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Ruggeri SY, Emerson A, Russell CL. A concept analysis of routines for improving health behaviors. Int J Nurs Sci 2023; 10:277-287. [PMID: 37545771 PMCID: PMC10401352 DOI: 10.1016/j.ijnss.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/09/2023] [Accepted: 06/17/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Chronic disease patients often have unhealthy routines, especially when away from health care professionals. These patients need clear guidance about establishing and maintaining routines. This study aimed to synthesize a definition of the concept of routines for improving health behaviors based on its uses in the literature. Methods We searched CINAHL, Medline, Scopus, and Google Scholar from January to May, 2022 for articles that included definitions of routines in the context of improving health behavior. We applied no date restriction. The systematic analytic method and Rodgers' evolutionary concept analysis method were used. We charted the attributes, antecedents, and consequences of routines for improving health behaviors, analyzed their uses in the literature, and synthesized the results in a definition of the concept. Result At total of 24 articles were included. Attributes of the concept were repeated patterns, controllable by the patient, goal-oriented health, and integration into an overarching lifestyle. Antecedents were individual characteristics and environmental factors. Consequences were psychological, physical, and social well-being at individual and environmental levels. Conclusion This clarified definition of routines for improving health behaviors will provide a starting point for future research and, eventually, a basis for clinical nursing interventions to support patients in developing and maintaining healthy routines to promote better patient outcomes.
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Affiliation(s)
- Sunny Y. Ruggeri
- School of Nursing and Health Studies, University of Missouri-Kansas City, Missouri, USA
- Dr. Lillian R. Goodman Department of Nursing, Worcester State University, Massachusetts, USA
| | - Amanda Emerson
- University of Kansas Medical Center, University of Kansas School of Nursing, Kansas, USA
| | - Cynthia L. Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Missouri, USA
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Schacter HL, D Ehrhardt A, MacDonell KE. Associations between peer experiences and health outcomes among adolescents and young adults with asthma. J Asthma 2023; 60:1359-1368. [PMID: 36369912 DOI: 10.1080/02770903.2022.2147080] [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: 03/30/2022] [Revised: 10/20/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Although peer relationships become increasingly important across adolescence and early adulthood, research examining links between peer relationships and the health outcomes of young people with asthma is scarce. Using a large sample of adolescents and young adults (AYAs) with asthma, the current study assessed whether positive and negative peer experiences are associated with AYAs' asthma control, asthma self-efficacy, and internalizing symptoms. METHODS In this cross-sectional study, a national sample of 440 diverse adolescents and young adults with asthma completed an online survey. Questionnaires assessed general and asthma-specific peer experiences (i.e. peer victimization; peer support; asthma-related peer problems) and health indicators (i.e. asthma control; asthma self-efficacy; internalizing symptoms). Regression analyses were performed to examine associations between peer experiences and health while controlling for participant age, gender, race/ethnicity, and age of asthma diagnosis. RESULTS Results from separate regression models indicated that adolescents who experienced greater peer victimization, less peer support, and more asthma-related peer problems also reported worse asthma control, lower asthma self-efficacy, and more severe internalizing symptoms. Follow-up exploratory analyses indicated that peer victimization and asthma-related peer problems were the strongest predictors of asthma control and internalizing, whereas peer support and asthma-related peer problems were the strongest predictors of asthma self-efficacy. CONCLUSIONS This study underscores connections between peer relationships and health outcomes among AYAs with asthma. Interventions that leverage peer support and mitigate peer stress may offer a developmentally appropriate approach for mitigating physical and psychological distress among adolescents and young adults with asthma.
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Affiliation(s)
| | | | - Karen E MacDonell
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
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Cushman GK, Koinis-Mitchell D, Alsina M, Barker D, Drew L, DeCesare C, Yeo AJ, Durkin K, Elwy AR, Jandasek B, Pearlman DN, Vivier P, McQuaid EL. Design of a community-based, Hybrid Type II effectiveness-implementation asthma intervention study: The Rhode Island Asthma Integrated Response (RI-AIR) program. Contemp Clin Trials 2023; 129:107204. [PMID: 37088129 PMCID: PMC11157426 DOI: 10.1016/j.cct.2023.107204] [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: 12/01/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Pediatric asthma is among the most common health conditions and disproportionately impacts Black and Latino children. Gaps in asthma care exist and may contribute to racial and ethnic inequities. The Rhode Island Asthma Integrated Response (RI-AIR) program was developed to address current limitations in care. The aims of the RI-AIR Hybrid Type II effectiveness-implementation trial were to: a) simultaneously evaluate the effectiveness of RI-AIR on individual-level and community-level outcomes; b) evaluate implementation strategies used to increase uptake of RI-AIR. In this manuscript, we outline the design and methods used to implement RI-AIR. METHODS School-based areas (polygons) with the highest asthma-related urgent healthcare utilization in Greater Providence, R.I., were identified using geospatial mapping. Families with eligible children (2-12 years) living in one of the polygons received evidence-based school- and/or home-based asthma management interventions, based on asthma control level. School-based interventions included child and caregiver education programs and school staff trainings. Home-based interventions included individualized asthma education, home-environmental assessments, and strategies and supplies for trigger remediation. Implementation strategies included engaging school nurse teachers as champions, tailoring interventions to school preferences, and engaging families for input. RESULTS A total of 6420 children were screened throughout the study period, 811 were identified as eligible, and 433 children were enrolled between November 2018 and December 2021. CONCLUSIONS Effective implementation of pediatric asthma interventions is essential to decrease health inequities and improve asthma management. The RI-AIR study serves as an example of a multi-level intervention to improve outcomes and reduce disparities in pediatric chronic disease. CLINICAL TRIALS REGISTRATION NUMBER NCT03583814.
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Affiliation(s)
- Grace K Cushman
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Miosotis Alsina
- Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - David Barker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Linnea Drew
- Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Catherine DeCesare
- Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Anna J Yeo
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA; Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Kristine Durkin
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Barbara Jandasek
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Deborah N Pearlman
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Patrick Vivier
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.
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4
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Cejas I, Sanchez C, Holcomb M, Coto J. Parents of children with hearing loss: Impact and exposure of COVID-19 on mental health. PLoS One 2023; 18:e0285249. [PMID: 37130117 PMCID: PMC10153707 DOI: 10.1371/journal.pone.0285249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/18/2023] [Indexed: 05/03/2023] Open
Abstract
The aim of this study was to evaluate the impact and exposure of COVID-19 on parent mental health (e.g., depression, anxiety, and post-traumatic stress disorder (PTSD), for parents of children with hearing loss. The survey was distributed via an electronic survey to families subscribed to a pediatric program listserv as part of a university medical center. Fifty-five percent of parents reported elevated symptoms of anxiety, while 16% scored in the clinically significant range for depression. In addition, 20% of parents reported elevated symptoms of PTSD. Liner regressions found that impact of COVID-19 predicted anxiety symptoms, while both impact and exposure predicted depression and PTSD symptoms. In addition, both impact and exposure predicted COVID related parental distress. Exposure and impact of COVID-19 has had negative consequences on parents of children with hearing loss. Although exposure influenced parental mental health, impact uniquely affected depression and PTSD. Results highlight the need for mental health screening, as well implementation of psychological interventions using telehealth or in-person consultations. Future work should focus on post-pandemic challenges, including long-term psychological functioning due to the established relationship between parental mental health and pediatric outcomes.
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Affiliation(s)
- Ivette Cejas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Chrisanda Sanchez
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Meredith Holcomb
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Jennifer Coto
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America
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Jébrak G, Houdouin V, Terrioux P, Lambert N, Maitre B, Ruppert AM. [Therapeutic adherence among asthma patients: Variations according to age groups. How can it be improved? The potential contributions of new technologies]. Rev Mal Respir 2022; 39:442-454. [PMID: 35597725 DOI: 10.1016/j.rmr.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
While asthma patients' treatment adherence (TA) generally leaves to be desired, few data exist on TA evolution from age group to another. During the meeting of a working group of pneumo-pediatricians and adult pulmonologists, we reviewed the literature on adherence according to age group, examined explanations for poor adherence, and explored ways of improving adherence via new technologies. Asthma is a chronic disease for which TA is particularly low, especially during adolescence, but also among adults. Inhaled medications are the least effectively taken. Several explanations have been put forward: cost and complexity of treatments, difficulties using inhalation devices, poor understanding of their benefits, erroneous beliefs and underestimation of the severity of a fluctuating disease, fear of side effects, neglect, and denial (especially among teenagers). Poor TA is associated with risks of needless treatment escalation, aggravated asthma with frequent exacerbations, increased school absenteeism, degraded quality of life, and excessive mortality. Better compliance is based on satisfactory relationships between caregivers and asthmatics, improved caregiver training, and more efficient transmission to patients of relevant information. The recent evolution of innovative digital technologies opens the way for enhanced communication, via networks and dedicated applications, and thanks to connected inhalation devices, forgetfulness can be limited. Clinical research will also help to ameliorate TA. Lastly, it bears mentioning that analysis of the existing literature is hampered by differences in terms of working definitions and means of TA measurement.
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Affiliation(s)
- G Jébrak
- Service de pneumologie B et de transplantations pulmonaires, hôpital Bichat, Paris, France.
| | - V Houdouin
- Service de pneumologie, allergologie et CRCM pédiatrique, hôpital Robert-Debré, Paris, France
| | - P Terrioux
- Cabinet libéral de pneumologie, Meaux, France
| | - N Lambert
- Service d'allergologie (centre de l'asthme et des allergies), Hôpital A. Trousseau, Paris, France
| | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal de Créteil, université Paris Est Créteil, Créteil, France
| | - A-M Ruppert
- Service de pneumologie, UF tabacologie, hôpital Tenon, DMU APPROCHES, Paris, France
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6
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Lu MA, Eckmann T, Ruvalcaba E, McQuaid EL, Rand CS, Riekert KA, Eakin MN. Family management of asthma in Head Start preschool children. Ann Allergy Asthma Immunol 2022; 128:178-183. [PMID: 34774736 PMCID: PMC8810596 DOI: 10.1016/j.anai.2021.11.002] [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: 07/22/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Urban minority preschool children are disproportionately affected by asthma with increased asthma morbidity and mortality. It is important to understand how families manage asthma in preschool children to improve asthma control. OBJECTIVE To evaluate family asthma management and asthma outcomes among a low-income urban minority population of Head Start preschool children. METHODS The family asthma management system scale (FAMSS) evaluates how families manage a child's asthma. A total of 388 caregivers completed the FAMSS at baseline. Asthma outcomes were evaluated at baseline and prospectively at 6 months, including asthma control (based on the Test for Respiratory and Asthma Control in Kids), courses of oral corticosteroids (OCSs) required, and caregiver health-related quality of life (Pediatric Asthma Caregiver's Quality of Life Questionnaire [PACQLQ]). Multiple regression models evaluated the relationship between the FAMSS total score, FAMSS subscales, and asthma outcomes. RESULTS Higher FAMSS total scores were associated with fewer courses of OCSs required (b = -0.23, P < .01) and higher PACQLQ scores (b = 0.07, P < .05). At baseline, higher integration subscale scores (b = -0.19, P < .05) were associated with fewer courses of OCSs required, and higher family response scores were associates with higher PACQLQ scores (b = 0.06, P < .05). Nevertheless, higher collaboration scores were associated with lower PACQLQ at baseline (b = -0.06, P < .05) and 6 months (b = -0.07, P < .05). CONCLUSION Among this population of low-income minority preschool children, understanding how a family manages their child's asthma may help identify gaps for education to possibly improve caregiver asthma-related quality of life and reduce courses of OCSs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01519453 (https://clinicaltrials.gov/ct2/show/NCT01519453); protocol available from meakin1@jhmi.edu.
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Affiliation(s)
- Monica A Lu
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Eckmann
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island; Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Cynthia S Rand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Chong-Fah-Shen K, Bumbacea R, Bassani C, Beltran CFP, Pham D, Lefevre S, Brandatan E, Vasconcelos MJ, Baldaçara R, Monsell S, Djuric-Filipovic I, Darlenski R, Pouessel G, Gonzalez-Estrada A, Caminati M, Tanno LK. Physician's experience on managing asthma in adolescents: results of the International AMADO (Asthma Management in ADOlescents) survey. Asia Pac Allergy 2021; 11:e45. [PMID: 34786375 PMCID: PMC8563100 DOI: 10.5415/apallergy.2021.11.e45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background Worldwide prevalence of asthma seems to be increasing in adolescents, but limited data is available regarding the management of asthma in this age group. Objective Therefore, we conducted an international survey focused on physicians who manage asthma in order to understand how Asthma Management in ADOlescents (AMADO) is currently performed. Methods The AMADO survey is a web-based global survey of physician's attitudes towards the management of asthma in adolescents, circulated for 17 weeks. The survey had an anonymous and voluntary standard. The questionnaire consisted in 27 questions covering the training background of respondents, difficulties in diagnosis, and in management of asthma in adolescents. Results Two hundred forty-four responses were received from 46 countries, from all continents. Most (65%) of participants indicated allergy as being their main specialty. The majority of participants (62%) had more than 5 years of clinical practice, but 62% have no formal training in management of adolescents with asthma. Most of participants (96%) indicated having at least one case of asthma in adolescents per month. 60% of respondents mentioned that the asthmatic adolescents only had the consultation due to the family imposition. All respondents mentioned having difficulties in the management of asthma in adolescents due to patient poor adherence. Overall, 44% of participants have no specific health care resources for adolescents in their departments. Main suggestions from the participants were: optimization of time and personalized communication to these cohort, and standardization of multidisciplinary actions to improve adherence to asthma control treatment. Conclusion Management of asthma in adolescents is still a challenge in clinical practice. The results from this survey helped us to identify the key issues to improve clinical outcomes in the future. This survey is the first step of the international AMADO initiative, which intends to optimize diagnosis and control of asthma and prevent avoidable deaths.
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Affiliation(s)
| | - Roxana Bumbacea
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | | | - Duy Pham
- Department of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Sebastien Lefevre
- Regional Institute for Allergic and Environmental Diseases - Clinical Immunology, Metz Regional Hospital, Metz, France
| | - Elena Brandatan
- Centre Hospitalier Regional, Department of Pediatrics Pneumology - Allergology, Namur, Belgium
| | - Maria João Vasconcelos
- Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | | | | | - Razvigor Darlenski
- Department of Dermatolgy and Venereology, Tokuda Hospital Sofia, Sofia, Bulgaria
| | - Guillaume Pouessel
- Pediatric Pulmonology and Allergy Department, Pôle enfant, Hôpital Jeanne de Flandre, CHRU de Lille and Université Nord de France, Lille, France
| | - Alexei Gonzalez-Estrada
- Divsion of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Marco Caminati
- Department of Medicine, University of Verona and Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Luciana Kase Tanno
- University Hospital of Montpellier, Montpellier, France.,Desbrest Institute of Epidemiology and Public Health, Université de Montpellier, UMR UA11 INSERM, Montpellier, France
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Feldman ECH, Durkin LK, Greenley RN. Family Support is Associated with Fewer Adherence Barriers and Greater Intent to Adhere to Oral Medications in Pediatric IBD. J Pediatr Nurs 2021; 60:58-64. [PMID: 33618177 DOI: 10.1016/j.pedn.2021.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE Medication nonadherence is common among adolescents, and family support can enhance adherence. In a sample of youth with inflammatory bowel disease (IBD), we aimed to describe barriers to oral medication adherence and intent to adhere. Additionally, we examined the role of family support in influencing adherence barriers and intent to adhere, and assessed if age moderated these relationships. DESIGNS AND METHODS A secondary analysis of baseline data from an adherence-promotion intervention trial was conducted. Youth reported perceptions of family support, adherence barriers, and intent to adhere via validated measures. RESULTS Among youth (N = 76, ages 11-18), age moderated the impact of family support on total adherence barriers, disease/regimen barriers, social support/self-efficacy barriers, and intent to adhere. At higher levels of family support, younger (Mage = 12.93 years) and mid-age (Mage = 14.68 years) youth reported fewer barriers to adherence and greater intent to adhere. No main effect of family support or evidence of age moderation was found for denial/distrust or peer influences barrier domains. CONCLUSIONS Younger and mid-aged adolescents benefitted from family support in the context of IBD management. Future research should examine whether interventions to enhance family support may enhance youth adherence. PRACTICAL IMPLICATIONS Given prior findings highlighting the success of nurse-led interventions in promoting adherence in patients with IBD, present findings suggest additional intervention points for nurses working with pediatric IBD populations.
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Affiliation(s)
- Estée C H Feldman
- Department of Psychology, Rosalind Franklin University of Medicine and Science, IL, United States of America.
| | - Lindsay K Durkin
- Department of Psychology, Rosalind Franklin University of Medicine and Science, IL, United States of America
| | - Rachel Neff Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, IL, United States of America
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Yildirim B, Tuncay T. Relationship between psychosocial characteristics and asthma management self-efficacy of caregiver mothers: a pilot study of pediatric asthma management in Turkey. Health Care Women Int 2021; 43:620-641. [PMID: 34165396 DOI: 10.1080/07399332.2021.1893731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We analyzed the relationships between family functionality, caregiver burden, perceived social support, and asthma management self-efficacy of 300 Turkish mothers who provide care to pediatric asthma patients in this cross-sectional sampling study. The mean age of the caregiver mothers was 31.82 ± 5.08. Our study results showed that the participants had above moderate but insufficient perceived social support and asthma management self-efficacy and they were moderately satisfied with caregiver burden and family functioning. As mothers' perceived social support increased, their satisfaction with family functioning and asthma management self-efficacy also increased but their caregiver burden decreased. Additionally, the caregiver mothers had a sufficiently high level of self-confidence in caregiving to children with asthma, and the caregiver mothers who received training or more information about asthma believed that they were able to manage asthma to a great degree. The researchers conducted regression analysis and they found that biological and social factors and the degree of caregiving burden were significantly associated with asthma management self-efficacy levels. The multivariate biopsychosocial model accounted for 37.4% of the total variance in asthma management self-efficacy. Parent asthma management self-efficacy levels of the caregiver mothers are largely linked to their biological and psychosocial characteristics.
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Affiliation(s)
- Bugra Yildirim
- Department of Social Work, Manisa Celal Bayar University, Manisa, Turkey
| | - Tarik Tuncay
- Department of Social Work, Hacettepe University, Ankara, Turkey
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10
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Sloand E, Butz A, Rhee H, Walters L, Breuninger K, Pozzo RA, Barnes CM, Wicks MN, Tumiel-Berhalter L. Influence of social support on asthma self-management in adolescents. J Asthma 2021; 58:386-394. [PMID: 31771375 PMCID: PMC7269846 DOI: 10.1080/02770903.2019.1698601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Adolescents with asthma are influenced by peers and family. The objective was to better understand family social support and test its association with medication adherence, asthma control, and Emergency Department (ED) use. METHODS This study is a cross-sectional secondary data analysis from a randomized controlled trial with urban adolescents from three U.S. cities. Participants (12-20 years old) with asthma completed the Perceived Family Support Scale (PFS) and Horne's Medication Adherence Report Scale (MARS). Data from both tools were classified into 2 categories- high and low (< 25th percentile) perceived family support and high (total score >10) and low medication adherence, respectively. Chi-square statistic and logistic regression were used for analysis. RESULTS Of the 371 participants, the majority were young (96% ≤ 17 years), African American or Bi-racial (85%), and Medicaid-insured (72%); over one-third had maternal family history of asthma. Among those on a controller medication (n = 270), only 37% reported its use ≥8 days over 2 weeks. Asthma control was poor with 50% categorized "not well controlled," 34% "very poorly controlled." Participants responded positively to most social support items. One item, providing and receiving social support to and from family members, was less often positively reported. Low medication adherence was significantly associated with lower perceived social support (p = 0.018). CONCLUSION This study underscores the importance of family social support in understanding the extent of adolescents' self-management, particularly medication adherence.
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Affiliation(s)
| | - Arlene Butz
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hyekyun Rhee
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Leanne Walters
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Kathleen Breuninger
- Primary Care Pediatric Nurse Practitioner, Park Pediatrics, Takoma Park, MD, USA
| | | | - Christina Marie Barnes
- Pediatric Nurse Practitioner, Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mona Newsome Wicks
- Health Promotion and Disease Prevention Department, University of Tennessee Health Science Center, College of Nursing, Memphis, TN, USA
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
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11
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Srour-Alphonse P, Cvetkovski B, Azzi E, Rand C, Cheong LHM, Kritikos V, Bosnic-Anticevich S. Understanding the Influences Behind Parents' Asthma Decision-Making: A Qualitative Exploration of the Asthma Network of Parents with Children with Asthma. Pulm Ther 2021; 7:151-170. [PMID: 33569733 PMCID: PMC8137740 DOI: 10.1007/s41030-021-00145-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Interventions aimed at optimizing parents’ ability to manage their children’s asthma could be strengthened by better understanding the networks that influence these parents’ choices when managing asthma. This study aimed to explore the asthma networks of parents of children with asthma—specifically to gain insights into whom parents select to be within their networks and why; how individuals within parents’ networks influence the way in which they manage their children’s asthma medications, and factors driving the development of these networks. Methods A qualitative research methodology utilizing semi-structured interviews with parents of children with asthma was employed to fulfil the objectives of this study. Results Twenty-six face-to-face interviews with parents of children with asthma were conducted, recorded, and transcribed. Transcriptions were independently coded for concepts and themes by the research team. Asthma medications was a dominant theme identified, and revealed that parents actively sought advice and support from a series of complex and multidimensional relationships with people and resources in their health network. These not only included health care professionals (HCPs) but also personal connections, lay individuals, and resources. The composition and development of these asthma networks occurred over time and were determined by several key factors: satisfaction with their HCP provider; need for information; convenience; trust and support; self-confidence in management; and parents’ perceptions of their children’s asthma severity. Conclusions By exploring parents’ asthma network, this study uncovers the complex relationship between HCPs, family and friends of parents of children with asthma, and provides new insight into the intimate and parallel influence they have on parent’s decision-making.
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Affiliation(s)
- Pamela Srour-Alphonse
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. .,Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.
| | - Biljana Cvetkovski
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Elizabeth Azzi
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Cynthia Rand
- Pulmonary and Critical Care Medicine Department, John Hopkins University, Baltimore, MD, USA
| | - Lynn H M Cheong
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Vicky Kritikos
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sinthia Bosnic-Anticevich
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Central Sydney Local Area Health District, Sydney, Australia
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12
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Achilleos M, Merkouris A, Charalambous A, Papastavrou E. Medication adherence, self-efficacy and health literacy among patients with glaucoma: a mixed-methods study protocol. BMJ Open 2021; 11:e039788. [PMID: 33472775 PMCID: PMC7818806 DOI: 10.1136/bmjopen-2020-039788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION As the world population ages, glaucoma is becoming an increasingly significant cause of blindness. A key component in the management of glaucoma is the use of prescribed medications and the adherence to treatment. However, there is evidence of low adherence to prescribed medication in chronic diseases, such as glaucoma. This study aims to explore the level of medication adherence, self-efficacy, social support and health literacy among the patients with glaucoma and to determine if there are any correlations between them. The ultimate aim is to use the information to develop an educational programme for patients with glaucoma at a later stage. METHODS AND ANALYSIS This is a mixed-methods study which includes two stages: a descriptive study (stage 1) and focus group discussions (stage 2). SAMPLE Patients with glaucoma or ocular hypertension, using at least one kind of drops, from two ophthalmology clinics. Selected measures include: The Glaucoma Treatment Compliance Assessment Tool, The European Health Literacy Survey Questionnaire, The Glaucoma Medication Self-Efficacy Questionnaire and The Multidimensional Scale of Perceived Social Support. Two focus groups will be used for the collection of qualitative data, aiming to enrich the study with the patients' experiences. The data will be analysed with SPSS, using descriptive and inferential statistics for stage 1 whereas content analysis will be used for the data from the focus group discussions (stage 2). ETHICS AND DISSEMINATION Permission to conduct the study was received from the National Bioethics Committee and the board of management of the two ophthalmology clinics. All participants will be informed fully on the purpose and methods of the study. Consent forms will be signed and at any time participants will have the right to withdraw. Confidentiality and the protection of data will be respected at all times.
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Affiliation(s)
- Maria Achilleos
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Anastasios Merkouris
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andreas Charalambous
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
- Nursing, Turun Yliopisto, Turku, Finland
| | - Evridiki Papastavrou
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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13
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Netz M, Fedele DA, Sweenie R, Baker D, Light M, McQuaid EL. Asthma Management Responsibility, Control, and Quality of Life Among Emerging Adolescents. J Pediatr Psychol 2020; 45:40-49. [PMID: 31579923 DOI: 10.1093/jpepsy/jsz069] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine how asthma control is related to the association between the division of responsibility for asthma management and asthma-related quality of life among early adolescents. METHODS Forty-nine youth aged 10-15 years (Mage = 12.25, 57.1% female) with a physician-verified asthma diagnosis completed the Standardized Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and Asthma Control Test (ACT). Youth and their caregivers also completed the Asthma Responsibility Questionnaire (ARQ). Higher ACT scores indicate better asthma control. RESULTS There was a significant difference in ARQ scores between youth and caregivers (p < .001, d = .94). Youth reported sharing equal responsibility for asthma management with caregivers, while caregivers reported having more responsibility relative to youth. Greater youth-reported ARQ (p = .004) and greater ACT scores (p < .001) were associated with higher PAQLQ scores. ACT scores moderated the effect of youth-reported ARQ on PAQLQ scores (p = .043). For youth with lower ACT scores, higher youth-reported responsibility was associated with higher PAQLQ scores; while for youth with higher ACT scores, PAQLQ scores were high regardless of perceived responsibility. The interaction between caregiver ARQ scores and ACT scores was not significant. CONCLUSION This study suggests youth and caregivers report discrepant ARQ for asthma management tasks. Responsibility and level of asthma control are important factors for PAQLQ, with results indicating that fostering responsibility is an important factor, even among youth with poorly controlled asthma. Findings suggest that healthcare providers should assess family responsibility and help caregivers support adolescents in developing asthma management skills.
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Affiliation(s)
- Mallory Netz
- Department of Clinical and Health Psychology, University of Florida
| | - David A Fedele
- Department of Clinical and Health Psychology, University of Florida
| | - Rachel Sweenie
- Department of Clinical and Health Psychology, University of Florida
| | - Dawn Baker
- Department of Pediatrics, University of Florida
| | | | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University and Rhode Island Hospital
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14
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Roberts G, Vazquez‐Ortiz M, Knibb R, Khaleva E, Alviani C, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Garriga‐Baraut T, Gore C, Gowland MH, Hox V, Jensen B, Mortz CG, Pfaar O, Pite H, Santos AF, Sanchez‐Garcia S, Timmermans F. EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma. Allergy 2020; 75:2734-2752. [PMID: 32558994 DOI: 10.1111/all.14459] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
Adolescent and young adult (AYA) patients need additional support, while they experience the challenges associated with their age. They need specific training to learn the knowledge and skills required to confidently self-manage their allergies and/or asthma. Transitional care is a complex process, which should address the psychological, medical, educational and vocational needs of AYA in the developmentally appropriate way. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline to provide evidence-based recommendations for healthcare professionals to support the transitional care of AYA with allergy and/or asthma. This guideline was developed by a multidisciplinary working panel of experts and patient representatives based on two recent systematic reviews. It sets out a series of general recommendations on operating a clinical service for AYA, which include the following: (a) starting transition early (11-13 years), (b) using a structured, multidisciplinary approach, (c) ensuring AYA fully understand their condition and have resources they can access, (d) active monitoring of adherence and (e) discussing any implications for further education and work. Specific allergy and asthma transition recommendations include (a) simplifying medication regimes and using reminders; (b) focusing on areas where AYA are not confident and involving peers in training AYA patients; (c) identifying and managing psychological and socio-economic issues impacting disease control and quality of life; (d) enrolling the family in assisting AYA to undertake self-management; and (e) encouraging AYA to let their friends know about their allergies and asthma. These recommendations may need to be adapted to fit into national healthcare systems.
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Affiliation(s)
- Graham Roberts
- Faculty of Medicine University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Marta Vazquez‐Ortiz
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | | | - Cherry Alviani
- Faculty of Medicine University of Southampton Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology, Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine Section of Paediatrics University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Teresa Garriga‐Baraut
- Unitat d'Allergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d'Investigació “Creixement i Desenvolupament” Institut de Recerca de l'Hospital Universitari Vall d'Hebron (VHIR) Barcelona Spain
| | - Claudia Gore
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | | | - Valérie Hox
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children's Health (Paediatric Allergy School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King's College London London UK
- Children's Allergy Service Guy's and St Thomas' Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | | | - Frans Timmermans
- Nederlands Anafylaxis Netwerk—European Anaphylaxis Taskforce Dordrecht The Netherlands
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15
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Moskowitz DA, Macapagal K, Mongrella M, Pérez-Cardona L, Newcomb ME, Mustanski B. What If My Dad Finds Out!?: Assessing Adolescent Men Who Have Sex with Men's Perceptions About Parents as Barriers to PrEP Uptake. AIDS Behav 2020; 24:2703-2719. [PMID: 32157491 PMCID: PMC7462124 DOI: 10.1007/s10461-020-02827-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy for high-risk adults and recently was given US FDA approval for use among adolescents. Yet, the barriers to medication uptake for this population are unique when compared to adult populations, as parents may be just as likely as prescribers to be gatekeepers to access. To better understand the role of parents in adolescents' attitudes towards PrEP, we surveyed 491 adolescent men who have sex with men (AMSM) ages 13-18, using forced choice and open-ended response questions. We measured perceived parent-PrEP supportiveness, hypothetical parent reactions to a request to initiate PrEP, and perceived positive and negative aspects of taking PrEP without parents knowing. A mixed-methods approach was employed. Results indicated a majority of AMSM had heard of PrEP and most reported their parents would be unsupportive of their taking PrEP. Teens perceived their parents would likely be angry, accusatory, and punitive if PrEP use was discovered, and that accessing PrEP independent of parents might increase their health autonomy, agency, and prevent awkward conversations about sex. Furthermore, a path model revealed that fears of parental reaction and poor self-efficacy to communicate with parents about PrEP significantly contributed to participants feeling PrEP was not "right" for them, and as a corollary, less interest in starting PrEP. The study suggests that improving parental knowledge of PrEP and encouraging parents to begin the conversation about PrEP could help increase uptake in AMSM.
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Affiliation(s)
- David A Moskowitz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA
| | - Leishla Pérez-Cardona
- Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Floor 14, Chicago, IL, 60611, USA.
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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16
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Vazquez‐Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Gore C, Hox V, Jensen B, Pite H, Santos AF, Sanchez S, Alviani C, Garriga‐Baraut T, Knibb R, Mortz CG, Gowland MH, Timmermans F, Roberts G. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review. Allergy 2020; 75:1850-1880. [PMID: 32141620 DOI: 10.1111/all.14258] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions. METHODS A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken. RESULTS A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life-impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors-asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence-suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management-facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships-families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals. CONCLUSIONS We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.
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Affiliation(s)
- Marta Vazquez‐Ortiz
- Department of Paediatrics Faculty of Medicine Imperial College London London UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Department of Paediatrics Imperial College London London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Claudia Gore
- Department of Paediatrics Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Valérie Hox
- Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital Lisbon Portugal
- CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children’s Health (Paediatric Allergy) Faculty of Life Sciences and Medicine School of Life Course Sciences King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Silvia Sanchez
- Allergy Department Hospital Infantil Universitario del Niño Jesús Madrid Spain
| | - Cherry Alviani
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
| | - Teresa Garriga‐Baraut
- Unitat d'Al.lergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d’Investigació “Creixement i Desenvolupament” Institut de Recerca de l’Hospital Universitari Vall d’Hebron (VHIR) Barcelona Spain
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | | | - Frans Timmermans
- Frans Timmermans: Nederlands Anafylaxis Netwerk – European Anaphylaxis Taskforce Dordrecht The Netherlands
| | - Graham Roberts
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
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17
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Perceptions of HIV Self-Management Roles and Challenges in Adolescents, Caregivers, and Health Care Providers. J Assoc Nurses AIDS Care 2020; 30:415-427. [PMID: 31241506 DOI: 10.1097/jnc.0000000000000011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Self-management of HIV is a desirable goal for the millions of adolescent persons living with HIV (PLWH). Adolescent PLWH continue to experience poor HIV care outcomes, primarily due to poor rates of medication adherence and retention in care, highlighting a need to develop adolescent self-management skills. The aim of our study was to examine adolescent, caregiver, and health care provider perceptions of adolescent PLWH self-management roles, barriers, and facilitators. Swendeman et al.'s self-management framework for chronic diseases guided the analyses. Participant narratives highlighted perceptions of their responsibilities and related challenges with regard to self-management of HIV by adolescents. Our findings highlighted the complexity of HIV self-management for adolescents and underscored the need for multifaceted programs to strengthen adolescent-caregiver-health care provider partnerships in order to improve adolescent PLWH health and wellbeing.
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18
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Federico MJ, McFarlane AE, Szefler SJ, Abrams EM. The Impact of Social Determinants of Health on Children with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1808-1814. [PMID: 32294541 DOI: 10.1016/j.jaip.2020.03.028] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 12/20/2022]
Abstract
SzAsthma is the most common chronic disease of childhood. Disparities in asthma outcomes have led to international attention on the biologic, social, economic, and other factors that impact the health of children with asthma. Studies indicate that social determinants of health such as housing, neighborhood safety, and access to care significantly impact the health of children with asthma. However, screening for socioeconomic and environmental factors that impact asthma can be difficult to integrate into clinical practice. In addition, it is not yet clear which interventions to address these factors are most effective. This article will review recent studies of determinants and social determinants of health and propose a framework for identifying and addressing them in the care of children with asthma in a clinical setting.
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Affiliation(s)
- Monica J Federico
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Arthur E McFarlane
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada.
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19
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Cushing CC, Fedele DA, Patton SR, McQuaid EL, Smyth JM, Prabhakaran S, Gierer S, Koskela-Staples N, Ortega A, Fleming KK, Nezu AM. Responsive Asthma Care for Teens (ReACT): development protocol for an adaptive mobile health intervention for adolescents with asthma. BMJ Open 2019; 9:e030029. [PMID: 31434777 PMCID: PMC6707700 DOI: 10.1136/bmjopen-2019-030029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Asthma is a leading cause of youth morbidity in the USA, affecting >8% of youth. Adherence to inhaled corticosteroids (ICS) can prevent asthma-related morbidity; however, the typical adolescent with asthma takes fewer than 50% of their prescribed doses. Adolescents are uniquely vulnerable to suboptimal asthma self-management due to still-developing executive functioning capabilities that may impede consistent self-regulation and weaken attempts to use problem solving to overcome barriers to ICS adherence. METHODS AND ANALYSIS The aims of this project are to improve adherence to ICS as an important step towards better self-management among adolescents aged 13-17 years diagnosed with asthma by merging the efficacious behaviour change strategies found in behavioural health interventions with scalable, adaptive mobile health (mHealth) technologies to create the Responsive Asthma Care for Teens programme (ReACT). ReACT intervention content will be developed through an iterative user-centred design process that includes conducting (1) one-on-one interviews with 20 teens with asthma; (2) crowdsourced feedback from a nationally representative panel of 100 adolescents with asthma and (3) an advisory board of youth with asthma, a paediatric pulmonologist and a behavioural health expert. In tandem, we will work with an existing technology vendor to programme ReACT algorithms to allow for tailored intervention delivery. We will conduct usability testing of an alpha version of ReACT with a sample of 20 target users to assess acceptability and usability of our mHealth intervention. Participants will complete a 4-week run-in period to monitor their adherence with all ReACT features turned off. Subsequently, participants will complete a 4-week intervention period with all ReACT features activated. The study started in October 2018 and is scheduled to conclude in late 2019. ETHICS AND DISSEMINATION Institutional review board approval was obtained at the University of Kansas and the University of Florida. We will submit study findings for presentation at national research conferences that are well attended by a mix of psychologists, allied health professionals and physicians. We will publish study findings in peer-reviewed journals read by members of the psychology, nursing and pulmonary communities.
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Affiliation(s)
- Christopher C Cushing
- Clinical Child Psychology Program and Schiefelbusch Institute for LifeSpan Studies, University of Kansas
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Susana R Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Joshua M Smyth
- Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Selina Gierer
- Division of Allergy and Immunology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Adrian Ortega
- Clinical Child Psychology Program and Schiefelbusch Institute for LifeSpan Studies, University of Kansas
| | | | - Arthur M Nezu
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
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20
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Smaldone A, Manwani D, Green NS. Greater number of perceived barriers to hydroxyurea associated with poorer health-related quality of life in youth with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27740. [PMID: 30941907 PMCID: PMC6538386 DOI: 10.1002/pbc.27740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite medical benefits, hydroxyurea adherence in adolescents is often poor. As part of a baseline assessment of 28 youth (10-18 years) parent dyads who participated in a 6-month feasibility trial to improve hydroxyurea adherence, we measured the relationship between greater barriers to adherence and health-related quality of life (HRQL) from youth and parent perspectives. PROCEDURE Barriers were measured using the Adolescent and Parent Medication Barriers Scales with nine hydroxyurea items added. Barriers reported by ≥25% of the sample were considered common. Generic and disease-specific HRQL were measured by PedsQL and PedsQL Sickle Cell Disease modules. Data were analyzed using descriptive statistics, Cronbach alpha, Spearman correlation coefficients, and paired t tests. RESULTS Fifty-six subjects (28 dyads) participated. Youth reported greater barriers compared with parents (5.0 ± 3.9 and 3.5 ± 3.2; P = 0.03), with >80% of respondents reporting ≥1 barriers. Twelve barriers were reported by ≥25% of adolescents, whereas six were reported by ≥25% of parents. Of these, only two were common to both dyad members. Approximately one-third of youth had generic and disease-specific HRQL scores that fell at or below cutoff scores, suggesting being at risk for impaired HRQL. Greater barriers were inversely associated with poorer generic (parent r = -0.43, P = 0.03; youth r = -0.44, P < 0.001) and disease-specific HRQL (parent r = -0.53, P = 0.005; youth r = -0.53, P < 0.001). CONCLUSIONS Hydroxyurea barriers were frequently reported but differed by dyad members' perspective. Greater barriers were associated with poorer generic and disease-specific HRQL. To reduce barriers to hydroxyurea in youth with sickle cell disease, perspectives of both dyad members should be addressed.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, New York
- College of Dental Medicine, Columbia University Medical Center, New York, New York
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Nancy S. Green
- Department of Pediatrics, Columbia University Medical Center, New York, New York
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21
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Şanlıtürk D, Alkaya SA. Development of an Allergen-Exposure Avoidance Scale and Inhaler Use Scale for Patients with Asthma: A Reliability and Construct Validity Study. Turk Thorac J 2018; 19:110-116. [PMID: 30083400 DOI: 10.5152/turkthoracj.2018.17074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/15/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the reliability of the allergen-exposure avoidance scale (AEAS) and inhaler use scale (IUS) in patients with asthma. MATERIALS AND METHODS The present study was performed as a methodological design. The study included 130 patients with asthma. Each scale of allergen-exposure avoidance and inhaler use comprised 13 items. Cronbach's alpha and total item correlation were performed to calculate internal consistency of the scales, and the Kaiser-Meyer-Olkin, Bartlett's, and exploratory factor analysis tests were performed to assess construct validity. RESULTS The Cronbach's alpha coefficients were 0.724 for IUS and 0.624 for AEAS. After exploratory factor analysis, the factors with eigenvalues >1.00 in the analysis (eigenvalues for IUS were 3.790, 1.793, and 1.789 and for AEAS were 2.990, 2.195, and 1.291) were considered. In the results of the analysis, three factors emerged in parallel with the theoretical structure. These three factors explained 52.087% of the total variance in IUS (29.151%, 13.790%, and 9.145%, respectively) and 53.960% of the total variance in AEAS (24.916%, 18.289%, and 10.754%, respectively). CONCLUSION Inhaler use scale and AEAS were determined to be reliable and construct valid scales. They can be used to measure factors affecting the behavioral intentions toward individuals with asthma.
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Affiliation(s)
- Döndü Şanlıtürk
- Department of Nursing, Gaziosmanpaşa University, Faculty of Health Sciences, Tokat, Tukey
| | - Sultan Ayaz Alkaya
- Department of Nursing, Gazi University, Faculty of Health Sciences, Ankara, Turkey
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22
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Holley S, Walker D, Knibb R, Latter S, Liossi C, Mitchell F, Radley R, Roberts G. Barriers and facilitators to self-management of asthma in adolescents: An interview study to inform development of a novel intervention. Clin Exp Allergy 2018; 48:944-956. [PMID: 29573024 DOI: 10.1111/cea.13141] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/01/2018] [Accepted: 02/09/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite literature that spans twenty years describing the barriers to asthma self-management in adolescents, successful, clinically based interventions to address this important issue are lacking. Given the limitations of some of the previous studies, we conducted a study that aimed to gain a broader insight into barriers and facilitators to self-management of asthma by adolescents, not just adherence to treatment, and triangulated their views with those of their parents and healthcare professionals. METHODS Focus groups and interviews were conducted separately for 28 adolescents with asthma aged 12-18 years, 14 healthcare professionals and 12 parents. Focus groups and interviews were audio-recorded, and transcripts from each participant group were analysed separately using inductive thematic analysis. We triangulated the three perspectives by comparing themes that had emerged from each analysis. RESULTS Adolescents', parents' and healthcare professionals' views were summarized into ten related themes that included forgetting and routines, knowledge, embarrassment and confidence, communication with healthcare professionals, triggers, support at school, apathy and taking responsibility. We found that adolescents, parents and healthcare professionals raised similar barriers and facilitators to self-management and our results provide further validation for previous studies. CONCLUSION AND CLINICAL RELEVANCE Our study highlights that healthcare professionals may need to consider a range of psychological and contextual issues influencing adolescents' ability to effectively self-manage their asthma, in particular, how they implement treatment routines and the understanding that adolescents have of their condition and treatments. Crucially, healthcare professionals need to consider how this information is communicated and ensure they facilitate open, inclusive, two-way consultations. From this more comprehensive understanding, we have developed interventional strategies that healthcare professionals can utilize to empower adolescents to improve their asthma self-management.
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Affiliation(s)
- S Holley
- Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D Walker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R Knibb
- Aston University, Birmingham, UK
| | - S Latter
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - C Liossi
- School of Psychology, University of Southampton, Southampton, UK.,Department of Paediatric Psychology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - F Mitchell
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
| | - R Radley
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Roberts
- Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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23
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Improving adherence to asthma medications: current knowledge and future perspectives. Curr Opin Pulm Med 2018; 23:62-70. [PMID: 27755160 DOI: 10.1097/mcp.0000000000000334] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Poor adherence to asthma controller medications, particularly inhaled corticosteroids, has been well known for decades and is a major cause of uncontrolled asthma and increased healthcare utilization. This review presents recent evidence on factors leading to nonadherence in specific age groups, parents of young children, adolescents and young adults, adults, and the elderly. Novel management strategies including electronic sensors with associated smart phone applications for adherence improvement are discussed. RECENT FINDINGS Interventions to promote adherence must include a focus on issues important to the patient. Parents are concerned about adverse effects and the difficulty of medication administration in their child; adolescents and young adults need help with organizational skills and social barriers; adults may be more receptive to the need for daily medication after an acute exacerbation and acceptance of their disease; the elderly may have medication misuse issues associated with cognitive decline and other comorbidities related to aging. In all age groups, a trusting relationship with the provider is the key. New digital devices to track adherence may provide feedback to the patient and provider to evaluate and to promote adherence. SUMMARY Personalized approaches are required to address adherence barriers in target populations. Research on specific needs and barriers in target populations and development of appropriate strategies for use of new digital technology for adherence monitoring is needed.
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24
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Pickles K, Eassey D, Reddel HK, Locock L, Kirkpatrick S, Smith L. "This illness diminishes me. What it does is like theft": A qualitative meta-synthesis of people's experiences of living with asthma. Health Expect 2018; 21:23-40. [PMID: 28768067 PMCID: PMC5750696 DOI: 10.1111/hex.12605] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND What matters to people in their everyday experiences of living with asthma is influenced by a diverse range of personal, social, medical and environmental factors. Previous reviews of the asthma literature have largely focused on medical aspects of asthma or specific population groups with particular needs. OBJECTIVE To identify, describe and synthesize from the available qualitative literature the views and experiences of adults living with asthma. METHOD We systematically searched for qualitative studies reporting on the personal experience of living with asthma. A meta-synthesis approach was used to analyse and interpret the data. Key themes relating to personal perspectives on asthma were identified and grouped into overarching concepts. RESULTS We identified 26 studies. There was a paucity of literature on the physical burden of asthma symptoms and the role of social support. Our synthesis generated a central concept of the "work" associated with living with asthma: work was of a personal nature, and at times an intensely emotional experience. Individuals tailored their behaviour in response to demands of the physical and social environment, including interactions with health-care professionals. CONCLUSION This is the first systematic review of the qualitative literature reporting on people's own perspectives of living with asthma. Our findings draw attention to the nuances and sensitivities surrounding patient experiences of self-management. Medical care is a central plank of managing chronic conditions, but our health-care systems are now expected to deliver patient-centred care. Considering the broader aspects of asthma management, beyond that of symptoms and treatment, will help to facilitate comprehensive care.
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Affiliation(s)
- Kristen Pickles
- Centre for Values, Ethics & the Law in MedicineUniversity of SydneySydneyNSWAustralia
| | - Daniela Eassey
- Faculty of PharmacyUniversity of SydneySydneyNSWAustralia
| | - Helen K. Reddel
- Woolcock Institute of Medical ResearchUniversity of SydneySydneyNSWAustralia
| | - Louise Locock
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordOxfordUK
| | - Susan Kirkpatrick
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordOxfordUK
| | - Lorraine Smith
- Faculty of PharmacyUniversity of SydneySydneyNSWAustralia
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25
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Berg CA, Butner J, Wiebe DJ, Lansing AH, Osborn P, King PS, Palmer DL, Butler JM. Developmental model of parent-child coordination for self-regulation across childhood and into emerging adulthood: Type 1 diabetes management as an example. DEVELOPMENTAL REVIEW 2017; 46:1-26. [DOI: 10.1016/j.dr.2017.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Fedele DA, McConville A, Graham Thomas J, McQuaid EL, Janicke DM, Turner EM, Moon J, Abu-Hasan M. Applying Interactive Mobile health to Asthma Care in Teens (AIM2ACT): Development and design of a randomized controlled trial. Contemp Clin Trials 2017; 64:230-237. [PMID: 28986245 DOI: 10.1016/j.cct.2017.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 01/01/2023]
Abstract
Early adolescents have difficulties performing asthma self-management behaviors, placing them at-risk for poor asthma control and reduced quality of life. This paper describes the development and plans for testing an interactive mobile health (mHealth) tool for early adolescents, ages 12-15years, and their caregivers to help improve asthma management. Applying Interactive Mobile health to Asthma Care in Teens (AIM2ACT) is informed by the Pediatric Self-management model, which posits that helpful caregiver support is facilitated by elucidating disease management behaviors and allocating treatment responsibility in the family system, and subsequently engaging in collaborative caregiver-adolescent asthma management. The AIM2ACT intervention was developed through iterative feedback from an advisory board composed of adolescent-caregiver dyads. A pilot randomized controlled trial of AIM2ACT will be conducted with 50 early adolescents with poorly controlled asthma and a caregiver. Adolescent-caregiver dyads will be randomized to receive the AIM2ACT smartphone application (AIM2ACT app) or a self-guided asthma control condition for a 4-month period. Feasibility and acceptability data will be collected throughout the trial. Efficacy outcomes, including family asthma management, lung function, adolescent asthma control, asthma-related quality of life, and self-efficacy for asthma management, will be collected at baseline, post-treatment, and 4-month follow-up. Results from the current study will inform the utility of mHealth to foster the development of asthma self-management skills among early adolescents.
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Affiliation(s)
- David A Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States.
| | - Andrew McConville
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Elise M Turner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Jon Moon
- MEI Research, Ltd, Edina, MN, United States
| | - Mutasim Abu-Hasan
- Pediatric Pulmonary Division, University of Florida, Gainesville, FL, United States
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27
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McRoy L, Rust G, Xu J. Factors Associated with Asthma ED Visit Rates among Medicaid-enrolled Children: A Structural Equation Modeling Approach. AIMS MEDICAL SCIENCE 2017; 4:71-82. [PMID: 30519630 PMCID: PMC6277032 DOI: 10.3934/medsci.2017.1.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Asthma is one of the leading causes of emergency department visits and school absenteeism among school-aged children in the United States, but there is significant local-area variation in emergency department visit rates, as well as significant differences across racial-ethnic groups. ANALYSIS We first calculated emergency department (ED) visit rates among Medicaid-enrolled children age 5-12 with asthma using a multi-state dataset. We then performed exploratory factor analysis using over 226 variables to assess whether they clustered around three county-level conceptual factors (socioeconomic status, healthcare capacity, and air quality) thought to be associated with variation in asthma ED visit rates. Measured variables (including ED visit rate as the outcome of interest) were then standardized and tested in a simple conceptual model through confirmatory factor analysis. RESULTS County-level (contextual) variables did cluster around factors declared a priori in the conceptual model. Structural equation models connecting the ED visit rates to socioeconomic status, air quality, and healthcare system professional capacity factors (consistent with our conceptual framework) converged on a solution and achieved a reasonable goodness of fit on confirmatory factor analysis. CONCLUSION Confirmatory factor analysis offers an approach for quantitatively testing conceptual models of local-area variation and racial disparities in asthma-related emergency department use.
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Affiliation(s)
- Luceta McRoy
- Southern Adventist University, Department of Business, Collegedale, TN 37363
| | - George Rust
- Center for Medicine and Public Health, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32304
| | - Junjun Xu
- National Center for Primary Care, Morehouse School of Medicine Atlanta, GA 30310
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28
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de Benedictis D, Bush A. Asthma in adolescence: Is there any news? Pediatr Pulmonol 2017; 52:129-138. [PMID: 27273858 DOI: 10.1002/ppul.23498] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/18/2016] [Accepted: 05/25/2016] [Indexed: 12/22/2022]
Abstract
Asthma is a chronic disease that has a significant impact quality of life, which is particularly important in adolescence. We will discuss aspects of epidemiology, the clinical spectrum, diagnostics, and management of asthma in adolescence. In particular, we will highlight the psychological implications of having asthma during this developmental period. Data published in the past 10 years, since we last reviewed the subject, will be the main focus of this paper. The care of the teenager with asthma should take into account the rapid physical, emotional, cognitive, and social changes that occur during normal adolescence. The diagnostic process may be more difficult since teenagers tend to deny their illness. Thus, both under-diagnosis and under-assessment of asthma severity may lead to under-treatment and potentially avoidable morbidity and even mortality. Conversely, teenagers may be often misdiagnosed as having asthma or their asthma severity may be overestimated leading to inappropriate and sometimes excessive treatment. Educational programs, environmental avoidance measures, proper use of medications along with a skilled approach, and a caring attitude of health providers are all very important for successful management. Pediatr Pulmonol. 2017;52:129-138. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Andrew Bush
- Department of Pediatrics, Imperial College, London, UK.,Department of Pediatric Respiratory Medicine, National Heart and Lung Institute, London, UK.,Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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29
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Geryk LL, Roberts CA, Sage AJ, Coyne-Beasley T, Sleath BL, Carpenter DM. Parent and Clinician Preferences for an Asthma App to Promote Adolescent Self-Management: A Formative Study. JMIR Res Protoc 2016; 5:e229. [PMID: 27923777 PMCID: PMC5174724 DOI: 10.2196/resprot.5932] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 10/14/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most youth asthma apps are not designed with parent and clinician use in mind, and rarely is the app development process informed by parent or clinician input. OBJECTIVE This study was conducted to generate formative data on the use, attitudes, and preferences for asthma mHealth app features among parents and clinicians, the important stakeholders who support adolescents with asthma and promote adolescent self-management skills. METHODS We conducted a mixed-methods study from 2013 to 2014 employing a user-centered design philosophy to acquire feedback from a convenience sample of 20 parents and 6 clinicians. Participants were given an iPod Touch and asked to evaluate 10 features on 2 existing asthma apps. Participant experiences using the apps were collected from questionnaires and a thematic analysis of audio-recorded and transcribed (verbatim) interviews using MAXQDA. Descriptive statistics were calculated to characterize the study sample and app feature feedback. Independent samples t tests were performed to compare parent and clinician ratings of app feature usefulness (ratings: 1=not at all useful to 5=very useful). RESULTS All parents were female (n=20), 45% were black, 20% had an income ≥US $50,000, and 45% had a bachelor's degree or higher education. The clinician sample included 2 nurses and 4 physicians with a mean practice time of 13 years. Three main themes provided an understanding of how participants perceived their roles and use of asthma app features to support adolescent asthma self-management: monitoring and supervision, education, and communication/information sharing. Parents rated the doctor report feature highest, and clinicians rated the doctor appointment reminder highest of all evaluated app features on usefulness. The peak flow monitoring feature was the lowest ranked feature by both parents and clinicians. Parents reported higher usefulness for the doctor report (t(10)=2.7, P<.02), diary (t(10)=2.7, P<.03), and self-check quiz (t(14)=2.5, P<.02) features than clinicians. Specific participant suggestions for app enhancements (eg, a tutorial showing correct inhaler use, refill reminders, pop-up messages tied to a medication log, evidence-based management steps) were also provided. CONCLUSIONS Parent and clinician evaluations and recommendations can play an important role in the development of an asthma app designed to help support youth asthma management. Two-way asthma care communication between families and clinicians and components involving families and clinicians that support adolescent self-management should be incorporated into adolescent asthma apps.
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Affiliation(s)
- Lorie L Geryk
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Courtney A Roberts
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Adam J Sage
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Tamera Coyne-Beasley
- Division of General Pediatrics and Adolescent Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Betsy L Sleath
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
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30
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Bruzzese JM, Kingston S, Zhao Y, DiMeglio JS, Cespedes A, George M. Psychological Factors Influencing the Decision of Urban Adolescents With Undiagnosed Asthma to Obtain Medical Care. J Adolesc Health 2016; 59:543-548. [PMID: 27772661 PMCID: PMC5119912 DOI: 10.1016/j.jadohealth.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Adolescents are low users of medical care. Psychological factors and perceived reasons to not seek routine medical care may increase risk of nonuse by adolescents with undiagnosed asthma. This study tests if psychological factors were associated with seeing a medical provider for asthma-like symptoms; identifies adolescents' perceived reasons for not obtaining care; explores if psychological factors are associated with these perceptions; and explores if asthma severity moderates the relationships with psychological factors. METHODS We analyzed cross-sectional data from a baseline assessment of 349 urban, primarily ethnic minority adolescents with moderate to severe asthma-like symptoms but no asthma diagnosis who were enrolled in a controlled trial. RESULTS The odds of seeing a provider for their asthma-like symptoms were significantly higher for those with asthma-related anxiety (odds ratio [OR]: 1.644; 95% confidence interval [CI]: 1.242-2.176) and depressive symptoms (OR: 1.031; 95% CI: 1.004-1.059). The most commonly endorsed reason for noncare included a characterization of symptoms as not serious, past medical visits not diagnosed as asthma, fear of diagnosis, busy lifestyles, and not wanting medication. Psychological factors were not related to the number of reasons or to most of the commonly endorsed reasons. Adolescents with more asthma-related anxiety were less likely to characterize their breathing problems as serious (OR = .0583; 95% CI: .424-.802) and were more likely to report busy lifestyles (OR = 1.593; 95% CI: 1.122-2.261). CONCLUSIONS Adolescent-perceived reasons for noncare were not pragmatic, but instead highlighted denial. Asthma-related anxiety was the most robust psychological factor associated with the decision to seek medical care.
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Affiliation(s)
| | - Sharon Kingston
- Department of Psychology, Dickinson College, P.O. Box 1773, Carlisle, PA 17013,
| | - Yihong Zhao
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016,
| | - John S. DiMeglio
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016,
| | - Amarilis Cespedes
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016,
| | - Maureen George
- Columbia University School of Nursing, Office of Scholarship and Research, 630 West 168th Street, New York, NY 10032,
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31
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Bruzzese JM, Reigada LC, Lamm A, Wang J, Li M, Zandieh SO, Klein RG. Association of Youth and Caregiver Anxiety and Asthma Care Among Urban Young Adolescents. Acad Pediatr 2016; 16:792-798. [PMID: 27049680 PMCID: PMC5047850 DOI: 10.1016/j.acap.2016.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/16/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the association of adolescent asthma-related anxiety, social anxiety, separation anxiety, and caregiver asthma-related anxiety with asthma care by urban adolescents. METHODS Participants were 386 ethnic minority adolescents (mean age 12.8 years) with persistent asthma and their caregivers. Adolescents reported what they do to prevent asthma symptoms and to manage acute symptoms, and if they or their caregiver is responsible for their asthma care. Adolescents completed the Youth Asthma-Related Anxiety Scale, and the social and separation anxiety subscales of the Screen for Child Anxiety and Emotional Disorders (SCARED); caregivers completed the Parent Asthma-Related Anxiety Scale. Linearity of the associations was assessed by generalized additive models. When there was no evidence for nonlinearity, linear mixed effects models were used to evaluate the effects of the predictors. RESULTS Adolescent asthma-related anxiety had a strong curvilinear relationship with symptom prevention (P < .001). Adolescents took more prevention steps as their anxiety increased, with a plateau at moderate anxiety. There was a linear relationship of adolescent asthma-related anxiety to symptom management (β = 0.03, P = .021) and to asthma responsibility (β = 0.11, P = .015), and of caregiver asthma-related anxiety to adolescent symptom prevention (β = 0.04, P = .001). Adolescent social and separation anxiety had weak to no relationship with asthma care. Results remained consistent when controlling for each of the other anxieties. CONCLUSIONS Asthma-related anxiety plays an important, independent role in asthma care. When low, adolescents may benefit from increased support from caregivers and awareness of the consequences of uncontrolled asthma. When elevated, health providers should ensure the adolescents are not assuming responsibility for asthma care prematurely.
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Affiliation(s)
- Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Laura C. Reigada
- Department of Psychology, Brooklyn College of the City University of New York, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
| | - Alexandra Lamm
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Jing Wang
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Meng Li
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Stephanie O. Zandieh
- Department of Pediatrics, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Rachel G. Klein
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
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32
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Roberts CA, Geryk LL, Sage AJ, Sleath BL, Tate DF, Carpenter DM. Adolescent, caregiver, and friend preferences for integrating social support and communication features into an asthma self-management app. J Asthma 2016; 53:948-54. [PMID: 27116540 DOI: 10.3109/02770903.2016.1171339] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study examines: 1) adolescent preferences for using asthma self-management mobile applications (apps) to interact with their friends, caregivers, medical providers, and other adolescents with asthma and 2) how caregivers and friends would use mobile apps to communicate with the adolescent and serve as sources of support for asthma management. METHODS We recruited 20 adolescents aged 12-16 years with persistent asthma, their caregivers (n = 20), and friends (n = 3) from two suburban pediatric practices in North Carolina. We gave participants iPods with two preloaded asthma apps and asked them to use the apps for 1 week. Adolescents and caregivers provided app feedback during a semi-structured interview at a regularly-scheduled clinic appointment and during a telephone interview one week later. Friends completed one telephone interview. Interviews were audio-recorded and transcribed verbatim. An inductive, theory-driven analysis was used to identify themes and preferences. RESULTS Adolescents preferred to use apps for instrumental support from caregivers, informational support from friends, and belonging and informational support from others with asthma. The majority of adolescents believed apps could enhance communication with their caregivers and medical providers, and the theme of self-reliance emerged in which caregivers and adolescents believed apps could enable adolescents to better self-manage their asthma. Friends preferred to use apps to provide instrumental and informational support. CONCLUSIONS Given preferences expressed in this study, apps may help adolescents obtain social support to better self-manage their asthma. Future app-based interventions should include features enabling adolescents with asthma to communicate and interact with their caregivers, medical providers, and friends.
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Affiliation(s)
- Courtney A Roberts
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Lorie L Geryk
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Adam J Sage
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Betsy L Sleath
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Deborah F Tate
- b Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA
| | - Delesha M Carpenter
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
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Ahmad A, Sorensen K. Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review. J Asthma 2016; 53:862-78. [PMID: 27053332 DOI: 10.3109/02770903.2016.1155217] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this systematic literature review is to study the enabling and hindering factors influencing adherence to asthma treatment among adolescents. Furthermore, it explores the role of caregivers and the healthcare provider in terms of supporting adolescents to manage and live with asthma. DATA SOURCES The literature review was conducted using the MeSH terms asthma, adherence, health literacy, behavior, adolescents, tools, healthcare provider, caregiver, peer influence, self-management, quality of life, morbidity and mortality in PubMed, PsycInfo, MEDLINE and CINAHL. STUDY SELECTION The literature search resulted in 652 articles of which 304 were screened based on title and abstracts. Ninety-one of the screened articles were then selected for full-text assessment resulting in 42 articles for in-depth analysis. RESULTS The literature review identified nine enabling and hindering factors relevant for adherence to asthma treatment among adolescents: behavior, belief, self-management, health literacy, role of health provider, assessment of adherence, role of caregiver, role of peers and the national asthma guidelines. CONCLUSION Working with this particular age group is complex and further research in understanding adolescent's behavior, motives, beliefs and perceptions towards adherence to asthma treatment is required to guide them towards better self-management and acceptance of their condition.
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Affiliation(s)
- Anam Ahmad
- a Department of International Health , CAPHRI, Faculty of Health Medicine and Life Science, Maastricht University , Maastricht , The Netherlands
| | - Kristine Sorensen
- a Department of International Health , CAPHRI, Faculty of Health Medicine and Life Science, Maastricht University , Maastricht , The Netherlands
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Brockow K, Ring J, Scheewe S, Staab D. Schulungen. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scheckner B, Arcoleo K, Feldman JM. The effect of parental social support and acculturation on childhood asthma control. J Asthma 2015; 52:606-13. [PMID: 25428771 PMCID: PMC4662868 DOI: 10.3109/02770903.2014.991969] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/23/2014] [Accepted: 11/22/2014] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There exists large ethnic disparities in asthma among Latino children; Puerto Ricans (PRs) are disproportionately affected, while Mexicans have the lowest prevalence and morbidity. Disparities are poorly understood, however, acculturation and social support are suggested to influence asthma control among children. This study investigated the relationship between acculturation, social support and asthma control among PR and Mexican children and their caregivers. METHODS Primary caregiver-child dyads (n = 267) of PR (n = 79) and Mexican (n = 188) descent were recruited from clinics at two inner-city hospitals in Bronx, NY and three clinics in Phoenix, AZ. Children were 5-12 years of age and had a confirmed asthma diagnosis. Dyads completed measures of social support, acculturation and asthma control; logistic regression was used for analysis. RESULTS Mexican children had better asthma control than PR children (p < 0.001). PR caregivers were more acculturated than Mexican caregivers (p < 0.05); however, acculturation did not predict control. Across Latino subgroups caregivers' total level of social support predicted better asthma control among children (p < 0.05), and support received from family and friends each independently predicted better control (p < 0.05). CONCLUSIONS Results suggest that social support reduces some of the burden associated with asthma management enabling caretakers to better control their children's asthma.
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Affiliation(s)
- Bari Scheckner
- Ferkauf Graduate School of Psychology, Yeshiva University, NY
| | | | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, NY
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Greenlee H, Gaffney AO, Aycinena AC, Koch P, Contento I, Karmally W, Richardson JM, Lim E, Tsai WY, Crew K, Maurer M, Kalinsky K, Hershman DL. ¡Cocinar Para Su Salud!: Randomized Controlled Trial of a Culturally Based Dietary Intervention among Hispanic Breast Cancer Survivors. J Acad Nutr Diet 2015; 115:S42-S56.e3. [PMID: 25911520 DOI: 10.1016/j.jand.2015.02.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is a need for culturally relevant nutrition programs targeted to underserved cancer survivors. OBJECTIVE Our aim was to examine the effect of a culturally based approach to dietary change on increasing fruit/vegetable (F/V) intake and decreasing fat intake among Hispanic breast cancer survivors. DESIGN Participants were randomized to Intervention and Control groups. Diet recalls, detailed interviews, fasting blood, and anthropometric measures were collected at baseline, 3, 6, and 12 months. PARTICIPANTS/SETTING Hispanic women (n=70) with stage 0 to III breast cancer who completed adjuvant treatment and lived in New York City were randomized between April 2011 and March 2012. INTERVENTION The Intervention group (n=34) participated in ¡Cocinar Para Su Salud!, a culturally based nine-session (24 hours over 12 weeks) intervention including nutrition education, cooking classes, and food-shopping field trips. The Control group (n=36) received written dietary recommendations for breast cancer survivors. MAIN OUTCOME MEASURES Change at 6 months in daily F/V servings and percent calories from total fat were the main outcome measures. STATISTICAL ANALYSES Linear regression models adjusted for stratification factors and estimated marginal means were used to compare changes in diet from baseline to 3 and 6 months. RESULTS Baseline characteristics were the following: mean age 56.6 years (standard deviation 9.7 years), mean time since diagnosis 3.4 years (standard deviation 2.7 years), mean body mass index (calculated as kg/m(2)) 30.9 (standard deviation 6.0), 62.9% with annual household income ≤$15,000, mean daily servings of all F/V was 5.3 (targeted F/V 3.7 servings excluding legumes/juices/starchy vegetables/fried foods), and 27.7% of daily calories from fat. More than 60% in the Intervention group attended seven or more of nine classes, with overall study retention of 87% retention at 6 months. At month 6, the Intervention group compared with Control group reported an increase in mean servings of F/V from baseline (all F/V: +2.0 vs -0.1; P=0.005; targeted F/V: +2.7 vs +0.5; P=0.002) and a nonsignificant decrease in percent calories from fat (-7.5% vs -4.4%; P=0.23) and weight (-2.5 kg vs +3.8 kg; P=0.22). CONCLUSIONS ¡Cocinar Para Su Salud! was effective at increasing short-term F/V intake in a diverse population of Hispanic breast cancer survivors.
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Greenlee H, Gaffney AO, Aycinena AC, Koch P, Contento I, Karmally W, Richardson JM, Lim E, Tsai WY, Crew K, Maurer M, Kalinsky K, Hershman DL. ¡Cocinar Para Su Salud!: Randomized Controlled Trial of a Culturally Based Dietary Intervention among Hispanic Breast Cancer Survivors. J Acad Nutr Diet 2015; 115:709-723.e3. [PMID: 25578926 DOI: 10.1016/j.jand.2014.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/29/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is a need for culturally relevant nutrition programs targeted to underserved cancer survivors. OBJECTIVE Our aim was to examine the effect of a culturally based approach to dietary change on increasing fruit/vegetable (F/V) intake and decreasing fat intake among Hispanic breast cancer survivors. DESIGN Participants were randomized to Intervention and Control groups. Diet recalls, detailed interviews, fasting blood, and anthropometric measures were collected at baseline, 3, 6, and 12 months. PARTICIPANTS/SETTING Hispanic women (n=70) with stage 0 to III breast cancer who completed adjuvant treatment and lived in New York City were randomized between April 2011 and March 2012. INTERVENTION The Intervention group (n=34) participated in ¡Cocinar Para Su Salud!, a culturally based nine-session (24 hours over 12 weeks) intervention including nutrition education, cooking classes, and food-shopping field trips. The Control group (n=36) received written dietary recommendations for breast cancer survivors. MAIN OUTCOME MEASURES Change at 6 months in daily F/V servings and percent calories from total fat were the main outcome measures. STATISTICAL ANALYSES Linear regression models adjusted for stratification factors and estimated marginal means were used to compare changes in diet from baseline to 3 and 6 months. RESULTS Baseline characteristics were the following: mean age 56.6 years (standard deviation 9.7 years), mean time since diagnosis 3.4 years (standard deviation 2.7 years), mean body mass index (calculated as kg/m²) 30.9 (standard deviation 6.0), 62.9% with annual household income ≤$15,000, mean daily servings of all F/V was 5.3 (targeted F/V 3.7 servings excluding legumes/juices/starchy vegetables/fried foods), and 27.7% of daily calories from fat. More than 60% in the Intervention group attended seven or more of nine classes, with overall study retention of 87% retention at 6 months. At month 6, the Intervention group compared with Control group reported an increase in mean servings of F/V from baseline (all F/V: +2.0 vs -0.1; P=0.005; targeted F/V: +2.7 vs +0.5; P=0.002) and a nonsignificant decrease in percent calories from fat (-7.5% vs -4.4%; P=0.23) and weight (-2.5 kg vs +3.8 kg; P=0.22). CONCLUSIONS ¡Cocinar Para Su Salud! was effective at increasing short-term F/V intake in a diverse population of Hispanic breast cancer survivors.
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Kintner EK, Cook G, Marti CN, Gomes M, Meeder L, Van Egeren LA. Effectiveness of a school-based academic asthma health education and counseling program on fostering acceptance of asthma in older school-age students with asthma. J SPEC PEDIATR NURS 2015; 20:49-61. [PMID: 25443593 PMCID: PMC4293268 DOI: 10.1111/jspn.12098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/24/2014] [Accepted: 10/26/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of the academic asthma education and counseling Staying Healthy-Asthma Responsible and Prepared™ (SHARP) program on fostering psychosocial acceptance of asthma. DESIGN AND METHODS This was a phase III, two-group, cluster-randomized, single-blinded, longitudinal study. Students from grades 4 and 5 (N = 205) with asthma and their caregivers completed surveys at pre-intervention and at 1-, 12-, and 24-months post-intervention. Analysis involved multilevel modeling. RESULTS All students demonstrated significant improvement in aspects of acceptance; students in SHARP demonstrated significant improvement in openness to sharing and connectedness with teachers over students in the control condition. PRACTICE IMPLICATIONS The SHARP program offers a well-tested, effective program for psychosocial acceptance of asthma, which is welcomed by schools.
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Affiliation(s)
- Eileen K Kintner
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
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Ellis DA, King P, Naar-King S, Lam P, Cunningham PB, Secord E. Effects of family treatment on parenting beliefs among caregivers of youth with poorly controlled asthma. J Dev Behav Pediatr 2014; 35:486-93. [PMID: 25186121 PMCID: PMC4180784 DOI: 10.1097/dbp.0000000000000093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Caregiver involvement is critical in ensuring optimal adolescent asthma management. The study investigated whether multisystemic therapy (MST), an intensive home-based family therapy, was superior to family support for changing beliefs regarding asthma-related positive parenting among caregivers of African-American youth with poorly controlled asthma. The relationship between parenting beliefs and asthma management at the conclusion of the intervention was also assessed. METHODS A randomized controlled trial was conducted with 167 adolescents with moderate-to-severe, persistent, poorly controlled asthma and their primary caregivers. Families were randomly assigned to MST or family support (FS), a home-based family support condition. Data were collected at baseline and 7-month posttest. Changes in caregiver ratings of importance and confidence for engaging in asthma-related positive parenting were assessed through questionnaire. Illness management was assessed by the Family Asthma Management System Scale. RESULTS Participation in MST was associated with more change in caregiver beliefs as compared with FS for both importance (t = 2.39, p = .02) and confidence (t = 2.04, p = .04). Caregiver beliefs were also significantly related to youth controller medication adherence at the conclusion of treatment (importance: r = .21, p = .01; confidence: r = .23, p = .004). CONCLUSION Results support the effectiveness of MST for increasing parental beliefs in the value of asthma-related positive parenting behaviors and parental self-efficacy for these behaviors among families of minority adolescents with poorly controlled asthma.
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Affiliation(s)
- Deborah A Ellis
- *Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, MI; †Department of Psychiatry, Medical University of South Carolina, Charleston, SC
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Panzera AD, Schneider TK, Martinasek MP, Lindenberger JH, Couluris M, Bryant CA, McDermott RJ. Adolescent asthma self-management: patient and parent-caregiver perspectives on using social media to improve care. THE JOURNAL OF SCHOOL HEALTH 2013; 83:921-930. [PMID: 24261527 DOI: 10.1111/josh.12111] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/13/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control. METHODS Between August 2010 and January 2011, 18 teens with asthma and 18 parent-caregivers participated in semistructured in-depth interviews to identify mechanisms for improving asthma self-management and propose characteristics for developing a digital media tool to aid such efforts. RESULTS Teens and caregivers enumerated physician-recommended strategies for asthma management as well as currently employed strategies. Both groups thought of a potential digital media solution as positive, but indicated specific design requirements for such a solution to have utility. Whereas most participants perceived mobile platforms to be viable modes to improve asthma self-management, interest in having social networking capabilities was mixed. CONCLUSIONS A digital media product capable of tracking conditions, triggers, and related asthma activities can be a core element of improved asthma control for youth. Improved asthma control will help decrease school absenteeism.
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Affiliation(s)
- Anthony D Panzera
- Graduate Research Associate, , Florida Prevention Research Center & Social Marketing Group, University of South Florida College of Public Health, 13201 Bruce B Downs Blvd., MDC056, Tampa, FL 33612
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Petsios KT, Priftis KN, Hatziagorou E, Tsanakas JN, Antonogeorgos G, Matziou VN. Determinants of quality of life in children with asthma. Pediatr Pulmonol 2013; 48:1171-80. [PMID: 23401462 DOI: 10.1002/ppul.22768] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 11/19/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND HRQoL in children with asthma depends on multiple factors, among which asthma severity and level of control are believed to play a vital role. The determinants of the connection between asthma severity and asthma control with quality of life remain unclear. AIMS Primary aim of the study was to evaluate the HRQoL in children with asthma and to determine the factors that affect it. MATERIALS AND METHODS In total 504 children and one of their parents were recruited during a regular follow up visit in an outpatient asthma clinic. The measures used were the DISABKIDS smiley measure (DSmM), chronic generic measure-long form (DCGM-37) and the Condition-specific modules for asthma along with a special form for collecting demographic and clinical characteristics. RESULTS Three hundred fifteen children with mean age 5.35 years (Group A) and 189 with mean age 10.79 years (Group B), were recruited. Children with controlled asthma had significant higher mean score than the other asthma control groups (P < 0.001). Corticosteroid use, asthma severity, number of visits in doctor's office and lack of asthma control were significantly associated with the DCGM-37 scores as well as Impact Scale and Worry Scale. Lack of Asthma Control was the only factor that was associated with negative HRQoL in all the multiple regression models, controlling for the effect of the other covariates, in both age groups. CONCLUSIONS In conclusion, the evaluation of asthma HRQoL independently reflects the asthma control state and a dimension of its severity. These results highlight the need to modify asthma management strategy.
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Affiliation(s)
- Konstantinos Th Petsios
- Pediatric Cardiosurgical Intensive Care Unit, "Onassis" Cardiac Surgery Center, Athens, Greece; Faculty of Nursing, National & Kapodistrian University of Athens, Athens, Greece. ,
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McCormick King ML, Mee LL, Gutierrez-Colina AM, Eaton CK, Lee JL, Blount RL. Emotional Functioning, Barriers, and Medication Adherence in Pediatric Transplant Recipients. J Pediatr Psychol 2013; 39:283-93. [DOI: 10.1093/jpepsy/jst074] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med 2013; 107:1481-90. [PMID: 23643487 DOI: 10.1016/j.rmed.2013.04.005] [Citation(s) in RCA: 343] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/30/2013] [Accepted: 04/07/2013] [Indexed: 11/24/2022]
Abstract
Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD and clinical efficacy is positive, with improved symptom control and lung function shown in most studies of adults, adolescents and children. Satisfaction with inhaler devices is also positively correlated with improved adherence and clinical outcomes, and reduced costs. Reductions in healthcare utilisation are consistently observed with good adherence; however, costs associated with general healthcare and lost productivity tend to be offset only in more adherent patients with severe disease, versus those with milder forms of asthma or COPD. Non-adherence is associated with higher healthcare utilisation and costs, and reductions in health-related quality of life, and remains problematic on an individual, societal and economic level. Further development of measures to improve adherence is needed to fully address these issues.
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Stewart M, Letourneau N, Masuda JR, Anderson S, McGhan S. Online support for children with asthma and allergies. JOURNAL OF FAMILY NURSING 2013; 19:171-197. [PMID: 23559663 DOI: 10.1177/1074840713483573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Children with asthma and allergies experience social isolation and gaps in social support particularly from peers. The objective of this pilot study was to design and test an accessible online support intervention for these children. Children (n = 27) aged 7 to 11 from across Canada participated. GoToMeeting was employed for the support group sessions and Club Penguin for social connections during and between support group meetings. Content included: strategies for coping with asthma and allergies, role playing and games to help children deal with difficult situations, fun and enjoyment, and presentations by positive role models. Participation in the online peer support intervention was high, 86.3% on average over the 8-week intervention. By sharing their experiences, listening to peers' experiences, and role playing, children were introduced to practical skills: problem solving, communicating, seeking support, and self-advocacy.
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Affiliation(s)
- Miriam Stewart
- Faculty of Nursing & School of Public Health, University of Alberta, Edmonton, AB, Canada
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Chua KP, Schuster MA, McWilliams JM. Differences in health care access and utilization between adolescents and young adults with asthma. Pediatrics 2013; 131:892-901. [PMID: 23610211 PMCID: PMC4074656 DOI: 10.1542/peds.2012-2881] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Studies suggest that young adults have worse health care access, use less primary care, and visit emergency departments more frequently than adolescents. We examined whether these differences existed between older adolescents and young adults with asthma. METHODS Using nationally representative data from the 1999 to 2009 Medical Expenditure Panel Survey, we performed cross-sectional comparisons of access and utilization between older adolescents (ages 14-17) and young adults (ages 19-25) with asthma. In longitudinal analyses, we assessed whether changes in health insurance coverage, schooling, and adult presence at home predicted changes in access and utilization. RESULTS Young adults with asthma were less likely to have a usual source of care (-13.7 percentage points; P < .001) or primary care visit within the past year (-13.9 percentage points; P = .006). They were less likely to fill a short-acting beta-agonist prescription (-10.6 percentage points; P = .02) and more likely to visit the emergency department within the past year (+9.7 percentage points; P = .01). Adjusting for differences in insurance coverage reduced differences in usual source of care and primary care use by 32.4% to 38.0% but reduced the difference in emergency department use by only 10.3%. Among participants aged 16 to 19 in the first survey year, becoming uninsured strongly predicted losing a usual source of care (change relative to no coverage loss: -25.2 percentage points; P = .003). CONCLUSIONS Compared with older adolescents with asthma, young adults with asthma have worse health care access and may use care less optimally. These differences were associated with but were not completely explained by differences in insurance coverage.
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Affiliation(s)
- Kao-Ping Chua
- Harvard PhD Program in Health Policy, Harvard University, Cambridge, MA 02138, USA.
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Joseph CLM, Ownby DR, Havstad SL, Saltzgaber J, Considine S, Johnson D, Peterson E, Alexander G, Lu M, Gibson-Scipio W, Johnson CC. Evaluation of a web-based asthma management intervention program for urban teenagers: reaching the hard to reach. J Adolesc Health 2013; 52:419-26. [PMID: 23299008 PMCID: PMC3632347 DOI: 10.1016/j.jadohealth.2012.07.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 07/19/2012] [Accepted: 07/21/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE Asthma interventions targeting urban adolescents are rare, despite a great need. Motivating adolescents to achieve better self-management of asthma is challenging, and the literature suggests that certain subgroups are more resistant than others. We conducted a school-based, randomized controlled trial (RCT) to evaluate Puff City, a Web-based, tailored asthma intervention, which included a referral coordinator, and incorporated theory-based strategies to target urban teens with characteristics previously found to be associated with lack of behavior change. METHODS To identify eligible teens, we administered questionnaires on asthma diagnoses and symptoms to ninth through 12th graders of participating schools during a scheduled English class. We randomized eligible, consenting students to Puff City (treatment) or generic asthma education (control). RESULTS We randomized 422 students (98% African-American, mean age = 15.6 years). At 12-month follow-up, adjusted odds ratios (aORs) (95% confidence intervals) indicated intervention benefit for treatment teens for symptom-days and restricted activity days (analyzed as categorical variables) as aOR = .49 (.24-.79), p = .006 and .53 (.32-.86), p = .010, respectively. Among teens meeting baseline criteria for rebelliousness, treatment teens reported fewer symptom-days, symptom-nights, school absences, and restricted activity days: aOR = .30 (.11-.80), .29 (.14-.64), .40 (.20-.78), and .23 (.10-.55); all p < .05. Among teens reporting low perceived emotional support, treatment students reported only fewer symptom-days than controls: aOR = .23 (.06-.88), p = .031. We did not observe statistically significant differences in medical care use. CONCLUSIONS Results suggest that a theory-based, tailored approach, with a referral coordinator, can improve asthma management in urban teens. Puff City represents a viable strategy for disseminating an effective intervention to high-risk and hard-to-reach populations.
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Affiliation(s)
- Christine L M Joseph
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA.
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Gupta RS, Lau CH, Springston EE, Warren CM, Mears CJ, Dunford CM, Sharp LK, Holl JL. Perceived Factors Affecting Asthma Among Adolescents. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/2150129712472342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe the development, implementation, and findings of a participatory media-based asthma afterschool program. Methods: A pilot study was conducted during the 2010/2011 school year in an inner-city Chicago high school with high asthma rates and poor asthma morbidity. Students met after school twice a week over 10 weeks. Students were given basic training in research and media production using photovoice participatory research technique and were instructed to identify personally relevant factors affecting asthma through photography and journaling. Students’ journal entries and photographs were qualitatively coded. Relative frequencies of codes were calculated to determine common themes among identified factors. Students worked with a videographer to compile their findings into informational videos, which were used to educate peers and community members about asthma. Results: Fifteen students aged 13 to 18 attended a mean of 11 sessions (out of 20). One hundred eighty photographs (mean = 12 per student) and 112 journal entries (mean = 7.5 per student) were reviewed, with 4 predominant positive and negative factors identified. Reported factors influencing students’ health and asthma included social support (22% of student photos and journal entries), neighborhood environment (17%), and lifestyle (28%), in addition to well-established asthma factors (43%). Conclusions: Results from the Student Asthma Research Team pilot demonstrate that adolescent students, given appropriate instruction and opportunity, are able to identify factors affecting their asthma. Interventions engaging adolescents via self-directed identification and participatory media production techniques hold promise as vehicles for enabling students to own and share health-related experiences through research and peer/community outreach.
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Affiliation(s)
- Ruchi S. Gupta
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Claudia H. Lau
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Elizabeth E. Springston
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Christopher M. Warren
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Cynthia J. Mears
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Christine M. Dunford
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Lisa K. Sharp
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Jane L. Holl
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
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Mammen J, Rhee H. Adolescent Asthma Self-Management: A Concept Analysis and Operational Definition. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012; 25:180-189. [PMID: 23285426 DOI: 10.1089/ped.2012.0150] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 08/15/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND: Adolescents with asthma have a higher risk of morbidity and mortality than other age groups. Asthma self-management has been shown to improve outcomes; however, the concept of asthma self-management is not explicitly defined. METHODS: We use the Norris method of concept clarification to delineate what constitutes the concept of asthma self-management in adolescents. Five databases were searched to identify components of the concept of adolescent asthma self-management, and lists of relevant subconcepts were compiled and categorized. RESULTS: Analysis revealed 4 specific domains of self-management behaviors: (1) symptom prevention; (2) symptom monitoring; (3) acute symptom management; and (4) communication with important others. These domains of self-management were mediated by intrapersonal/cognitive and interpersonal/contextual factors. CONCLUSIONS: Based on the analysis, we offer a research-based operational definition for adolescent asthma self-management and a preliminary model that can serve as a conceptual base for further research.
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Affiliation(s)
- Jennifer Mammen
- School of Nursing, University of Rochester , Rochester, New York
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49
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RINGOLD SARAH, GRANT SHANNON, GIRDISH CHARMAINE, WALLACE CAROLA, SULLIVAN SEAND. Methotrexate and Injectable Tumor Necrosis Factor-α Inhibitor Adherence and Persistence in Children with Rheumatic Diseases. J Rheumatol 2012; 40:80-6. [DOI: 10.3899/jrheum.120753] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To measure adherence and persistence with methotrexate (MTX) and injectable tumor necrosis factor-α (iTNF-α) inhibitors (etanercept, adalimumab) among children prescribed these medications by a rheumatologist.Methods.Data were obtained from a US pharmacy benefits management firm. Children were included if they were < 18 years of age, had ≥ 1 prescription claim between January 2009 and December 2010 for MTX or an iTNF-α inhibitor that was prescribed by an adult or pediatric rheumatologist. The medication possession ratio (MPR) was calculated for each medication, with MPR ≥ 80% indicating good adherence. MPR were compared by route of administration, age, and by new users versus continuing users. Persistence was measured for new users of each medication from initiation until discontinuation, or for a maximum of 1 year.Results.A total of 1964 children were included. The majority of children had MPR < 80%. Children taking subcutaneous MTX had the lowest mean MPR [46.9%; median 44.9%; interquartile range (IQR) 23%–69.6%] and the lowest persistence, with 26% of children continuing the medication at 1 year. Mean MPR was highest for iTNF-α (65.7%; median 70.1%; IQR 46%–89.3%), as was persistence, with 52% of children continuing the medication at 1 year. Children age < 13 years tended to have higher MPR, but this was statistically significant only for oral MTX (61.1% vs 54.9% in children age ≥ 13 yrs; p = 0.02).Conclusion.Adherence and persistence in this cohort varied by medication and route of administration. Both outcomes are important considerations for physicians prescribing these medications in routine clinical care and for the assessment of treatment effectiveness in the research setting.
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50
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Ringlever L, Otten R, van Schayck OCP, Engels RCME. The role of maternal illness perceptions in perceived asthma symptoms in school-aged children. J Asthma 2012; 49:1030-6. [PMID: 23050929 DOI: 10.3109/02770903.2012.726305] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the unique contribution of perceptions held by mothers about their children's asthma in relation to the symptoms as reported by their children. METHODS Families with a child diagnosed with asthma participating in a larger smoking prevention study were invited to participate. For all, 89 children (mean age 10.1 years) and 87 mothers questionnaire and lung function data during home visits were provided. The main outcome of this study involved asthma symptoms as measured by the Pediatric Quality of Life Inventory. Mothers' and children's reports of symptoms, as well as the lung function parameter of percentage of predicted Forced Expiratory Volume in one second (% of predicted FEV1), were analyzed in relation to maternal illness perceptions. RESULTS Mothers' perceptions of illness were not associated with % of predicted FEV(1.) However, while controlling for gender and children's baseline asthma symptoms, four out of eight mothers' perceptions of illness (i.e., identity, consequences, concern, and emotional influence) were associated with children's asthma symptoms. Additional analyses controlling for % of predicted FEV(1) in the models with subjective asthma symptoms reports of mother and child did not change the study findings. CONCLUSIONS This pilot study provides evidence that, in addition to children's lung function and baseline symptoms, maternal perception of illness contributes to symptom-related quality of life (QoL) of children. More research on underlying mechanisms, which addresses the linking of mothers' perceptions of concern and emotion to the QoL symptoms as reported by children is necessary.
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Affiliation(s)
- Linda Ringlever
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands.
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