Text2Breathe: Enhance Parent Communication to Reduce Pediatric Asthma Disparities

描述（由申请人提供）：慢性疾病，如哮喘，不成比例地影响非裔美国人（AA）儿童。国家哮喘教育和预防计划（NAEPP）哮喘诊断和管理指南的一个关键建议是医疗保健提供者和患者（及其父母，儿童）之间的伙伴关系。促进父母与医疗保健提供者就医疗状况和问题进行公开沟通，可以使他们更有效地与孩子的初级保健提供者（PCP）合作。因此，提高非裔美国人（AA）父母的健康沟通技巧可以提高父母对治疗建议的依从性，包括对哮喘护理初级保健的利用，并最终改善其孩子的哮喘健康结果。我们的团队最近完成了一项面对面健康沟通干预的随机对照试验，结果与pcp合作进行哮喘治疗和降低紧急护理使用率，但干预后2个月后效果未持续。移动技术，如短消息服务（SMS，“文本信息”），是扩大这种干预的剂量和范围的低成本手段，可能对广泛使用短消息的行政助理特别有用。本研究采用短信增强的医疗沟通干预（Text2Breathe），旨在为城市低收入AA父母提供工具/技术，使他们能够更有效地与孩子的PCP进行沟通。268名参加急诊科哮喘教育诊所的儿童家长将被随机分配到常规护理组或Text2Breathe组。在长达一年的干预期间，Text2Breathe小组将持续收到个性化的短信，提供有关哮喘护理沟通的指导。关于父母自我效能感和结果预期、对哮喘护理治疗建议的依从性（例如，初级保健利用）和儿童哮喘结果的结果数据将通过结构化电话访谈收集。

DESCRIPTION (provided by applicant): Chronic diseases, such as asthma, disproportionately affect African American (AA) children. A key recommendation of the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma is partnership between healthcare providers and patients (and their parents, for children). Facilitating parents' open communication with providers regarding healthcare status and concerns can equip them to more effectively partner with their child's primary care provider (PCP). Thus, improving the health communication skills of African American (AA) parents could improve parent's adherence to treatment recommendations including utilization of the primary care for asthma care, and ultimately improve their child's asthma health outcomes. Our team recently completed a randomized controlled trial of an in- person health communication intervention that resulted in more partnerships with PCPs for asthma care and lower urgent care usage, but effects were not sustained past 2 months post-intervention. Mobile technology, such as Short Message Service (SMS, "text messaging"), is a low-cost means of extending the dosage and scope of this intervention and may be particularly useful among AAs, for whom the use of SMS is widespread. The proposed study involves a SMS-enhanced healthcare communication intervention (Text2Breathe) designed to equip urban, low-income AA parents with tools/techniques to empower parents to more effectively communicate with their children's PCP. 268 AA parents of children attending an emergency department asthma education clinic will be randomized to usual care or Text2Breathe. The Text2Breathe group will receive ongoing individualized text messages providing instruction about asthma care communication during the year- long intervention period. Outcome data on parental self-efficacy and outcome expectations, adherence to asthma care treatment recommendations (e.g., primary care utilization), and child asthma outcomes will be collected via structured telephone interviews at 3, 6, 12, 18, and 24 months post-enrollment. This trial can reduce pediatric health disparities by verifying the efficacy of a SMS-enhanced healthcare communication intervention that can extend to other chronic conditions and have health and policy implications.