技术，并使用肺量测定法检查他们的肺功能。护理人员将填写调查问卷。广义估计方程将被用来检查如何医生和护士沟通哮喘管理，哮喘护理行为的建模，以及在医疗访问期间的儿童和照顾者的参与，与治疗依从性。

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.