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Bickel S, Cohen RT, Needleman JP, Volerman A. Appropriate inhaler use in children with asthma: barriers and opportunities through the lens of the socio-ecological model. J Asthma 2023; 60:1269-1279. [PMID: 36420559 PMCID: PMC10192155 DOI: 10.1080/02770903.2022.2152352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022]
Abstract
Objective: Proper use of inhaled medications is essential for management of asthma, as inhaled therapies are recommended as first-line for both prevention and treatment of asthma symptoms. Optimizing adherence requires identifying and understanding multiple layers of systemic complexity to obtaining and using these therapies and offering specific solutions to address these barriers. Bronfenbrenner's socio-ecological model provides a framework for examining multilevel systems - both internal and external - that contribute to the management of childhood asthma. The four levels in this model consist of factors related to the individual, interpersonal relationships, organizational entities, and societal structures and rules. This narrative review identifies influences and factors related to asthma inhaler adherence by each level and offers evidence-based solutions to each obstacle.Data Sources: We conducted PubMed searches to identify relevant articles for barriers and solutions impacting asthma control at each level of the socio-ecological model.Study Selection: Common barriers to asthma control at each model level were identified. Pertinent studies for each barrier were identified and reviewed by the writing group for inclusion into the narrative review.Results: For each level of the socio-ecological model, three primary issues were identified based on the literature review. Approaches for addressing each issue in an evidence-based, systematic fashion are presented.Conclusion: Understanding the obstacles and potential interventions to achieve proper use of inhaled medications is a critical step necessary to develop and implement systematic solutions aimed at improving asthma control and morbidity for the more than 6 million affected children in the United States.
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Affiliation(s)
- Scott Bickel
- Division of Pediatric Pulmonology, Allergy & Immunology, Norton Children’s and University of Louisville School of Medicine, Louisville, KY, USA
| | - Robyn T. Cohen
- Division of Pediatric Pulmonary and Allergy, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Joshua P. Needleman
- Division of Pediatric Pulmonology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Anna Volerman
- Department of Medicine and Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Delgado-Martinez R, Barry MF, Porras-Javier L, Thompson LR, Howard BJ, Sturner R, Halterman JS, Szilagyi PG, Okelo SO, Dudovitz RN. What Parents Want Doctors to Know: Responses to an Open-Ended Item on an Asthma Questionnaire. Acad Pediatr 2022; 22:657-666. [PMID: 34800723 DOI: 10.1016/j.acap.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Unstructured parental comments could solicit important information about children's asthma, yet are rarely captured in clinical asthma questionnaires. This mixed-methods study describes parents' written responses to an open-ended question in a validated asthma questionnaire. METHODS The Pediatric Asthma Control and Communication Instrument (PACCI) asthma questionnaire was administered to parents of children with asthma symptoms presenting to 48 pediatric primary care offices (PPCP), 1 pediatric pulmonology office, and 1 emergency department (ED). Responses to the question, "Please write down any concern or anything else you would like your doctor to know about your child's asthma" were analyzed using a phenomenological approach until thematic saturation was achieved for each site. Logistic regressions tested whether sociodemographic and clinical characteristics were associated with responding to the open-ended question. RESULTS Of 7,988 parents who completed the PACCI, 954 (12%) responded to the open-ended question-2% in PPCP, 31% in the ED, and 50% in the pulmonary setting. More severe asthma was associated with higher odds of responding (odds ratio, 2.01; 95% confidence interval, 1.42-2.84). Based on responses provided, we identified 3 communication types: 1) clarifying symptoms, 2) asking questions, and 3) communicating distress. Responses also covered 5 asthma-related themes: 1) diagnostic uncertainty, 2) understanding asthma etiology and prognosis, 3) medication management, 4) impact on child function, and 5) personal asthma characteristics. CONCLUSION Parents of children with severe asthma provided clarifying details, asked questions, and relayed health concerns and distress. None of these topics may be easily captured by closed-ended asthma questionnaires.
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Affiliation(s)
- Roxana Delgado-Martinez
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif.
| | - Melanie Frances Barry
- Department of Pediatrics, The Johns Hopkins University School of Medicine (BJ Howard and R Sturner), Baltimore, Md
| | - Lorena Porras-Javier
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
| | - Lindsey R Thompson
- Kaiser Permanente Bernard J. Tyson School of Medicine (LR Thompson), Pasadena, Calif
| | - Barbara J Howard
- Department of Pediatrics, The Johns Hopkins University School of Medicine (BJ Howard and R Sturner), Baltimore, Md
| | - Raymond Sturner
- Department of Pediatrics, The Johns Hopkins University School of Medicine (BJ Howard and R Sturner), Baltimore, Md
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine (JS Halterman), Rochester, NY
| | - Peter G Szilagyi
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
| | - Sande O Okelo
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
| | - Rebecca N Dudovitz
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
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Manis DR, Bielska IA, Cimek K, Costa AP. Community-informed, integrated, and coordinated care through a community-level model: A narrative synthesis on community hubs. Healthc Manage Forum 2022; 35:105-111. [PMID: 34610778 PMCID: PMC8873305 DOI: 10.1177/08404704211046604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We identify the core services included in a community hub model of care to improve the understanding of this model for health leaders, decision-makers in community-based organizations, and primary healthcare clinicians. We searched Medline, PubMed, CINAHL, Scopus, Web of Science, and Google from 2000 to 2020 to synthesize original research on community hubs. Eighteen sources were assessed for quality and narratively synthesized (n = 18). Our analysis found 4 streams related to the service delivery in a community hub model of care: (1) Chronic disease management; (2) mental health and addictions; (3) family and reproductive health; and (4) seniors. The specific services within these streams were dependent upon the needs of the community, as a community hub model of care responds and adapts to evolving needs. Our findings inform the work of health leaders tasked with implementing system-level transformations towards community-informed models of care.
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Affiliation(s)
- Derek R. Manis
- McMaster University, Hamilton, Ontario, Canada
- McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Iwona A. Bielska
- McMaster University Medical Centre, Hamilton, Ontario, Canada
- Hamilton Niagara Haldimand Brant Local Health Integration Network, Hamilton, Ontario, Canada
| | - Kelly Cimek
- Hamilton Niagara Haldimand Brant Local Health Integration Network, Hamilton, Ontario, Canada
| | - Andrew P. Costa
- McMaster University, Hamilton, Ontario, Canada
- McMaster University Medical Centre, Hamilton, Ontario, Canada
- McMaster University, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- St. Joseph’s Health System, Hamilton, Ontario, Canada
- Schlegel Research Institute for Aging, Waterloo, Ontario, Canada
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Childs E, Demers LB. Qualitative Coding Boot Camp: An Intensive Training and Overview for Clinicians, Educators, and Administrators. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10769. [PMID: 30800969 PMCID: PMC6342422 DOI: 10.15766/mep_2374-8265.10769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/03/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Qualitative coding is a tool for analyzing data involving strings of meaningful words. While many schools and universities have staff who can assist faculty with quantitative data analysis, qualitative data analysis is interpretive and requires both content-specific knowledge and research methodology tools. In this qualitative coding boot camp, we introduce clinician-educators, staff, and administrators to a general overview of qualitative coding and analysis. METHODS We designed and implemented an in-person training to help researchers who had limited exposure to qualitative research gain a general orientation to it. We provided an overview of qualitative data collection and qualitative coding and developed focused research questions related to sample interviews for participants to use in working together to develop a codebook. We concluded by discussing the iterative process of coding, how to work from codes to themes for a manuscript, and how to present and disseminate results. RESULTS To examine participants' learning during the boot camp session, we used a series of nonparametric sign tests to compare pre- and postsession responses on our evaluation form. The results of these tests showed significant growth in participant comfort with undertaking qualitative analysis. DISCUSSION Qualitative coding is an important skill for clinicians and their research teams to have, as it can help them to understand the experiences of those around them through an empirical lens. With this 2-hour training, we were able to increase participants' comfort level with the set of skills required to analyze qualitative data rigorously.
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Affiliation(s)
- Ellen Childs
- Research Scientist, Health, Law, Policy and Management Department, Boston University School of Public Health
| | - Lindsay B. Demers
- Assistant Professor, Education Evaluation Core, Department of Medicine, Boston University School of Medicine
- Director, Education Evaluation Core, Department of Medicine, Boston University School of Medicine
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