A Family Intervention for Pediatric Asthma Self-Management in Puerto Ricans

描述（由研究者提供）：美国波多黎各儿童的哮喘和哮喘急性发作发生率在所有种族/族裔群体中最高。本申请集中在两个可改变的哮喘急性发作的危险因素-高水平的家庭哮喘诱因和吸入性皮质类固醇药物的依从性差。改变这些危险因素需要干预措施，可以最大限度地提高儿童和父母的哮喘管理技能。这一探索性的R21应用比较了哮喘自我管理干预，提供给家庭并根据他们的需求和文化信仰定制，标准哮喘教育对这两个风险因素的哮喘急性发作在高危波多黎各青少年和青少年前8-16岁。干预措施将是由波多黎各社区保健工作者进行一系列家访。在家访期间，将使用标准哮喘核心课程对家庭进行教育，该课程使用工具包针对个人需求，优势和信念进行量身定制。核心课程包括药物治疗，症状识别和家庭触发的哮喘主题。该工具包将环境重新安排、解决问题、自我监测和争取社会支持方面的具体自我管理技能培训纳入核心课程。它还包括文化整合，用于将文化信仰与哮喘教育和自我管理技能联系起来。具体目标1是测试这种以家庭为中心的、量身定制的自我管理干预措施在波多黎各青少年和青少年前哮喘患者中减少哮喘加重风险因素的能力。我们的假设是，干预组的触发行为综合评分至少比对照组低一分，并且在积极干预阶段后，与对照组相比，吸入性皮质类固醇药物的依从性至少提高20%。具体目标2是测试与该干预相关的哮喘急性发作风险因素的变化是否在主动干预完成后持续8个月。将使用行为随机对照试验设计（包括50名受试者和1：1随机化方案）测试该干预措施的疗效。长期目标是将这些试点数据应用于设计和实施一项更大的行为随机对照试验，该试验将测试类似哮喘干预措施对改善波多黎各儿童哮喘控制的有效性。这种干预措施的创新之处在于，它提供了针对个人家庭的特定哮喘自我管理教育，以促进文化敏感性和技能发展。通过创新整合行为临床试验有效性研究和基于社区的参与性研究中使用的方法来评估干预措施。本申请中的调查人员在为目标人群服务的社区机构和以社区为基础的参与性研究方面具有丰富的经验。这项研究产生的数据将提高我们对如何改善波多黎各儿童哮喘管理的理解。公共卫生相关性：波多黎各 在美国的所有种族/族裔群体中，黎加儿童的哮喘和哮喘急性发作率最高。这项研究产生的数据将有助于我们了解如何改善哮喘管理和减少波多黎各儿童和青少年的哮喘急性发作。参与性设计有助于建设社区研究能力，提高研究质量和效率。

DESCRIPTION (provided by investigator): Puerto Rican children in the United States experience the highest rates of asthma and asthma exacerbations of all racial/ethnic groups. This application focuses on two modifiable risk factors for asthma exacerbations-high levels of home asthma triggers and poor adherence to inhaled corticosteroid medication. Changing these risk factors requires interventions that can maximize the asthma management skills of both the child and the parent. This exploratory R21 application compares an asthma self-management intervention, delivered to the family and tailored to their needs and cultural beliefs, to standard asthma education on these two risk factors for asthma exacerbations in high-risk Puerto Rican teens and pre-teens ages 8-16 years old. The intervention will be a series of home visits provided by Puerto Rican community health workers. During home visits, the family will be educated using a standard asthma Core Curriculum which is tailored to individual needs, strengths, and beliefs using a Toolkit. The Core Curriculum includes the asthma topics of medications, symptom recognition, and home triggers. The Toolkit incorporates specific self-management skills training in environmental rearrangement, problem solving, self-monitoring, and enlisting social support into the Core Curriculum. It also includes cultural integration which is used to connect cultural beliefs with asthma education and self-management skills. Specific Aim 1 is to test the ability of this family-focused, tailored self-management intervention to reduce asthma exacerbation risk factors in Puerto Rican teens and pre-teens with asthma. Our hypotheses are that the intervention group will score at least one point less than the control group on the trigger behavior summary score and will have at least 20 per cent improved adherence to inhaled corticosteroid medications compared to controls after the active intervention phase. Specific Aim 2 is to test if changes in asthma exacerbation risk factors associated with this intervention are sustained 8 months after the completion of the active intervention. The efficacy of this intervention will be tested using a behavioral randomized controlled trial design featuring 50 subjects and a 1:1 randomization scheme. The long-term goal is to apply these pilot data to the design and implementation of a larger behavioral randomized controlled trial that will test the efficacy of a similar asthma intervention to improve asthma control in Puerto Rican children. The innovation of this intervention is that it provides specific asthma self-management education that is tailored to the individual family to promote cultural sensitivity and skills development. The intervention is evaluated through the innovative integration of methodologies used in behavioral clinical trial efficacy studies and in community-based participatory research. The investigators in this application have significant experience with community agencies serving the target population and with community-based participatory research. The data generated from this research will improve our understanding of how to improve asthma management in Puerto Rican children. PUBLIC HEALTH RELEVANCE: Puerto Rican children in the United States experience the highest rates of asthma and asthma exacerbations of all racial/ethnic groups. The data generated from this research will aid our understanding of how to improve asthma management and reduce asthma exacerbations in Puerto Rican children and adolescents. The participatory design serves to build community capacity for research and improve research quality and effectiveness.