AIM2ACT: A Mobile Health Tool to Facilitate Asthma Self-Management during Early Adolescence

项目总结 哮喘是最常见的儿童慢性病，影响9.7%的青少年。国家指导方针 强调坚持自我管理行为对控制和预防哮喘的重要性 健康和生活质量受损。青少年对哮喘自我管理的依从性不佳 行为，使他们面临发病和生活质量下降的风险。哮喘自我管理困难 出现在青春期早期，因为年轻人开始向更多地控制他们的治疗过渡 养生法，使其成为关键的干预期。帮助照顾者的支持在以下方面至关重要 确定早期青少年是否最终发展并掌握哮喘自我管理行为。我们的 跨学科团队获得了NIH的资助(PI：Fedele；R21 HD083830)，以响应对 制定干预措施，以促进早期青少年(12-15岁)的有益照顾者支持 哮喘控制不佳。AIM2ACT是一种二元智能手机干预，由儿科自我告知 专门为增加照顾者支持和青少年哮喘而量身定做的管理模式 自我效能，从而改善哮喘控制。AIM2ACT包含三个组成部分：1)生态 瞬间评估以确定哮喘自我管理的个性化优势和劣势 行为；2)协作确定和跟踪有助于早期青少年成为 越来越独立地管理他们的哮喘；以及3)一套引人入胜的技能培训视频，以帮助 Diads了解如何使用AIM2ACT并共同努力设定哮喘自我管理目标，开发和 达成目标，并参与解决问题的沟通。我们的中试结果显示了很高的可行性 以及我们方案的可接受性和AIM2ACT改善哮喘控制的初步疗效。这个 拟议的研究将测试AIM2ACT的疗效和长期维持治疗效果的完全- 160例年龄控制不佳的持续性哮喘早期青少年的动力性随机对照试验 12-15年，还有照顾者。家庭将被随机分配到接受AIM2ACT(n=80)或mHealth 注意力控制条件(n=80)，说明员工的注意力和基于技术的新颖性 干预6个月。处于控制状态的二人将不会接受个性化的哮喘治疗 反馈，不会通过协作性识别和跟踪哮喘自我管理目标进行指导， 并且将无法访问技能培训视频。取而代之的是，他们将收到关于 他们的智能手机关于行为管理技术，他们可以用来针对改善哮喘自我 管理层。控制条件的设计是为了在优化招聘的同时保持兴趣 对哮喘治疗的影响最小。评估将在基线、干预后和 3个月、6个月和12个月的随访时间点。患者报告(例如，哮喘控制测试)和客观 将收集监测结果(例如，肺活量测定、服药依从性)。

PROJECT SUMMARY Asthma is the most prevalent childhood chronic illness, affecting 9.7% of adolescents. National guidelines emphasize the importance of adherence to self-management behaviors for controlling asthma and preventing impaired health and quality of life. Adolescents have suboptimal adherence to asthma self-management behaviors, placing them at risk for morbidity and reduced quality of life. Asthma self-management difficulties emerge in early adolescence as youth begin to transition towards taking more control of their treatment regimen, making it a critical intervention period. The presence of helpful caregiver support is pivotal in determining whether early adolescents ultimately develop and master asthma self-management behaviors. Our interdisciplinary team received NIH funding (PI: Fedele; R21 HD083830) to respond to the critical need for the development of an intervention to facilitate helpful caregiver support in early adolescents (12-15 year-olds) with poorly controlled asthma. AIM2ACT is a dyadic smartphone intervention, informed by the Pediatric Self- Management Model that is specifically tailored to increase helpful caregiver support and adolescent asthma self-efficacy, thereby improving asthma control. AIM2ACT contains three components: 1) ecological momentary assessment to identify personalized strengths and weaknesses in asthma self-management behaviors; 2) collaborative identification and tracking of goals that help early adolescents to become increasingly independent in managing their asthma; and 3) a suite of engaging skills training videos to help dyads understand how to use AIM2ACT and work together to set asthma self-management goals, develop and achieve goals, and engage in problem-solving communication. Results of our pilot trial revealed high feasibility and acceptability of our protocol and preliminary efficacy for AIM2ACT in improving asthma control. The proposed study will test the efficacy of AIM2ACT and long-term maintenance of treatment effects in a fully- powered randomized controlled trial with 160 early adolescents with poorly controlled persistent asthma, ages 12-15 years, and a caregiver. Families will be randomly assigned to receive AIM2ACT (n=80) or a mHealth attention control condition (n=80) that accounts for staff attention and novelty of a technology-based intervention for 6 months. Dyads in the control condition will not receive personalized asthma management feedback, will not be guided through collaborative identification and tracking of asthma self-management goals, and will not have access to skills training videos. Instead, they will receive static educational information on their smartphones about behavioral management techniques they can use to target improving asthma self- management. The control condition is designed to optimize recruitment and sustain interest while concurrently having a minimal impact on asthma management. Assessments will occur at baseline, post-intervention, and 3-, 6-, and 12-month follow-up time points. Patient-reported (e.g., Asthma Control Test) and objectively monitored (e.g., spirometry, medication adherence) outcomes will be collected.