Multi-component technology intervention for African American emerging adults with asthma

种族和少数民族青年的哮喘状况比高加索青年差，即使在控制了 社会经济变量。正确使用哮喘控制药物是降低哮喘死亡率的关键 和发病率。哮喘管理不善的临床后果包括增加疾病并发症， 过度的功能障碍和致命性哮喘发作。在这方面的研究有很大的局限性 改善少数族裔人群、特别是少数族裔青少年哮喘管理的干预措施 和年轻人，尽管疾病管理在青春期之后往往会恶化 成年期，青春期之后但成年期之前的独特发展阶段。的所有元素 拟议的研究方案在NHLBI资助的先导研究(1R34HL107664-01A1 MacDonell)中进行了试点。 结果表明研究方案的可行性和可接受性，以及概念的验证。我们现在是 准备在一项更大的随机临床试验中测试干预措施。拟议的研究将包括192名非洲人 患有中到重度持续性哮喘和低控制性用药依从性的美国新兴成年人 从诊所和急诊科招募。一半的样本将被随机化，以获得 多组分基于技术的干预(MCTI)，目标是坚持每日控制性用药。这个 MCTI由两个部分组成：1)2次计算机授课的激励性访谈目标 服药依从性，以及2)专注于 会话。短信将根据生态瞬时评估(EMA)进行个性化。这个 剩下的一半参与者将完成一系列与之匹配的计算机授课的哮喘教育模块 关于干预会议的时间、地点和交付方法。控制参与者还将收到 干预会话之间的文本消息。所有控制参与者的消息内容将相同，并且 包含哮喘的一般事实(不是量身定做的)。青年将从底特律医疗中心招募， 密歇根州底特律唯一的大学附属医疗中心。据推测，年轻人被随机分配到MCTI 将显示坚持服药(主要结果)和哮喘控制(次要结果)方面的改善 结果)与干预后所有随访(3、6、9和12个月)的对照情况进行比较。

Racial and ethnic minority youth have poorer asthma status than Caucasian youth, even after controlling for socioeconomic variables. Proper use of asthma controller medications is critical in reducing asthma mortality and morbidity. The clinical consequences of poor asthma management include increased illness complications, excessive functional morbidity, and fatal asthma attacks. There are significant limitations in research on interventions to improve asthma management in racial minority populations, particularly minority adolescents and young adults, though illness management tends to deteriorate after adolescence during emerging adulthood, the unique developmental period beyond adolescence but before adulthood. All elements of the proposed study protocol were piloted in an NHLBI-funded pilot study (1R34HL107664-01A1 MacDonell). Results suggested feasibility and acceptability of the study protocol as well as proof of concept. We are now ready to test the intervention in a larger randomized clinical trial. The proposed study will include 192 African American emerging adults with moderate to severe persistent asthma and low controller medication adherence recruited from clinic and emergency department settings. Half of the sample will be randomized to receive a multi-component technology-based intervention (MCTI) targeting adherence to daily controller medication. The MCTI consists of two components: 1) 2 sessions of computer-delivered motivational interviewing targeting medication adherence, and 2) individualized text messaging focused on medication adherence between the sessions. Text messages will be individualized based on Ecological Momentary Assessment (EMA). The remaining half of participants will complete a series of computer-delivered asthma education modules matched for length, location, and method of delivery of the intervention session. Control participants will also receive text messages between intervention sessions. Message content will be the same for all control participants and contain general facts about asthma (not tailored). Youth will be recruited from the Detroit Medical Center, the only university affiliated medical center in Detroit, Michigan. It is hypothesized that youth randomized to MCTI will show improvements in adherence to medication (primary outcome) and asthma control (secondary outcome) compared to the comparison condition at all post-intervention follow ups (3, 6, 9, and 12 months).