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Promoting Children’s Adherence to Asthma Self-Management
Patricia
Burkhart, Ph.D., Principal Investigator
Funded by the National
Institutes of Health, National Institute of Nursing
Research
Grant #1
R15 NR08106-01
(2002-2005)
Abstract
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The
long-term objective of this randomized, controlled clinical
trial is to improve pediatric asthma outcomes, a Healthy
People 2010 objective, by enhancing adherence to
recommended asthma self-management. Asthma affects 26.3
million Americans, including 9 million children. Recent
statistics reveal an alarming increase in pediatric asthma
morbidity and mortality. Peak expiratory flow rate (PEFR)
monitoring is integral to asthma symptom management.
However, there are no published studies regarding the
efficacy of strategies to enhance children’s adherence to
daily PEFR monitoring.
The
specific aim is to evaluate the effect of an intervention
combining a contingency management protocol with asthma
education (based on the National Asthma Education and
Prevention Program treatment guidelines, National Heart,
Lung, and Blood Institute) on:
-
adherence
to PEFR monitoring;
-
asthma
quality of life;
-
health
care utilization for asthma problems;
-
missed
school days due to asthma; and
-
number
of asthma episodes.
The
contingency management protocol will include
self-monitoring, a contingency contract, reinforcing,
tailoring, and cueing. The sample (N = 86) of 7- through
11-year-old children with persistent asthma and their
parents/guardians will be recruited primarily from physician
practices in central Kentucky. Subjects will be randomly
assigned to the intervention or usual care group. Data will
be collected electronically on PEFR monitoring adherence
using the AccuTrax Personal Diary Spirometer that records
the date, time, and PEFR value and includes a self-report
symptom and medication diary. The intervention will be
delivered Weeks 4 through 6. Adherence (defined as
electronically recorded PEFR monitoring divided by
prescribed PEFR monitoring) and asthma episodes will be
measured throughout the 16-week study. Data on the other
outcome variables will be collected at baseline, following
the intervention, and 10 weeks post-intervention.
This
study will provide further evaluation and refinement of the
intervention for the development of an R01 proposal for a
randomized, controlled clinical trial of an asthma
self-management program for children.
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