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Al-Juhaishi M, Lim CX, Chan V, Stupans I, Thrimawithana TR. Exploring Experiences and Asthma Management Among Middle Eastern Arabic-Speaking Migrants and Refugees with Asthma: A Qualitative Study. Patient Prefer Adherence 2024; 18:1789-1801. [PMID: 39220106 PMCID: PMC11365489 DOI: 10.2147/ppa.s471347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose Effective asthma management relies on individuals' knowledge, inhaler technique, and perceptions of asthma and medications. Investigating barriers and enablers to optimal asthma management is vital. This research pursues a comprehensive understanding of asthma control, asthma-related experiences, perceptions, inhaler technique, and knowledge among Arabic-speaking Middle Eastern migrants and refugees living in Australia. Furthermore, it aims to explore the factors influencing optimal asthma management within this demographic. Patients and Methods This study involved interviews with 17 participants, with nine identified as migrants and eight as refugees. All participants were Arabic-speaking Middle Eastern individuals residing in Australia and diagnosed with asthma. Interviews were thematically analysed, and findings were presented following the guidelines of the consolidated criteria for reporting qualitative research (COREQ). Results The thematic analysis yielded five key themes: (1) asthma experiences; (2) participant perspectives on asthma; (3) asthma management; (4) asthma health literacy; and (5) strategies to overcome obstacles in asthma management. Some disparities were noted between refugees and migrants in terms of their comprehension and views on asthma, medications use, interactions with healthcare providers, and inhaler technique. Refugees experienced more psychological distress and lacked social support, while migrants were more concerned about long-term medication use and preferred specialised care. Conclusion This research addresses a knowledge gap concerning asthma control among Middle Eastern immigrants. It provides insights into their beliefs and medication adherence. It underscores the importance of considering the unique characteristics of Middle Eastern migrants and refugees when delivering healthcare interventions to enhance overall health and medication adherence within these populations. To address these differences, the study recommends tailored education, specialised clinics, and culturally relevant asthma management plans to enhance self-management support for both groups. Future studies should explore the impact of modifying beliefs, attitudes, and knowledge regarding medications and asthma to enhance asthma management within this population.
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Affiliation(s)
- Malath Al-Juhaishi
- Discipline of Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3083, Australia
| | - Chiao Xin Lim
- Discipline of Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3083, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Vincent Chan
- Discipline of Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3083, Australia
| | - Ieva Stupans
- Discipline of Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3083, Australia
| | - Thilini R Thrimawithana
- Discipline of Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3083, Australia
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Shepperd JA, Hunleth JM, Maki J, Prabakaran S, Pogge G, Webster G, Ruiz S, Waters EA. Interpersonal comparison among caregivers of children with asthma. Psychol Health 2024; 39:969-988. [PMID: 36147010 PMCID: PMC10030381 DOI: 10.1080/08870446.2022.2125514] [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: 01/24/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Objective: We examined the extent to which caregivers of children with asthma used interpersonal comparisons-a novel comparison process that parallels social comparison and temporal comparison-to form judgments about their child. Methods & Measures: Using semi-structured interviews adapted from the McGill Illness Narrative Interview, we examined the interpersonal comparisons that caregivers of a child with asthma (n = 41) made regarding their child. Results: Interpersonal comparisons influenced caregiver thoughts, feelings, and behavior. They helped caregivers distinguish asthma from other breathing problems, evaluate the severity of the asthma, and understand their child's experience. However, they also created uncertainty by highlighting the complex, unpredictable nature of asthma. Interpersonal comparisons were a source of gratitude and hope, but also worry and frustration. Finally, interpersonal comparisons influenced caregivers' decisions and actions, resulting in decisions that aligned with and, at times, ran counter to biomedical models of asthma care. In some instances, caregivers used interpersonal comparisons to motivate their child's behavior. Conclusion: The interpersonal comparisons served as a source of information for caregivers trying to understand and manage their child's asthma. Investigating these comparisons also expands how we think about other comparison theories.
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Affiliation(s)
- James A. Shepperd
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Jean M. Hunleth
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Julia Maki
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Sreekala Prabakaran
- Department of Pulmonology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gabrielle Pogge
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Gregory Webster
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Sienna Ruiz
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Erika A. Waters
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
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Khan JR, Lingam R, Owens L, Chen K, Shanthikumar S, Oo S, Schultz A, Widger J, Bakar KS, Jaffe A, Homaira N. Social deprivation and spatial clustering of childhood asthma in Australia. Glob Health Res Policy 2024; 9:22. [PMID: 38910250 PMCID: PMC11194868 DOI: 10.1186/s41256-024-00361-2] [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: 01/29/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Asthma is the most common chronic respiratory illness among children in Australia. While childhood asthma prevalence varies by region, little is known about variations at the small geographic area level. Identifying small geographic area variations in asthma is critical for highlighting hotspots for targeted interventions. This study aimed to investigate small area-level variation, spatial clustering, and sociodemographic risk factors associated with childhood asthma prevalence in Australia. METHODS Data on self-reported (by parent/carer) asthma prevalence in children aged 0-14 years at statistical area level 2 (SA2, small geographic area) and selected sociodemographic features were extracted from the national Australian Household and Population Census 2021. A spatial cluster analysis was used to detect hotspots (i.e., areas and their neighbours with higher asthma prevalence than the entire study area average) of asthma prevalence. We also used a spatial Bayesian Poisson model to examine the relationship between sociodemographic features and asthma prevalence. All analyses were performed at the SA2 level. RESULTS Data were analysed from 4,621,716 children aged 0-14 years from 2,321 SA2s across the whole country. Overall, children's asthma prevalence was 6.27%, ranging from 0 to 16.5%, with significant hotspots of asthma prevalence in areas of greater socioeconomic disadvantage. Socioeconomically disadvantaged areas had significantly higher asthma prevalence than advantaged areas (prevalence ratio [PR] = 1.10, 95% credible interval [CrI] 1.06-1.14). Higher asthma prevalence was observed in areas with a higher proportion of Indigenous individuals (PR = 1.13, 95% CrI 1.10-1.17). CONCLUSIONS We identified significant geographic variation in asthma prevalence and sociodemographic predictors associated with the variation, which may help in designing targeted asthma management strategies and considerations for service enhancement for children in socially deprived areas.
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Affiliation(s)
- Jahidur Rahman Khan
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia.
| | - Raghu Lingam
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Louisa Owens
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Katherine Chen
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Shivanthan Shanthikumar
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Steve Oo
- Perth Children's Hospital, Perth, WA, Australia
| | - Andre Schultz
- Perth Children's Hospital, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - John Widger
- Women's and Children's Hospital, Adelaide, SA, Australia
| | - K Shuvo Bakar
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adam Jaffe
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Nusrat Homaira
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Rucker A, Watson A, Badolato G, Jarvis L, Patel SJ, Goyal MK. Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial. J Adolesc Health 2024; 74:292-300. [PMID: 37804303 DOI: 10.1016/j.jadohealth.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Adolescent emergency department (ED) patients have unmet social needs that contribute to ED use. This study aimed to evaluate the effect of social needs navigation for adolescents on subsequent ED visits and community resource use and to identify characteristics associated with elevated social risk. METHODS Between July 2017 and August 2019, we used a random date generator to establish intervention and control group enrollment dates. All adolescents completed a social needs survey. Adolescents enrolled on intervention dates received in-person, risk-tailored social needs navigation. Those enrolled on control dates received a preprinted resource guide. We used chart review and follow-up calls to assess 12-month ED revisits and community resource use. Logistic regression was used to compare these outcomes between groups. We measured the association between ≥3 reported unmet needs and characteristics hypothesized a priori to be associated with elevated social risk (nonurgent visits, obesity, or any of nine "socially sensitive" chief complaints) using logistic regression. RESULTS A total of 399 adolescents were randomized. There was no difference between groups in the number of ED revisits. There was increased community resource use in the intervention group (adjusted odds ratio [aOR]: 3.5 [95% confidence interval {CI}: 1.5, 8.2]). Adolescents with a socially sensitive chief complaint had increased odds of ≥3 unmet needs (aOR: 2.2 [95% CI: 1.3, 3.6]), as did those with food insecurity in a post hoc analysis (aOR: 9.9 [95% CI: 4.0, 24.6]). DISCUSSION Social needs navigation increased community resource use but not subsequent ED visits. Adolescents with socially sensitive chief complaints or food insecurity reported increased unmet needs.
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Affiliation(s)
- Alexandra Rucker
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C.
| | - Ar'Reon Watson
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C
| | - Gia Badolato
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C
| | - Lenore Jarvis
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
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Ramsey RR, Noser A, McDowell KM, Sherman SN, Hommel KA, Guilbert TW. Children with uncontrolled asthma from economically disadvantaged neighborhoods: Needs assessment and the development of a school-based telehealth and electronic inhaler monitoring system. Pediatr Pulmonol 2023; 58:2249-2259. [PMID: 37194988 PMCID: PMC10524439 DOI: 10.1002/ppul.26457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/11/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Children from economically disadvantaged communities often encounter healthcare access barriers, increasing risk for poorly controlled asthma and subsequent healthcare utilization. This highlights the need to identify novel intervention strategies for these families. OBJECTIVE To better understand the needs and treatment preferences for asthma management in children from economically disadvantaged communities and to develop a novel asthma management intervention based on an initial needs assessment and stakeholder feedback. METHODS Semistructured interviews and focus groups were conducted with 19 children (10-17 years old) with uncontrolled asthma and their caregivers, 14 school nurses, 8 primary care physicians, and three school resource coordinators from economically disadvantaged communities. Interviews and focus groups were audio-taped and transcribed verbatim and then analyzed thematically to inform intervention development. Using stakeholder input, an intervention was developed for children with uncontrolled asthma and presented to participants for feedback to fully develop a novel intervention. RESULTS The needs assessment resulted in five themes: (1) barriers to quality asthma care, (2) poor communication across care providers, (3) problems identifying and managing symptoms and triggers among families, (4) difficulties with adherence, and (5) stigma. A proposed video-based telehealth intervention was proposed to stakeholders who provided favorable and informative feedback for the final development of the intervention for children with uncontrolled asthma. CONCLUSIONS Stakeholder input and feedback provided information critical to the development of a multicomponent (medical and behavioral) intervention in a school setting that uses technology to facilitate care, collaboration, and communication among key stakeholders to improve asthma management for children from economically disadvantaged neighborhoods.
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Affiliation(s)
- Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Amy Noser
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Karen M. McDowell
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center
| | | | - Kevin A. Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Theresa W. Guilbert
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center
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Rodriguez-Martinez CE, Sossa-Briceño MP. Disparities in prevalence and outcomes of respiratory disease in low- and middle-income countries. Pediatr Pulmonol 2023. [PMID: 37378459 DOI: 10.1002/ppul.26573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To provide a comprehensive overview of disparities in prevalence and outcomes of respiratory diseases and notable challenges for providing optimal treatment to pediatric patients with respiratory diseases living in low- and middle-income countries (LMICs), as an input to help better understand the roots of respiratory health disparities. METHODS We conducted a narrative review of relevant literature published in electronic databases from inception to February 2023 that present data on disparities in prevalence and outcomes of respiratory disease in LMICs. Additionally, we included studies that describe and discuss challenges for providing optimal treatment to pediatric patients with respiratory diseases living in LMICs. RESULTS A number of early life exposures have been associated with adverse respiratory outcomes in later life. Several studies have shown marked geographical variations in the prevalence and burden of pediatric asthma, with consistently lower prevalence rates but significantly higher burdens and worse outcomes in LMICs. There is a wide range of challenges that adversely affect the efficient care of children with respiratory diseases that can be classified into three categories: patient-related factors, social/environmental factors, and factors related to healthcare providers or the healthcare system. CONCLUSIONS Respiratory health disparities in children living in LMICs represent a global public health issue mainly explained by an unequal distribution of preventable and modifiable risk factors for respiratory diseases across different demographic groups.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
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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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D'Agostino EM, Zhang S, Day SE, Konty KJ, Armstrong S, Skinner A, Neshteruk CD. The longitudinal association between asthma severity and physical fitness among new York City public school youth. Prev Med 2023; 170:107486. [PMID: 36931475 DOI: 10.1016/j.ypmed.2023.107486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
Severe persistent childhood asthma is associated with low physical activity and may be associated with poor physical fitness. Research on the asthma severity-fitness association longitudinally and across sociodemographic subgroups is needed to inform fitness interventions targeting youth with asthma. We evaluated the relationship between asthma severity (categorized as severe, mild, or no asthma) and subsequent fitness in New York City (NYC) public school youth enrolled in grades 4-12 using the NYC Fitnessgram dataset (2010-2018). Longitudinal mixed models with random intercepts were fit to test the association between asthma severity and one-year lagged fitness z-scores by clustering repeated annual observations at the student level. Models were adjusted for sex, race/ethnicity, grade level, poverty status, time, and stratified by sociodemographic factors. The analytic sample included 663,137 students (51% male; 31% non-Hispanic Black, 40% Hispanic; 55% in grades 4-8, 70% high poverty; 87%, 11% and 1% with no, mild, and severe asthma, respectively). Students with severe asthma and mild asthma demonstrated -0.19 (95% CI, -0.20 to -0.17) and - 0.10 (95% CI, -0.11 to -0.10), respectively, lower fitness z-scores in the subsequent year relative to students without asthma. After stratifying by demographics, the magnitude of the asthma severity-fitness relationship was highest for non-Hispanic white vs. all other racial/ethnic subgroups, and was similar across sex, grade level, and household poverty status. Overall, we observed an inverse longitudinal relationship between asthma severity and subsequent fitness among urban youth, particularly non-Hispanic Whites. Future research should examine how neighborhood-level factors impact the asthma severity-fitness relationship across racial/ethnic subgroups.
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Affiliation(s)
- Emily M D'Agostino
- Department of Orthopaedic Surgery, Duke University Medical School, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America.
| | - Sue Zhang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, United States of America
| | - Sophia E Day
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Kevin J Konty
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Sarah Armstrong
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Pediatrics, Duke University Medical School, Durham, NC, United States of America; Duke Global Health Institute, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Asheley Skinner
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
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9
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Drouin O, Perez T, Barnett TA, Ducharme FM, Fleegler E, Garg A, Lavoie K, Li P, Métras MÉ, Sultan S, Tse SM, Zhao J. Impact of Unmet Social Needs, Scarcity, and Future Discounting on Adherence to Treatment in Children With Asthma: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e37318. [PMID: 36881458 PMCID: PMC10131837 DOI: 10.2196/37318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asthma is one of the most prevalent chronic diseases of childhood and disproportionately affects children with lower socioeconomic status. Controller medications such as inhaled corticosteroids significantly reduce asthma exacerbations and improve symptoms. However, a large proportion of children still have poor asthma control, in part owing to suboptimal adherence. Financial barriers contribute to hindering adherence, as do behavioral factors related to low income. For example, unmet social needs for food, lodging, and childcare may create stress and worry in parents, negatively influencing medication adherence. These needs are also cognitively taxing and force families to focus on immediate needs, leading to scarcity and heightening future discounting; thus, there is the tendency to attribute greater value to the present than to the future in making decisions. OBJECTIVE In this project, we will investigate the relationship between unmet social needs, scarcity, and future discounting as well as their predictive power over time on medication adherence in children with asthma. METHODS This 12-month prospective observational cohort study will recruit 200 families of children aged 2 to 17 years at the Asthma Clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary care pediatric hospital in Montreal, Canada. The primary outcome will be adherence to controller medication, measured using the proportion of prescribed days covered during follow-up. Exploratory outcomes will include health care use. The main independent variables will be unmet social needs, scarcity, and future discounting, measured using validated instruments. These variables will be measured at recruitment as well as at 6- and 12-month follow-ups. Covariates will include sociodemographics, disease and treatment characteristics, and parental stress. Primary analysis will compare adherence to controller medication, measured using the proportion of prescribed days covered, between families with versus those without unmet social needs during the study period using multivariate linear regression. RESULTS The research activities of this study began in December 2021. Participant enrollment and data collection began in August 2022 and are expected to continue until September 2024. CONCLUSIONS This project will allow the documentation of the impact of unmet social needs, scarcity, and future discounting on adherence in children with asthma using robust metrics of adherence and validated measures of scarcity and future discounting. If the relationship between unmet social needs, behavioral factors, and adherence is supported by our findings, this will suggest the potential for novel targets for integrated social care interventions to improve adherence to controller medication and reduce risk across the life course for vulnerable children with asthma. TRIAL REGISTRATION ClinicalTrials.gov NCT05278000; https://clinicaltrials.gov/ct2/show/NCT05278000. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37318.
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Affiliation(s)
- Olivier Drouin
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Tamara Perez
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Tracie A Barnett
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Francine M Ducharme
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Clinical Research and Knowledge Transfer Research Centre, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Boston, MA, United States
- Division of General Academic Pediatrics, Department of Pediatrics, Boston Medical Center and School of Medicine, Boston University, Boston, MA, United States
| | - Kim Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Ile-de-Montreal, Montreal, QC, Canada
- Department of Psychology, Université de Quebec à Montreal, Montreal, QC, Canada
| | - Patricia Li
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Division of General Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Marie-Élaine Métras
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Serge Sultan
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, QC, Canada
| | - Sze Man Tse
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Jiaying Zhao
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, BC, Canada
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10
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Lewis G, Milnes L, Adams A, Schwarze J, Duff A. Influences on indoor environmental trigger remediation uptake for children and young people with asthma: A scoping review. Health Expect 2022; 26:87-97. [PMID: 36478049 PMCID: PMC9854302 DOI: 10.1111/hex.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/21/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Children and young people (CYP) with asthma can benefit from reduced exposure to indoor environmental allergens and triggers but may not consistently have avoidance strategies implemented. To inform future interventions to increase trigger and allergen avoidance and enhance asthma control, a greater understanding of the influences on avoidance behaviours is necessary. METHODS A systematic scoping review was selected to summarize evidence on what influences family uptake of indoor environmental asthma trigger avoidance strategies for CYP with asthma and identify research gaps. Primary studies of any design, including CYP (≤18 years) with asthma, and/or parent-carers, available in English and conducted since 1993, were eligible. Searches included nine databases, hand-searching reference lists and citation searching. FINDINGS Thirty-three articles were included and are summarized narratively due to heterogeneity. Influences appear complex and multifactorial and include barriers to strategy uptake, health beliefs and personal motivation. Research specifically related to family understanding of allergic sensitisation status and exposure risks, and how these may inform avoidance implementation is required. Patient and public involvement (PPI) was not reported in included articles, although two studies used participatory methods. CONCLUSION There is limited research on family asthma trigger management, particularly what influences current management behaviours. Variation in families' ability to identify important triggers, understand exposure risk and consistently reduce exposures warrants further exploratory research to explain how families reach avoidance decisions, and what future interventions should aim to address. Further PPI-informed research to address such gaps, could enable theory-based, person-centred interventions to improve the uptake of asthma trigger remediation. PATIENT OR PUBLIC CONTRIBUTION An asthma-specific PPI group contributed to the decision-making for the funding for the wider project this review sits within. The findings of this scoping review have informed the subsequent phases of the project, and this was discussed with PPI groups (both adult and CYP groups) when proposing the next phases of the project.
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Affiliation(s)
- Grace Lewis
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK,Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK
| | - Linda Milnes
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK,Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK
| | - Alexandra Adams
- Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK,Paediatric Respiratory UnitLeeds Children's HospitalLeedsUK
| | - Jürgen Schwarze
- Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK,Child Life and Health, Centre for Inflammation ResearchThe University of EdinburghEdinburghUnited Kingdom
| | - Alistair Duff
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK,Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK,Paediatric Respiratory UnitLeeds Children's HospitalLeedsUK
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11
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Rucker AC, Watson A, Badolato G, Boyle M, Hendrix C, Jarvis L, Patel SJ, Goyal MK. Predictors of Elevated Social Risk in Pediatric Emergency Department Patients and Families. Pediatr Emerg Care 2022; 38:e910-e917. [PMID: 34225329 DOI: 10.1097/pec.0000000000002489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of high unmet social needs among pediatric emergency department (ED) patients. We hypothesized that obesity, frequent nonurgent visits, reported food insecurity, or an at-risk chief complaint (CC) would predict elevated social risk. METHODS We administered a tablet-based survey assessing unmet social needs in 13 domains to caregivers of patients aged 0 to 17 years presenting to an urban pediatric ED. Responses were used to tabulate a social risk score (SRS). We performed multivariable logistic regression to measure associations between a high SRS (≥3) and obesity, frequent nonurgent visits, food insecurity, or an at-risk CC (physical abuse, sexual abuse, assault, mammalian bites, reproductive/sexual health complaints, intoxication, ingestion/poisoning, psychiatric/behavioral complaints, or any complaint triaged as "least urgent"). RESULTS Five hundred seventy caregivers completed the survey. Eighty-one percent reported at least one unmet social need, and 33% identified ≥3 social needs. Caregivers of patients with an at-risk CC had twice the odds of a high SRS (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.0-3.3). Caregivers of patients reporting food insecurity had 4 times the odds of a high SRS (aOR, 4.3; 95% CI, 2.5-7.3). Neither obesity (aOR, 1.5; 95% CI, 0.9-2.6) nor frequent nonurgent visits (aOR, 0.9; 95% CI, 0.4-1.9) were predictive of a high SRS. CONCLUSIONS Unmet social needs are prevalent among caregivers of pediatric ED patients, supporting universal screening in this population. Patients with an at-risk CC or reported food insecurity might benefit from proactive intervention. Future studies should examine optimal methods for ED-based interventions that address social determinants of health.
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Affiliation(s)
| | - Ar'Reon Watson
- Department of Psychiatry, Center for Child and Human Development, Georgetown University, Washington, DC
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12
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Kub JE, DePriest KN, Bellin MH, Butz A, Lewis-Land C, Morphew T. Predictors of Depressive Symptoms in Caregivers of Children With Poorly Controlled Asthma: Is the Neighborhood Context Important? FAMILY & COMMUNITY HEALTH 2022; 45:10-22. [PMID: 34783687 PMCID: PMC9600613 DOI: 10.1097/fch.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Children residing in low-income neighborhoods are disproportionately affected by asthma morbidity and mortality. Neighborhood violence has been explored in relationship to child morbidity and health and developmental outcomes, but less is known about the relationship of violence to caregiver mental health. The purpose of this study was to examine the relationship of neighborhood violent crime victimization (objective and subjective measures), perceptions of community well-being and support, and depressive symptoms among a sample of primarily single female caregivers of children with uncontrolled asthma. This is a secondary analysis of baseline data obtained from a randomized controlled trial of a home-based environmental control intervention for children aged 3 to 12 years, who were primarily African American, and diagnosed with persistent, uncontrolled asthma. Results showed that both objective and subjective measures of crime, particularly in those with relatively low life stress (P < .001), limited education of the caregiver (P < .001), and fewer children (P < .01) in the household had direct associations with depressive symptoms in caregivers of children with uncontrolled asthma. Neighborhood perceptions of satisfaction and a sense of community, as well as perceptions of social support, were not associated with depressive symptoms. Our findings emphasize the need to screen for depressive symptoms, life stress, as well as both objective and subjective perceptions of neighborhood violence among caregivers of children with poorly controlled asthma. Furthermore, when providing holistic care to these caregivers, stress reduction and the provision of mental health resources are paramount.
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Affiliation(s)
- Joan E Kub
- Johns Hopkins University School of Nursing, Baltimore, Maryland (Drs Kub and DePriest); University of Maryland School of Social Work, Baltimore (Dr Bellin); Department of Pediatrics (Dr Butz) and Institute for Clinical & Translation Research (Ms Lewis-Land), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Morphew Consulting, LLC, Bothell, Washington (Ms Morphew)
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13
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Mitchell SJ, Rangel A, Klein EJ, Stout JW, Lowry SJ, Wingfield E, Horn IB, Coker TR. Sociodemographic Differences in Asthma Self-Management Knowledge of Parents Seeking Asthma Care for their Children in Pediatric Emergency Departments. J Health Care Poor Underserved 2021; 32:2191-2201. [PMID: 34803068 DOI: 10.1353/hpu.2021.0191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To effectively support asthma self-management among children most at risk for poor outcomes, it is important to examine potential disparities in parents' asthma-related knowledge. This study draws on baseline data collected from a randomized controlled trial to analyze how knowledge of asthma self-management varies by sociodemographic characteristics in a racially and economically diverse sample of Medicaid-insured children seeking emergency asthma care (N=221). Multivariable linear regression revealed that parent race/ethnicity, preferred language, and education were independently associated with scores on the Asthma Self Management Knowledge Questionnaire, and there was a significant interaction between parent race/ethnicity and education. In analyses stratified by parent education level, Latinx race/ethnicity was associated with lower-self-management knowledge among parents with higher education level, but not among those with a lower level of education. Our findings call for further research to understand and address the unique barriers to improving asthma self-management knowledge among Latinx parents and parents with limited English proficiency.
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14
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Ali NM, Combs RM, Kakar RM, Muvuka B, Porter J. Promoting Interdisciplinary, Participatory Approaches to Address Childhood Asthma Disparities in an Urban Black Community. FAMILY & COMMUNITY HEALTH 2021; 44:32-42. [PMID: 33055573 DOI: 10.1097/fch.0000000000000283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Black children are twice as likely as non-Hispanic white children to have asthma due to an interplay of socioeconomic, historical, and industrial factors. The underlying socio-economic and structural inequities result in poor adherence to recommended asthma management treatments. National guidelines suggest asthma action plans (AAPs) as a tool for patient self-management, yet they remain underutilized. Boot Camp Translation (BCT), rooted in community-based participatory research, provides a method for engaging communities to improve health literacy. This article describes the successful use of BCT to develop a culturally relevant AAP promotion campaign in West Louisville, a predominantly Black community that experiences social and health disparities.
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Affiliation(s)
- Nida M Ali
- University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky (Drs Ali, Combs, Kakar, and Muvuka); and Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Dr Porter)
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15
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Kelada L, Molloy CJ, Hibbert P, Wiles LK, Gardner C, Klineberg E, Braithwaite J, Jaffe A. Child and caregiver experiences and perceptions of asthma self-management. NPJ Prim Care Respir Med 2021; 31:42. [PMID: 34504105 PMCID: PMC8429661 DOI: 10.1038/s41533-021-00253-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
Asthma is the most common chronic condition of childhood. Self-management is integral to good asthma control. This qualitative paper explores how children with asthma and their parents perceive asthma, their experience with asthma, and how they manage symptoms, preventions and medications within and outside the home. We undertook 15 focus groups with 41 school-aged (6-11 years) children with asthma and 38 parents. Parents and their children attended the same focus groups. We used thematic analysis to analyse the transcripts. Our findings show the impact asthma can have on children's social and emotional wellbeing and highlight how reliant school-aged children are on their parents to effectively manage their asthma. Parents reported being unsure when their child's symptoms warranted visiting their doctor or hospital. Schools were identified as a source of difficulty regarding asthma management; families reported that children may be self-conscious about their asthma and using their inhaler at school. School policies and teachers' lack of asthma knowledge were reported to exacerbate children's reluctance to use their inhaler at school. Our results have implications for the design and implementation of children's self-management interventions for their asthma, particularly when they are at school and away from their parents.
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Affiliation(s)
- Lauren Kelada
- grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW Australia
| | - Charlotte J. Molloy
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia ,grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA Australia ,grid.430453.50000 0004 0565 2606South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | - Peter Hibbert
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia ,grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA Australia ,grid.430453.50000 0004 0565 2606South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | - Louise K. Wiles
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia ,grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA Australia ,grid.430453.50000 0004 0565 2606South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | - Claire Gardner
- grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Emily Klineberg
- grid.416088.30000 0001 0753 1056Ministry of Health, NSW Health, St Leonards, NSW Australia
| | - Jeffrey Braithwaite
- grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia
| | - Adam Jaffe
- grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XRespiratory Department, Sydney Children’s Hospital, Randwick, NSW Australia ,grid.414009.80000 0001 1282 788XAiming for Asthma Improvement in Children, Sydney Children’s Hospital, Randwick, NSW Australia
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16
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Hunleth J, Spray J, Ruiz S, Maki J, Fedele DA, Prabhakaran S, Forsyth RB, Sykes C, Crepps K, Shepperd J, Bowen D, Waters EA. Situating household management of children's asthma in the context of social, economic, and environmental injustice. J Asthma 2020; 59:70-78. [PMID: 33107771 DOI: 10.1080/02770903.2020.1837159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Structural determinants of health are social, economic, and environmental forces that generate unequal opportunities for resources and unequally distribute exposure to risk. For example, economic constraint, racial discrimination and segregation, and environmental injustice shape population-level asthma prevalence and severity. Structural determinants are especially relevant to consider in clinical settings because they affect everyday household asthma management. OBJECTIVE To examine how structural determinants shape everyday household management of pediatric asthma and offer a framework for providers to understand asthma management in social context. DESIGN Qualitative interviews of caregivers for children with asthma. PARTICIPANTS Participants included 41 caregivers in two U.S. cities: St. Louis, Missouri (n = 25) and Gainesville, Florida (n = 16). Most caregivers were women (83%), Black (73%) and/or had low socioeconomic status (SES; 78%). Caregivers cared for children with asthma aged 0-4 (32%), 5-11 (68%) and 12-17 (54%). APPROACH We carried out narrative interviews with caregivers using an adapted McGill Illness Narrative Interview and using qualitative analysis techniques (e.g. inductive and deductive coding, constant comparison). KEY RESULTS Caregivers highlighted three ways that structural determinants complicated asthma management at home: 1) housing situations, 2) competing household illnesses and issues, and 3) multi-household care. CONCLUSIONS By connecting social, economic, and environmental injustices to the everyday circumstances of asthma management, our study can help providers understand how social contexts challenge asthma management and can open conversations about barriers to adherence and strategies for supporting asthma management at home. We offer recommendations for medical system reform, clinical interactions, and policy advocacy.
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Affiliation(s)
- Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sienna Ruiz
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Julia Maki
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | | | - Rachel B Forsyth
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Cassidy Sykes
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kaylah Crepps
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - James Shepperd
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Deb Bowen
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Erika A Waters
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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17
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Lin NY, Ramsey RR, Miller JL, McDowell KM, Zhang N, Hommel K, Guilbert TW. Telehealth delivery of adherence and medication management system improves outcomes in inner-city children with asthma. Pediatr Pulmonol 2020; 55:858-865. [PMID: 31905264 PMCID: PMC9125769 DOI: 10.1002/ppul.24623] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
Healthcare disparities exist in pediatric asthma in the United States. Children from minority, low-income families in inner-city areas encounter barriers to healthcare, leading to greater rates of poorly controlled asthma and healthcare utilization. Finding an effective way to deliver high-quality healthcare to this underserved population to improve outcomes, reduce morbidity and mortality, and reduce healthcare utilization is of the utmost importance. The purpose of this study was to assess the feasibility and efficacy of a novel school-based care delivery model that incorporates video-based telehealth (VBT) medical and self-management visits with electronic inhaler monitoring to improve asthma outcomes. Over a 6-month period, children from inner-city, low-income schools with uncontrolled asthma completed seven scheduled medical visits with an asthma specialist and five self-management visits with an adherence psychologist at school using VBT. Composite Asthma Severity Index (CASI) scores and electronic inhaler monitor data were recorded and analyzed. A total of 21 patients were enrolled in the study. Study subjects with higher baseline severity (CASI ≥ 4 at visit 1) demonstrated a greater reduction in their score than those with lower baseline severity (CASI < 4 at visit 1). The CASI domains showed improvement in daytime symptoms, nighttime symptoms, and exacerbations. Adherence results demonstrated a significant improvement in adherence from baseline to postintervention. Study retention was 100%. This study demonstrates that a multicomponent medical and behavioral interventional program delivered by VBT to a school-based setting is feasible and can significantly improve asthma outcomes and care in a challenging population.
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Affiliation(s)
- Nancy Y Lin
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Center for Health Technology Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James L Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen M McDowell
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nanhua Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kevin Hommel
- Division of Behavioral Medicine and Clinical Psychology, Center for Health Technology Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Theresa W Guilbert
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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18
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Margolis R, Bellin MH, Bookman JRM, Collins KS, Bollinger ME, Lewis-Land C, Butz AM. Fostering Effective Asthma Self-Management Transfer in High-Risk Children: Gaps and Opportunities for Family Engagement. J Pediatr Health Care 2019; 33:684-693. [PMID: 31253454 PMCID: PMC6815689 DOI: 10.1016/j.pedhc.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The process of self-management knowledge, behavior, and skill development in children with asthma from families with low income is understudied. METHOD Fifteen mothers of children with uncontrolled asthma participated in semistructured interviews exploring the transfer of asthma self-management responsibilities from parent to child. Team members performed thematic analysis of written transcripts. RESULTS All participants were all the biological mothers and were impoverished, with most (73%) reporting an annual family income of less than $30,000. Their children ranged from 5 to 15 years old, were African American (100%), and had uncontrolled asthma based on national guidelines. Themes showed that child asthma self-management is difficult to achieve, that the transfer of asthma responsibility from mother to child is variable, and that mothers overestimate their child's developmental capacities for independent asthma self-management and have poor understanding of what well-controlled asthma means. DISCUSSION Ongoing assessment and tailored guidance from health care providers are critical to support the pivotal role of mothers in their child's self-management development process.
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Affiliation(s)
- Rachel Margolis
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | - Melissa H. Bellin
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | | | - Kathryn S. Collins
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | | | - Cassie Lewis-Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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19
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Teach SJ, Shelef DQ, Fousheé N, Horn IB, Yadav K, Wang Y, Rand CS, Streisand R. Randomized clinical trial of parental psychosocial stress management to improve asthma outcomes. J Asthma 2019; 58:121-132. [PMID: 31545115 DOI: 10.1080/02770903.2019.1665063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Because higher parental psychosocial stress is associated with worsened asthma outcomes in children, we sought to determine if a parent-focused stress management intervention would improve outcomes among their at-risk African American children. METHODS We enrolled self-identified African American parent-child dyads (children aged 4-12 years old with persistent asthma, no co-morbidities, on Medicaid) in a prospective, single-blind, randomized clinical trial with follow-up at 3, 6, and 12 months. All children received care based on the guidelines of the National Institutes of Health. Developed with extensive local stakeholder engagement, the intervention consisted of four individual sessions with a community wellness coach (delivered over 3 months) supplemented with weekly text messaging and twice monthly group sessions (both delivered for 6 months). The main outcome was asthma symptom-free days in the prior 14 days by repeated measures at 3 and 6 months follow-up. RESULTS We randomized 217 parent-child dyads and followed 196 (90.3%) for 12 months. Coaches completed 338/428 (79%) of all individual sessions. Symptom-free days increased significantly from baseline in both groups at 3, 6, and 12 months, but there were no significant differences between groups over the first 6 months. At 12 months, the intervention group sustained a significantly greater increase in symptom-free days from baseline [adjusted difference = 0.92 days, 95% confidence interval (0.04, 1.8)]. CONCLUSION The intervention did not achieve its primary outcome. The efficacy of providing psychosocial stress management training to parents of at-risk African American children with persistent asthma in order to improve the children's outcomes may be limited. CLINICALTRIALS.GOV NCT02374138.
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Affiliation(s)
- Stephen J Teach
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA.,School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Deborah Q Shelef
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA
| | - Naja Fousheé
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA
| | | | - Kabir Yadav
- Los Angeles Medical Center, Harbor-University of California, Torrance, CA, USA
| | - Yunfei Wang
- Duke Human Vaccine Institute, Duke University, Durham, NC, USA
| | - Cynthia S Rand
- Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA
| | - Randi Streisand
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA.,School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
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20
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Sumino K, Bacharier LB, Taylor J, Chadwick-Mansker K, Curtis V, Nash A, Jackson-Triggs S, Moen J, Schechtman KB, Garbutt J, Castro M. A Pragmatic Trial of Symptom-Based Inhaled Corticosteroid Use in African-American Children with Mild Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:176-185.e2. [PMID: 31371165 DOI: 10.1016/j.jaip.2019.06.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Symptom-based adjustment (SBA) of inhaled corticosteroids may be an alternative patient-centered approach in which day-to-day inhaled corticosteroid use is adjusted by symptoms and short-acting β-agonist need. OBJECTIVE To evaluate the effectiveness of SBA in the primary care setting. METHODS We conducted a randomized, open-label, pragmatic equivalence trial in African-American children (6-17 years old) with mild asthma managed by 12 primary care providers (PCPs). A total of 206 participants were randomized to SBA (as-needed beclomethasone 80 μg with rescue short-acting β-agonist) or provider-based guideline-directed adjustment (PBA): maintenance beclomethasone 80 μg/d (6-11 years old), 160 μg/d (12-17 years old), with subsequent guideline-based dose adjustment by PCPs. PCPs implemented both treatment assignments, with outcomes measured by blinded staff. All participants received symptom recognition and albuterol use education from peer educators. Primary outcome was change in asthma control (measured by Asthma Control Test [ACT]/childhood ACT [cACT]) over 12 months. RESULTS Participants had adequately controlled asthma (mean ACT or cACT score = 21.6 ± 2.8) at baseline. After 1 year, there was no significant between-group difference in change in ACT scores (SBA - PBA): ACT: -0.88 (95% CI, -2.19 to 0.42), cACT: -0.73 (-2.09 to 0.62), or combined ACT and cACT (P = .10), and was within the predefined statistical clinical equivalence. The proportion with an exacerbation and measures of lung function were similar between groups. Compared with PBA, SBA led to less beclomethasone use (SBA: 526 μg/mo [95% CI, 412-639 μg] vs PBA: 1961 μg/mo [95% CI, 1681-2241]; P < .0001). More parents in the SBA arm felt they were managing their child's asthma. CONCLUSIONS SBA in African-American children with mild asthma was similar to PBA in asthma control and events when implemented by PCPs with lower inhaled corticosteroid exposure.
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Affiliation(s)
- Kaharu Sumino
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo.
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Mo; Division of Allergy, Immunology and Pulmonary Medicine, Washington University School of Medicine, Saint Louis, Mo
| | - Juanita Taylor
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo
| | - Kelley Chadwick-Mansker
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo
| | - Vanessa Curtis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo
| | - Alison Nash
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Mo
| | - Shawni Jackson-Triggs
- Department of Medicine, Division of Biostatistics, Washington University School of Medicine, Saint Louis, Mo
| | - Joseph Moen
- Department of Medicine, Division of Biostatistics, Washington University School of Medicine, Saint Louis, Mo
| | - Kenneth B Schechtman
- Department of Medicine, Division of Biostatistics, Washington University School of Medicine, Saint Louis, Mo
| | - Jane Garbutt
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Mo; Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, Saint Louis, Mo
| | - Mario Castro
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo
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21
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Volerman A, Kim TY, Sridharan G, Toups M, Hull A, Ignoffo S, Sharp LK, Press VG. A Mixed-methods Study Examining Inhaler Carry and Use among Children at School. J Asthma 2019; 57:1071-1082. [PMID: 31274042 DOI: 10.1080/02770903.2019.1640729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Asthma self-management depends partly on access to inhalers; for children, this includes independent inhaler carry and use at school ("self-carry"). Although laws and policies support self-carry, little is known about practices within schools. This study aimed to identify factors associated with inhaler self-carry among children and examine barriers and facilitators to self-carry.Methods: This mixed-methods observational study included child-parent dyads and nurses from four Chicago schools. Children and parents answered questions about asthma care and morbidity, confidence in self-carry skills, and facilitators and barriers to self-carry. Nurses reported asthma documentation on file and their confidence in children's self-carry skills. Analysis utilized logistic regression. Thematic analysis was performed for open-ended questions.Results: Of 65 children enrolled (mean = 10.66 years), 45 (69.2%) reported having quick-relief medication at school, primarily inhalers, and 35 (53.8%) reported self-carry. Inhaler self-carry was associated with controller medication use and parent confidence in child's self-carry skills. Children and parents identified several facilitators to self-carry: child's asthma knowledge, inhaler characteristics, and need for easy inhaler access. Barriers included child's limited understanding of asthma and inhalers, perception that inhaler is not needed, and limited inhaler access. Children also emphasized social relationships as facilitators and barriers, while parents described children's responsibility as a facilitator and inconsistent policy implementation as a barrier.Conclusions: Efforts to improve inhaler self-carry at school should focus on educating children about asthma and inhaler use, creating supportive environments for self-carry among peers and teachers, and fostering consistent implementation and communication about asthma policy among schools and families.
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Affiliation(s)
- Anna Volerman
- Department of Medicine and Pediatrics, University of Chicago Medicine, Chicago, IL, USA
| | - Tae Yeon Kim
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Geetha Sridharan
- Pediatrics Residency Program, University of Chicago, Chicago, IL, USA
| | - Madeleine Toups
- Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - Ashley Hull
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Lisa K Sharp
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Valerie G Press
- Department of Medicine and Pediatrics, University of Chicago Medicine, Chicago, IL, USA
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22
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Fallon M, Haynes L, Cadet T, Petrosino S, Cazeau E, Solis J, Cox J, Wu AC, Holder-Niles FF. A Group Visit for High-Risk Pediatric Asthma Patients: A Quality Improvement Initiative to Improve Asthma Care. Clin Pediatr (Phila) 2019; 58:746-751. [PMID: 30938184 DOI: 10.1177/0009922819839238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Asthma disproportionately affects poor and minority children. Limited parental knowledge and confidence in asthma management, as well as stress from chronic illness, may contribute to poor outcomes. Novel approaches for providing care are essential for this vulnerable population. Our objective was to evaluate the feasibility and impact of an asthma group visit for high-risk children. METHODS Our primary care practice cares for more than 2600 children with asthma. The majority have public insurance. Children classified as high risk (≥1 asthma-related emergency department visit/hospitalization in the preceding 2 years) were eligible. Children received brief physical examinations, medication review, and updated Asthma Action Plans. Educational sessions were held for children and parents. Pre and post surveys were used to assess parents' experience and changes in confidence in asthma management. RESULTS Twenty children and their parents participated. Mean parent confidence scores (5-point Likert-type scale, 5 indicating greatest confidence) improved in managing their child's asthma symptoms (3.60, 4.40, P ≤ .005), managing their child's asthma medications (3.85, 4.30, P ≤ .005), using their child's Asthma Action Plan (3.79, 4.45, P ≤ .02), communicating with the school about their child's food allergies (4.32, 4.72, P ≤ .03), and helping their child relax to reduce emotional triggers of asthma (3.25, 4.47, P ≤ .01). All families reported that they would return to a group visit. CONCLUSION Group visits are feasible for providing care, education, and peer support to a vulnerable population. Parents expressed satisfaction and improved confidence in aspects of asthma management. Group visits have the potential to improve asthma outcomes for high-risk families.
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Affiliation(s)
- Margaret Fallon
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Joanne Cox
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Ann Chen Wu
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA.,3 Center for Healthcare Research in Pediatrics (CHeRP), Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Faye F Holder-Niles
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
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23
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Gjelsvik A, Rogers ML, Garro A, Sullivan A, Koinis-Mitchell D, McQuaid EL, Smego R, Vivier PM. Neighborhood Risk and Hospital Use for Pediatric Asthma, Rhode Island, 2005-2014. Prev Chronic Dis 2019; 16:E68. [PMID: 31146802 PMCID: PMC6549429 DOI: 10.5888/pcd16.180490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Studies consistently show that children living in poor neighborhoods have worse asthma outcomes. The objective of our study was to assess the association between negative neighborhood factors (ie, neighborhood risk) and pediatric asthma hospital use. METHODS This retrospective study used data from children aged 2 to 17 years in a statewide (Rhode Island) hospital network administrative database linked to US Census Bureau data. We defined an asthma visit as an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code of 493 in any diagnosis field. We used 8 highly correlated measures for each census-block group to construct an index of neighborhood risk. We used maps and linear regression to assess the association of neighborhood risk with average annual census-block-group rates of asthma emergency department visits and hospitalizations. We used multivariable analyses to identify child characteristics and neighborhood risk associated with an asthma revisit, accounting for the child's sociodemographic information, season, and multiple measurements per child. RESULTS From 2005 through 2014, we counted 359,195 visits for 146,889 children. Of these, 12,699 children (8.6%) had one or more asthma visits. Linear regression results showed 1.18 (95% confidence interval, 1.06-1.30) more average annual emergency departments visits per 100 children and 0.41 (95% confidence interval, 0.34-0.47) more average annual hospitalizations per 100 children in neighborhoods in the highest-risk index quintile than in neighborhoods in the lowest-risk index quintile. CONCLUSION Interventions to improve asthma outcomes among children should move beyond primary care or clinic settings and involve a careful evaluation of social context and environmental triggers.
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Affiliation(s)
- Annie Gjelsvik
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Brown University, Box G-121S, Providence, RI 02912.
| | - Michelle L Rogers
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Aris Garro
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Adam Sullivan
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Raul Smego
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
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Davis SA, Carpenter D, Lee C, Garcia N, Reuland DS, Tudor G, Loughlin CE, Sleath B. Effect of an Asthma Question Prompt List and Video Intervention on Adolescents' Medication Adherence 12 Months Later. Ann Pharmacother 2019; 53:683-689. [PMID: 30758220 DOI: 10.1177/1060028019831259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Many adolescents do not obtain the maximum benefit from their asthma medications. Improving patient-provider communication may improve adolescents' asthma knowledge, adherence, and clinical outcomes. OBJECTIVE To determine how a question prompt list and educational video intervention affect youth- and caregiver-reported medication adherence and self-reported medication problems. METHODS Adolescents with persistent asthma (n = 359; 56.4% with moderate to severe asthma) and their caregivers were enrolled in a randomized controlled trial at 4 pediatric clinics. Intervention group families received a question prompt list and watched a short video before seeing the provider; control families received usual care. Youth- and caregiver-reported medication adherence was measured with a Visual Analog Scale, ranging from 0 to 100. Generalized estimating equations were used to determine how the intervention and covariates were associated with medication adherence and reported problems at 12 months. RESULTS The intervention was not a significant predictor of medication adherence at 12 months. Higher caregiver education was associated with higher youth-reported adherence (β = 1.1; 95% CI = 0.1, 2.1; P = 0.036) and caregiver-reported adherence (β = 1.2; 95% CI = 0.3, 2.0; P = 0.006). The intervention was associated with fewer caregiver-reported problems at 12 months (β = -0.32; 95% CI = -0.48, -0.16; P < 0.001). CONCLUSIONS AND RELEVANCE A question prompt list and educational video decreased the number of caregiver-reported medication problems, but did not significantly affect medication adherence. Further research is needed to develop more effective interventions to improve medication adherence and outcomes.
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Affiliation(s)
- Scott A Davis
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Nacire Garcia
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ceila E Loughlin
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Betsy Sleath
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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25
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Sadreameli SC, Riekert KA, Matsui EC, Rand CS, Eakin MN. Family Caregiver Marginalization is Associated With Decreased Primary and Subspecialty Asthma Care in Head Start Children. Acad Pediatr 2018; 18:905-911. [PMID: 29730244 PMCID: PMC6215521 DOI: 10.1016/j.acap.2018.04.135] [Citation(s) in RCA: 8] [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] [Received: 11/20/2017] [Revised: 04/27/2018] [Accepted: 04/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Urban minority children are at risk for poor asthma outcomes and might not receive appropriate primary or subspecialty care. We hypothesized that preschool children with asthma whose caregivers reported more barriers to care would be less likely to have seen their primary care provider (PCP) or an asthma subspecialist and more likely to have had a recent emergency department (ED) visit for asthma. METHODS The Barriers to Care Questionnaire (BCQ) is used to measure expectations, knowledge, marginalization, pragmatics, and skills. We assessed asthma control using the Test for Respiratory and Asthma Control in Kids and these outcomes: PCP visits for asthma in the past 6 months, subspecialty care (allergist or pulmonologist) in the past 2 years, and ED visits in the past 3 months. RESULTS Three hundred ninety-five caregivers (96% African-American, 82% low-income, 96% Medicaid) completed the BCQ. Sixty percent (n = 236) of children had uncontrolled asthma, 86% had seen a PCP, 23% had seen a subspecialist, and 29% had an ED visit. Barriers related to marginalization were associated with decreased likelihood of PCP (odds ratio [OR], 0.95; P = .014) and subspecialty visits (OR, 0.92; P = .019). Overall BCQ score was associated with decreased likelihood of subspecialty care (OR, 0.98; P = .027). Barriers related to expectations, knowledge, pragmatics, and skills were not associated with any of the care outcomes. CONCLUSIONS Among low-income, predominantly African-American preschool children with asthma, primary and subspecialty care were less likely if caregivers reported past negative experiences with the health care system (marginalization). Clinicians who serve at-risk populations should be sensitive to families' past experiences and should consider designing interventions to target the most commonly reported barriers.
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Affiliation(s)
- S. Christy Sadreameli
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kristin A. Riekert
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth C. Matsui
- Eudowood Division of Pediatric Allergy and Immunology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cynthia S. Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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26
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Naman J, Press VG, Vaughn D, Hull A, Erwin K, Volerman A. Student perspectives on asthma management in schools: a mixed-methods study examining experiences, facilitators, and barriers to care. J Asthma 2018; 56:1294-1305. [PMID: 30376385 DOI: 10.1080/02770903.2018.1534968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Children spend nearly a third of their day at school, making it a critical point of intervention for those with asthma. This study aimed to illuminate minority students' experiences with asthma at school and perceptions of facilitators and barriers to care. Methods: A mixed-methods study was conducted with elementary students with asthma. Participants completed a 24-question survey, drawing exercise to depict experiences caring for their asthma at school, and focus group discussion. Drawings were analyzed for narrative and pictorial themes. Discussions were audio-recorded, transcribed, and independently coded for themes. Results: Fifteen children with asthma (8-11 years) participated from two Chicago schools with predominately African-American populations. Most students (79%) indicated they had control of asthma at school, while 85% identified asthma as a problem when exercising. Half (53%) received help with asthma care at school. Drawings depicted cooperative management with adults or peers and the central role of inhalers as part of everyday asthma care in school. Finally, focus groups produced six key themes within the domains of facilitators: 1) support of others, 2) self-efficacy; 3) perception of being normal; and barriers: 4) lack of support from others; 5) difficulty accessing inhaler; 6) perception of being different. Conclusions: This study suggests asthma care plays an important role in students' school experiences. Stigma around inhaler use, lack of concern by school staff, and limited access to medications remain as barriers to school-based asthma management. Although facilitators, such as support from teachers and peers, do exist, future interventions must address existing barriers.
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Affiliation(s)
- Julia Naman
- Pritzker School of Medicine , University of Chicago , Chicago , Illinois , USA
| | - Valerie G Press
- Department of Medicine and Pediatrics, University of Chicago , Chicago , Illinois , USA
| | - Dagny Vaughn
- Department of Medicine, University of Chicago , Chicago , Illinois , USA
| | - Ashley Hull
- Department of Medicine, University of Chicago , Chicago , Illinois , USA
| | - Kim Erwin
- School of Design , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Anna Volerman
- Department of Medicine and Pediatrics, University of Chicago , Chicago , Illinois , USA
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27
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Volerman A, Dennin M, Vela M, Ignoffo S, Press VG. A qualitative study of parent perspectives on barriers, facilitators and expectations for school asthma care among urban, African-American children. J Asthma 2018; 56:1099-1109. [PMID: 30285497 DOI: 10.1080/02770903.2018.1520861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: Minority children experience the disproportionate burden of asthma and its consequences. Studies suggest ethnic groups may experience asthma differently with varied perceptions and expectations among parents of African-American and Latino children. Because parents coordinate asthma care with the school, where children spend a significant amount of their day, this study's goal was to determine parents' perspectives on school asthma management. Methods: Focus groups were conducted with parents of children with asthma at four urban schools whose student population is predominantly African-American. A semi-structured guide was utilized focusing on barriers, facilitators and expectations for asthma care at school. Grounded theory principles were applied in this study. Results: Twenty-two parents (91% females) representing 13 elementary and 10 middle school children with asthma (61% boys) participated in four focus groups. Most children (87%) had persistent asthma. The identified barriers to effective school-based asthma care included limited awareness of children with asthma by teachers/staff, communication issues (e.g. school/parent, within school), inadequate education and lack of management plans or systems in place. In contrast, the identified facilitators included steps that fostered education, communication and awareness, as supported by management plans and parent initiative. Parents described their expectations for increased communication and education about asthma, better systems for identifying children with asthma, and a trained asthma point person for school-based asthma care. Conclusions: Parents of children with asthma identified important barriers, facilitators and expectations that must be considered to advance school asthma management. Improved school-based asthma care could lead to better health and academic outcomes.
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Affiliation(s)
- Anna Volerman
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.,Department of Pediatrics, University of Chicago Medicine, Chicago, IL, USA
| | - Margaret Dennin
- Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Monica Vela
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Valerie G Press
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.,Department of Pediatrics, University of Chicago Medicine, Chicago, IL, USA
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28
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Bellin MH, Newsome A, Lewis-Land C, Kub J, Mudd SS, Margolis R, Butz AM. Improving Care of Inner-City Children with Poorly Controlled Asthma: What Mothers Want You to Know. J Pediatr Health Care 2018; 32:387-398. [PMID: 29540280 PMCID: PMC6026044 DOI: 10.1016/j.pedhc.2017.12.009] [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: 10/24/2017] [Accepted: 12/06/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Low-income caregiver perspectives on asthma management are understudied but may illuminate strategies to improve care delivery and child outcomes. METHOD Purposive sampling methods were used to recruit 15 caregivers of children with frequent asthma emergency department visits. Interviews explored how poverty and stress affect asthma management. Grounded theory coding techniques were used to analyze the data. RESULTS Participants were the biological mother (100%) and were poor (75% had mean annual income ≤ $30,000). Their children (mean age = 6.9 years) were African American (100%), enrolled in Medicaid (100%), and averaged 1.5 emergency department visits over the prior 3 months. Four themes emerged: (a) Deplorable Housing Conditions, (b) Allies and Adversaries in School-Based Asthma Management, (c) Satisfaction With Asthma Health Care Delivery, and (d) Prevalent Psychological Distress. DISCUSSION Impoverished caregivers of children with frequent asthma emergency department visits describe stress that is multifaceted, overwhelming, and difficult to eradicate. Their experiences underscore the need for improved school-based asthma management and family-centered approaches to health care delivery.
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Affiliation(s)
| | | | - Cassie Lewis-Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Joan Kub
- University of Southern California School of Social Work-Department of Nursing
| | - Shawna S. Mudd
- Johns Hopkins University School of Nursing, Medicine and Public Health
| | | | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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Parental Perspectives of Barriers to Physical Activity in Urban Schoolchildren With Asthma. Acad Pediatr 2018; 18:310-316. [PMID: 29309846 PMCID: PMC5889757 DOI: 10.1016/j.acap.2017.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 12/27/2017] [Accepted: 12/29/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Physical activity (PA) levels are low in today's youth and may even be lower in those with asthma. Barriers to PA have not been well studied in inner-city minority children with asthma. We conducted a qualitative study to characterize parental perceptions of barriers to PA and ways to improve PA levels in children with asthma. METHODS We used the socioecologic model to inform development of our interview guide. Questions fell into 2 socioecologic model domains: interpersonal (parent, family) barriers and community (neighborhood, school) barriers. Qualitative semistructured interviews were conducted with 23 parents (21 mothers, 2 fathers) of inner-city children with asthma (aged 8-10 years) from 10 Bronx, New York, elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. Emerging themes were discussed and agreed on by investigators. RESULTS Three themes surrounding interpersonal barriers to PA emerged: 1) parental fear of exercise-induced asthma due to lack of child symptom awareness, 2) nonadherence and refusal to take medications, and 3) challenges with asthma management. Four themes around community barriers to PA emerged: 1) lack of trust in school management of asthma, 2) lack of school PA facilities, 3) unsafe neighborhoods, and 4) financial burden of PA. CONCLUSIONS A complex, multilevel set of barriers to PA exist in children with asthma. Addressing these barriers by involving stakeholders at the family, school, and community levels may improve PA levels in children with asthma.
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Dy T, Lewis EM, Murugan V, Gehlert S, Taylor J, Garbutt J, Bacharier LB, Castro M, Sumino K. Caregiver and pediatric provider perspectives on symptom-based inhaled corticosteroid therapy in asthma. Respir Med 2018; 137:201-205. [PMID: 29605205 DOI: 10.1016/j.rmed.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/24/2018] [Accepted: 03/01/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Guidelines recommend that healthcare providers adjust the dose of inhaled corticosteroids (ICS) in asthma patients based on the degree of symptom severity and control. Symptom-based, intermittent ICS therapy (use of ICS together with short acting bronchodilators- symptom-based adjustment: SBA) has been demonstrated to be comparable to guideline-based management by providers in controlled clinical trials. We sought input from African American caregivers and pediatricians on the acceptability and barriers for this alternative management strategy. METHODS Focus group interviews of caregivers and individual interviews with community providers of African-American children ages 6-17 years with mild-moderate persistent asthma were conducted by trained facilitators to assess perceptions of how asthma affects children and their caregivers, and of SBA as a management strategy. Interview data were transcribed and analyzed using inductive thematic based coding. RESULTS Twenty-six parents participated in six focus groups. Fourteen pediatricians were interviewed. Caregivers reported facing financial burden and difficulty with tracking medications. Caregivers and pediatricians were favorable about SBA, citing its potential for decreased use of medications and cost and similarity to actual care provided. Some caregivers voiced concern that SBA would not be as effective as daily ICS. Caregivers suggested that education on symptom recognition and close communication between physician and patient would facilitate the implementation of SBA. CONCLUSIONS SBA was generally viewed favorably by caregivers and providers of African American children. However, concerns regarding effectiveness of SBA were voiced by both caregivers and providers. Patient education and provider-patient communication is important in implementing this alternative asthma management strategy.
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Affiliation(s)
- Tiffany Dy
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Ericka M Lewis
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Vithya Murugan
- Saint Louis University School of Public Health and Social Justice, Saint Louis, MO, USA
| | - Sarah Gehlert
- University of South Carolina College of Social Work, Columbia, SC, USA
| | - Juanita Taylor
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Jane Garbutt
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Mario Castro
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Kaharu Sumino
- Washington University School of Medicine, Saint Louis, MO, USA.
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31
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Abu-Shaheen A, AlFayyad I, Nofal A, Al-Tannir M, AlMadaney M, Heena H. Perceptions and Practices in Parents of Saudi Children with Asthma: A Cross-Sectional Survey. Cureus 2018; 10:e2213. [PMID: 29686955 PMCID: PMC5910016 DOI: 10.7759/cureus.2213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/21/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To acquire more precise data on perceptions and practices adopted by Saudi parents of asthmatic children regarding asthma and its management. METHODS A cross-sectional study was conducted through 2015 on 292 parents of children (aged 3-15 years) with asthma visiting the outpatient clinics and the emergency departments (ED) of two tertiary care medical centers in Riyadh city, using a self-administered questionnaire. RESULTS Out of 292 parents who participated in this study, 60.2% reported that their children had previously difficulty in sleeping at night due to an asthma attack. The majority (70.4%) of parents was worried about adverse effects of inhaled corticosteroids, and 58.8% of participants were worried about other inhaler adverse effects, whereas 29.0% believed that their child would develop a dependency on asthma medications. Around 82% reported visiting the pediatric emergency department for asthma treatment and 61.2% of participants reported going to the routine physician follow-up visits. Family income was significantly associated with parental concerns about the adverse effects of inhaled medications and corticosteroids as well as drug dependency (p = 0.044, p = 0.033, and p = 0.001, respectively). One hundred and seventy (57%) of the children used inhaled β-agonists while only 39 (13.3%) were using inhaled corticosteroids. CONCLUSIONS Participated parents had misperceptions regarding the use of asthma medications and thus adopted ineffectual practices in its management. Therefore, to enhance asthma care and compliance in children, it is essential to develop different comprehensive parental education programs.
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Affiliation(s)
| | - Isamme AlFayyad
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Nofal
- Disaster Management Unit, King Saud University Medical City
| | | | - May AlMadaney
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Humariya Heena
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Arnold CM, Bixenstine PJ, Cheng TL, Tschudy MM. Concordance among children, caregivers, and clinicians on barriers to controller medication use. J Asthma 2018; 55:1352-1361. [PMID: 29420091 DOI: 10.1080/02770903.2018.1424188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE While much research has addressed asthma medication adherence, few have combined quantitative and qualitative data, and none has addressed the triad of child, caregiver, and clinician simultaneously. This study assessed, with mixed methods, barriers to medication adherence within this triad. METHODS We conducted interviews with publicly-insured children with asthma, their caregivers, and their primary-care clinicians. Children (7-17 years) had been prescribed daily inhaled corticosteroids and visited the ED for asthma (past year). Participants answered open-ended and survey questions, rating suggested barriers to medication use (never vs. ever a barrier). McNemar's tests compared report of barriers by each group (children, caregivers, clinicians), and assessed concordance within triads. RESULTS Fifty child-caregiver dyads participated (34 clinicians). Children (40% female; median age 10 years) had mostly non-Hispanic black (90%) caregivers with less than or equal to high-school education (68%). For barriers, children and clinicians were more likely than caregivers to report medications running out. Clinicians were also more likely to cite controllers being a "pain to take" (vs. children) and forgetfulness (vs. caregivers) (all p < .05). There was a lack of within-triad concordance regarding barriers to adherence, especially regarding medication running out, worrying about taking a daily medication, and medication being a pain to take. Qualitative data revealed themes of competing priorities, home routines, and division of responsibility as prominent contributors to medication adherence. CONCLUSIONS There was significant disagreement among children, caregivers, and clinicians regarding barriers to daily use of asthma medications. To tailor asthma management conversations, clinicians should understand family-specific barriers and child-caregiver disagreements.
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Affiliation(s)
- Carolyn M Arnold
- a Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Paul J Bixenstine
- b Departments of Pediatrics & Internal Medicine , University of California Los Angeles School of Medicine , Los Angeles , CA , USA
| | - Tina L Cheng
- a Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Megan M Tschudy
- a Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Bellin MH, Collins KS, Osteen P, Kub J, Bollinger ME, Newsome A, Lewis-Land C, Butz AM. Characterization of Stress in Low-Income, Inner-City Mothers of Children with Poorly Controlled Asthma. J Urban Health 2017; 94:814-823. [PMID: 28560612 PMCID: PMC5722723 DOI: 10.1007/s11524-017-0162-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The goal of this longitudinal analysis was to characterize factors associated with the experience of life stress in low-income, inner-city mothers of minority children with high-risk asthma.Participants (n = 276) reported on family demographics, child asthma control and healthcare utilization, social support, contemporary life difficulties (housing, finances, violence exposure) measured by the validated Crisis in Family Systems scale, and daily stress. Latent growth curve modeling examined predictors of life stress across 12 months as a function of home and community difficulties, asthma-specific factors, and social support. Mothers were primarily single (73%), unemployed (55%), and living in extreme poverty with most (73%) reporting an annual family income <$20,000 (73%). The children were young (mean age = 5.59, SD = 2.17), African-American (96%), and had poorly controlled asthma (94%) at study enrollment. Higher daily stress was associated with financial difficulties, safety concerns in the home and community, and housing problems. Access to social support was consistently related to reduced stress. The only asthma-specific factor associated with life stress was healthcare utilization, with more emergency services for asthma related to higher daily stress. Findings underscore the clinical significance of assessing diverse home and community stressors and social support in low-income, inner-city caregivers of children with poorly controlled asthma.
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Affiliation(s)
- Melissa H Bellin
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA.
| | - Kathryn S Collins
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA
| | - Philip Osteen
- Florida State University College of Social Work, Tallahassee, USA
| | - Joan Kub
- Department of Nursing, University of Southern California, Los Angeles, USA
| | - Mary Elizabeth Bollinger
- Division of Pediatric Pulmonary and Allergy, University of Maryland School of Medicine, Baltimore, USA
| | - Angelica Newsome
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA
| | - Cassie Lewis-Land
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Arlene M Butz
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Dempster NR, Wildman BG, Masterson TL, Omlor GJ. Understanding Treatment Adherence With the Health Belief Model in Children With Cystic Fibrosis. HEALTH EDUCATION & BEHAVIOR 2017; 45:435-443. [DOI: 10.1177/1090198117736346] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. Children’s health beliefs are significantly related to their adherence; however, pediatric literature has rarely tested health-related theories as a whole. The goal of the present study was to evaluate the use of the health belief model (HBM) in understanding children’s adherence, both globally and to individual treatment components. Method. Thirty-three patient–parent dyads completed questionnaires regarding health beliefs and adherence to medical regimens. Results. Multiple linear regressions found a significant relationship among the HBM variables and reports of global adherence for children and parents. For children, the HBM variables were significantly related to adherence to aerosol medications, aerosol antibiotics, metered dose inhalers, and vitamins. For parents, the HBM variables were significantly related to children’s adherence to airway clearance, oral antibiotics, and vitamins. Paired sample t tests found children and parents had significantly discrepant heath beliefs. Conclusion. These findings provide further support for the HBM in evaluating pediatric adherence, with evidence that barriers and cues to action may be targets for early intervention. Future research using this model to identify a comprehensive way to assess, understand, and elicit change in the adherence to medical regimens for youth with chronic illness would be beneficial.
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Wagner F, Steefel L. Beliefs Regarding Asthma Management Relating to Asthma Action Plans (AAPs) of African American Caregivers Residing in Newark, New Jersey Public Housing Communities. J Pediatr Nurs 2017; 36:92-97. [PMID: 28888517 DOI: 10.1016/j.pedn.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to explore the beliefs regarding asthma management and Asthma Action Plans (AAPs) of African American caregivers residing in three New Jersey public housing communities in Newark, New Jersey. DESIGN A qualitative methods design was accomplished using semi-structured interviews with a purposive sample of nine African American caregivers of children with asthma. Information was coded using N'VIVO™; the textual analysis combined codes into categories, which were then assembled into themes. RESULTS Self-determination was found to be a fundamental goal of asthma management; however, three themes emerged as barriers and facilitators to this goal: challenges in the urban environment, preference of familial methods, and access to medical care. CONCLUSIONS Findings from this study regarding minority caregivers' beliefs regarding difficulty navigating the health care system coupled with insurance instability, leading to use of Emergency Departments, are consistent with past research. Although caregivers expressed belief in use of prescribed medications as indicated on AAPs, familial methods, found to provide a sense of control over asthma, were preferred.
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Affiliation(s)
- Frank Wagner
- Rutgers University School of Nursing, Newark, NJ, USA.
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Bellin MH, Newsome A, Land C, Kub J, Mudd SS, Bollinger ME, Butz AM. Asthma Home Management in the Inner-City: What can the Children Teach us? J Pediatr Health Care 2017; 31:362-371. [PMID: 27955875 PMCID: PMC6407130 DOI: 10.1016/j.pedhc.2016.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Knowledge of asthma home management from the perspective of poor, minority children with asthma is limited. METHOD Convenience sampling methods were used to recruit families of low-income children who are frequently in the emergency department for uncontrolled asthma. Thirteen youths participated in focus groups designed to elicit reflections on asthma home management. Data were analyzed using grounded theory coding techniques. RESULTS Participants (Mean age = 9.2 years) were African American (100%), enrolled in Medicaid (92.3%), averaged 1.4 (standard deviation = 0.7) emergency department visits over the prior 3 months, and resided in homes with at least 1 smoker (61.5%). Two themes reflecting multifaceted challenges to the development proper of self-management emerged in the analysis. DISCUSSION Findings reinforce the need to provide a multipronged approach to improve asthma control in this high-risk population including ongoing child and family education and self-management support, environmental control and housing resources, linkages to smoking cessation programs, and psychosocial support.
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Affiliation(s)
| | | | - Cassie Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Joan Kub
- Johns Hopkins University School of Nursing, Medicine and Public Health
| | - Shawna S. Mudd
- Johns Hopkins University School of Nursing, Medicine and Public Health
| | | | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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Using stakeholder engagement to develop a patient-centered pediatric asthma intervention. J Allergy Clin Immunol 2016; 138:1512-1517. [PMID: 27744029 DOI: 10.1016/j.jaci.2016.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/23/2022]
Abstract
Stakeholder engagement has the potential to develop research interventions that are responsive to patient and provider preferences. This approach contrasts with traditional models of clinical research in which researchers determine the study's design. This article describes the effect of stakeholder engagement on the design of a randomized trial of an intervention designed to improve child asthma outcomes by reducing parental stress. The study team developed and implemented a stakeholder engagement process that provided iterative feedback regarding the study design, patient-centered outcomes, and intervention. Stakeholder engagement incorporated the perspectives of parents of children with asthma; local providers of community-based medical, legal, and social services; and national experts in asthma research methodology and implementation. Through a year-long process of multidimensional stakeholder engagement, the research team successfully refined and implemented a patient-centered study protocol. Key stakeholder contributions included selection of patient-centered outcome measures, refinement of intervention content and format, and language framing the study in a culturally appropriate manner. Stakeholder engagement was a useful framework for developing an intervention that was acceptable and relevant to our target population. This approach might have unique benefits in underserved populations, leading to sustainable improvement in health outcomes and reduced disparities.
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Bellin MH, Land C, Newsome A, Kub J, Mudd SS, Bollinger ME, Butz AM. Caregiver perception of asthma management of children in the context of poverty. J Asthma 2016; 54:162-172. [PMID: 27304455 DOI: 10.1080/02770903.2016.1198375] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Low-income caregivers of young children with high-risk asthma experience social stressors and illness-related demands that may impede effective home asthma management. Knowledge of the caregiving experience in the context of poverty is limited. METHODS Convenience sampling methods were used to recruit low-income caregivers of children aged 7-12 years, who are frequently in the Emergency Room (ED) for uncontrolled asthma. Thirteen caregivers participated in focus groups that were designed to elicit reflections on asthma home and community management from the caregiver perspective. A grounded theory approach was used in the open coding of transcript data from three focus groups, as well as to revise and reorganize emerging themes and sub-themes. RESULTS Participants (Mean age = 33.9 years) were predominantly the biological mother (92.3%), single (84.6%), and impoverished (69.2% reported annual household income ≤ $30,000). Their children (Mean age = 7.8 years) were African-American (100%), enrolled in Medicaid (92.3%), averaged 1.38 (SD = 0.7) ED visits over the prior 3 months, resided in homes with at least one smoker (61.5%), and nearly all (84.6%) experienced activity limitations due to asthma. Five themes emerged in the analysis: intensive caregiving role, complex and shared asthma management responsibility, parental beliefs and structural barriers to guideline-based care, lack of control over environmental triggers, and parent advocacy to improve child asthma care and outcomes. CONCLUSIONS Caregivers managing a child with high-risk asthma in the context of poverty indicate the need for ongoing asthma education, increased sensitivity to the complexity of home asthma management, and family-centered interventions that enhance communication and collaboration between caregivers and providers.
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Affiliation(s)
- Melissa H Bellin
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Cassie Land
- b Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Angelica Newsome
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Joan Kub
- c School of Nursing, Medicine and Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Shawna S Mudd
- c School of Nursing, Medicine and Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Mary Elizabeth Bollinger
- d Division of Pediatric Pulmonary and Allergy, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Arlene M Butz
- b Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Bollmeier SG, Prosser TR. Patient perspectives on fluticasone-vilanterol versus other corticosteroid combination products for the treatment of asthma. Patient Prefer Adherence 2016; 10:825-36. [PMID: 27257375 PMCID: PMC4874727 DOI: 10.2147/ppa.s83946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Fluticasone furoate (FF), an inhaled corticosteroid (ICS), and vilanterol (VI), a long-acting beta2 receptor agonist (LABA), is a new combination used in an Ellipta(®) device. This article compares FF-VI to other ICS-LABA combinations available, particularly emphasizing product selection from the patient perspective. DATA SOURCES A PubMED and EMBASE search completed in October 2015 identified trials using the MeSH terms "fluticasone", "vilanterol", and "asthma". Additional information was gathered from references cited in the identified publications, the manufacturer, package insert, and ClinicalTrials.gov registry. STUDY SELECTION/DATA EXTRACTION Preference was given to randomized controlled clinical trials. Animal trials, trials for COPD, and non-English sources were excluded. DATA SYNTHESIS Seven efficacy trials of FF-VI in asthma were identified. Only one (24 weeks) trial compared FF-VI to another ICS-LABA combination (fluticasone propionate-salmeterol). Primary outcomes (usually lung function) and secondary outcomes (eg, quality of life and symptom scores) were comparable. In three FF-VI safety trials, the type and frequency of common adverse reactions (ie, thrush and dysphonia) were similar to those in clinical trials. Over 90% of subjects rated the Ellipta(®) device as "easy to use" and demonstrated correct device technique initially and at 4 weeks. CONCLUSION Individuals may have drug- and device-specific preferences that should be incorporated into therapeutic decision making. Limited data indicate that clinical and patient-oriented efficacy/safety outcomes of FF-VI are likely comparable to other available combinations for adults with asthma. Patient-friendly features include once-daily dosing, flexibility of dose timing, and design/ease of the use of the device. Additional larger and long-term comparative studies are needed to determine whether these features translate into greater efficacy, safety, patient preference, or adherence versus other ICS-LABA combinations. In the next few years, the availability of less expensive generic ICS-LABA products may strongly influence patient preference.
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Affiliation(s)
- Suzanne G Bollmeier
- St Louis College of Pharmacy, St Louis, MO, USA
- Correspondence: Suzanne G Bollmeier, St Louis College of Pharmacy, 4588 Parkview Place, St Louis, MO 63110, USA, Tel +1 314 446 8525, Fax +1 314 446 8500, Email
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Bignall WJR, Luberto CM, Cornette AF, Haj-Hamed M, Cotton S. Breathing retraining for African-American adolescents with asthma: a pilot study of a school-based randomized controlled trial. J Asthma 2015; 52:889-96. [PMID: 26374696 DOI: 10.3109/02770903.2015.1033724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma affects approximately seven million children/adolescents in the USA, with African-American children disproportionately affected. Breathing retraining techniques have been shown to improve asthma outcomes in adults, though research in youth is limited. The purpose of this pilot study was to test the feasibility and preliminary efficacy of a school-based randomized controlled trial of breathing retraining for asthma outcomes and anxiety symptoms in a sample of urban, African-American adolescents. METHODS Adolescents were randomized into either the intervention group (20-min breathing retraining plus education) or control group (20-min standard education). Participants completed two study visits, one month apart. Asthma control, asthma quality of life and lung functioning (FEV1 and peak flow) were the primary outcomes, and state anxiety (pre-post the intervention) and trait anxiety (over the one-month period) were the secondary outcomes. RESULTS Thirty-three African-American adolescents participated in the study, with a 90% retention rate between visit 1 and visit 2. Asthma control and asthma quality of life, significantly improved over time (p ≤ 0.01) with no differences between intervention and control groups. State anxiety significantly decreased (p ≤ 0.01) immediately post intervention at both time points with no differences between groups. There were no significant differences found in lung functioning or trait anxiety over the one-month time period. CONCLUSIONS These preliminary results suggest that breathing retraining is a feasible, acceptable and potentially efficacious intervention (although no significant differences between groups were found) for improving asthma symptoms in urban adolescents with asthma in a school-based setting.
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Affiliation(s)
| | | | - Adrianne Falkenberg Cornette
- b Division of Integrative Medicine, Department of Family and Community Medicine , University of Cincinnati , Cincinnati , OH , USA
| | - Monzer Haj-Hamed
- b Division of Integrative Medicine, Department of Family and Community Medicine , University of Cincinnati , Cincinnati , OH , USA
| | - Sian Cotton
- b Division of Integrative Medicine, Department of Family and Community Medicine , University of Cincinnati , Cincinnati , OH , USA
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Abstract
Improvement of medication adherence in the school-age child can lead to improvement in quality of life, decreased morbidity, and a potential decreased risk of deferred academic, social, and emotional development. The objective of this article is to review barriers to asthma medication adherence and identify evidence-based techniques that improve medication management of the asthmatic child 5 to 12 years of age. A literature review was performed and articles were obtained through database searches within Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PubMed. Research indicates that barriers to the adherence of medication regimens required for asthmatic children include poor understanding of the medication regimen, substandard education on symptom recognition and environmental triggers, rejection of the diagnosis, and a lack of support or understanding within the community. Researched techniques aimed to improve medication management in 5- to 12-year-olds include: computer-based education; workshops for parents, teachers, and children; incorporation of asthma education into classroom lessons; use of case managers; the introduction of a nurse practitioner in the school to provide care, including medication prescriptions for the asthmatic child; and assessment and evaluation of environmental and emotional triggers in the home and school. Collaboration of current data may help lead to a successful interventional model that can improve asthma management in this population.
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Affiliation(s)
- Mary Friend
- University of Cincinnati, Cincinnati, OH, USA
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Silva CM, Barros L, Simões F. Health-related quality of life in paediatric asthma: Children's and parents' perspectives. PSYCHOL HEALTH MED 2014; 20:940-54. [PMID: 25311376 DOI: 10.1080/13548506.2014.969745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to describe the quality of life of a group of Portuguese children with asthma, to explore the association between health-related quality of life (HRQL), asthma severity, child's characteristics and parental psychopathology. Additionally, the concordance between the children's HRQL self-report and the parents' HRQL proxy was assessed. Fifty children with asthma (7-13 years) and their primary caregiver participated in the study by filling out the DISABKIDS-37 and other self-report questionnaires. Results for the DISABKIDS-37 supported a good internal consistency and associations between the facets and the global score, in the two versions of the questionnaire. Children and their caregivers scored the child's HRQL positively. Parents of children with an asthma diagnosis for a longer period reported better HRQL. The distribution of the HRQL scores in the child's version showed differences across categories of subjective severity rated by children and across categories of asthma control assessed by the physician. The group with uncontrolled asthma obtained lower HRQL scores than the other groups. There was a lack of convergence between self-report and parent's report of HRQL, with the exception of the physical limitation facet. Asthma severity assessed by the child and parental psychopathology explained 28% of the variance in the children's self-rated HRQL. Findings reinforce that children and caregivers' reports are complementary to each other and support the recommendation to use both information sources.
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Affiliation(s)
- Cláudia M Silva
- a Department of Psychology and Education , University of Beira Interior , Covilhã , Portugal
| | - Luísa Barros
- b Faculty of Psychology , University of Lisbon , Lisbon , Portugal
| | - Fátima Simões
- a Department of Psychology and Education , University of Beira Interior , Covilhã , Portugal
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Walker TJ, Reznik M. In-school asthma management and physical activity: children's perspectives. J Asthma 2014; 51:808-13. [PMID: 24796650 DOI: 10.3109/02770903.2014.920875] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Regular physical activity (PA) is an important component of pediatric asthma management. No studies have examined how in-school asthma management influences PA from children's perspectives. The aim of this study was to explore children's perceptions of the impact of in-school asthma management on PA. METHODS Qualitative interviews with 23 inner-city minority children with asthma (aged 8-10 yrs; 12 girls, 11 boys) were conducted in 10 Bronx, New York elementary schools. Sampling continued until saturation was reached. Interviews were recorded, transcribed and independently coded for common themes. RESULTS Interviews produced five themes representing students' perceptions about (1) asthma symptoms during in-school PA; (2) methods to control asthma episodes during school PA; (3) methods to prevent asthma episodes during school; (4) limited accessibility of asthma medications; and (5) negative feelings about asthma and medication use. The majority of students experienced asthma symptoms while performing PA during school. Primary methods of managing asthma symptoms were sitting out during activity, drinking water, and visiting the nurse. Students lacked awareness or adherence to action plans to prevent or control asthma. Students reported limited access to medication during school and feelings of embarrassment and/or concerns of teasing when medicating in front of others. CONCLUSIONS Our results indicate inappropriate in-school management of asthma symptoms, poor asthma control, lack of accessible medication, and stigma around publicly using asthma medication. Thus, students often missed or were withheld from PA. Interventions to improve in-school asthma care must consider ways to address these issues.
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Affiliation(s)
- Timothy J Walker
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine , Bronx, New York , USA
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Shani Z, Scott RG, Schofield LS, Johnson JH, Williams ER, Hampton J, Ramprasad V. Effect of a home intervention program on pediatric asthma in an environmental justice community. Health Promot Pract 2014; 16:291-8. [PMID: 24733733 DOI: 10.1177/1524839914529593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Asthma prevalence rates are at an all-time high in the United States with over 25 million persons diagnosed with asthma. African Americans and other minorities have higher asthma prevalence and higher exposure to environmental factors that worsen asthma as compared to Caucasians. This article describes the evaluation of an inner-city home-based asthma education and environmental remediation program that addressed both indoor and outdoor triggers through collaboration between a health system and local environmental justice organization. The program enrolled 132 children older than 2.5 years and centers on a 4- to 6-week intervention with peer counselors using the U.S. Environmental Protection Agency Asthma Home Environment Checklist and the You Can Control Asthma curriculum. Families receive asthma-friendly environmental home kits. Peer counselors reinforce key asthma management messages and facilitate the completion of Asthma Action Plans. The environmental justice community partner organized block cleanups to reduce outdoor triggers. The evaluation used a pretest-posttest design to assess changes in client behavior and asthma symptoms. Data were collected at baseline and during a 6-month postintervention period. Participants saw enhanced conditions on asthma severity and control. The improvement was greatest for children whose asthma was considered "severe" based on the validated Asthma Control Test. Other positive results include the following: greater completion of Asthma Action Plans, significant reduction in the number of emergency room visits (p = .006), and substantial decreases in school absenteeism (p = .008) and use of rescue medications (p = .049). The evaluation suggests that the program was effective in improving asthma self-management in a high-risk population living within an environmental justice community.
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Jan RH, Sophie Lee HT, Cheng SC. Parents' views of self-management for children with moderate to severe persistent asthma. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2013.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Buu MC, Carter L, Bruce JS, Baca EA, Greenberg B, Chamberlain LJ. Asthma, tobacco smoke and the indoor environment: a qualitative study of sheltered homeless families. J Asthma 2014; 51:142-8. [PMID: 24147583 DOI: 10.3109/02770903.2013.857682] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma is common in homeless children with an incidence of 28-40%. There are few published studies investigating asthma in homeless children. This study examines the perspectives of both caregivers and shelter staff regarding challenges and opportunities of caring for children with asthma. METHODS A focus group of sheltered parents (n = 10) with children who have asthma was conducted to identify barriers to optimal asthma management. Key informant interviews (n = 6) were conducted with shelter staff to discuss the shelter systems and policies to address childhood asthma. Data were audio-recorded and transcribed. A representative analysis team performed qualitative theme analysis. RESULTS Key themes across 5 domains were identified: asthma education, access to asthma medication and equipment, asthma action plans, structural barriers to asthma management and environmental triggers. Parents identified multiple asthma triggers present in the shelter environment but cited lack of control as a barrier to remediation. Shelter staff desired elimination of asthma triggers but refer to the lack of resources as the primary barrier. Shelter staff favored a smoking ban on shelter property but named challenges to policy implementation. Both parents and staff identified asthma education and increased access to medications would be helpful. CONCLUSIONS Policies to reduce environmental exposures, such as a smoking ban, to asthma triggers has the potential to improve the health of sheltered children with asthma.
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Affiliation(s)
- MyMy C Buu
- Department of Pediatrics, Division of Pediatric Pulmonary
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Liberatos P, Leone J, Craig AM, Frei EM, Fuentes N, Harris IM. Challenges of asthma management for school nurses in districts with high asthma hospitalization rates. THE JOURNAL OF SCHOOL HEALTH 2013; 83:867-875. [PMID: 24261521 DOI: 10.1111/josh.12105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 12/21/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND School nurses play a central role in assisting elementary school children in managing their asthma, especially those in higher-risk school districts that are at increased risk of uncontrolled asthma. Study purposes are to (1) identify barriers to asthma management by school nurses in higher-risk school districts; and (2) assess the extent to which National Asthma Education and Prevention Program (NAEPP) recommendations are followed in these districts. METHODS School districts containing at least one zipcode with high asthma hospitalization rates among children (0-14 years) in a New York State county were identified. Nurses in 44 elementary schools were surveyed about asthma management during 2008. Both quantitative and qualitative data were collected. RESULTS Study nurses learned of children with asthma mainly through school records and when students presented with symptoms rather than through parents. The major obstacles to asthma management were communication with parents and parental support. Reluctance of some physicians to diagnose asthma in these children presented a barrier and contributed to the nurses' ability to gain parental cooperation. Adherence to the NAEPP school recommendations was inconsistent. CONCLUSIONS Improvement in the communication among parents, school nurses, and providers is critical to the improvement of asthma management for children in high-risk school districts.
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Affiliation(s)
- Penny Liberatos
- Assistant Professor, , Department of Epidemiology & Community Health, New York Medical College, School of Health Sciences & Practice, Valhalla, NY 10595
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Coutinho MT, McQuaid EL, Koinis-Mitchell D. Contextual and cultural risks and their association with family asthma management in urban children. J Child Health Care 2013; 17:138-52. [PMID: 23455872 DOI: 10.1177/1367493512456109] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines the association between caregivers' perceptions of home and neighborhood safety on family asthma management in the context of cultural risk factors (e.g., discrimination and acculturative stress) in a sample of urban and ethnic minority families. Participants included 147 children (ages 6-13) and their primary caregiver from Latino, African American and Non-Latino White (NLW) backgrounds. When controlling for poverty, caregivers' perceptions of home and neighborhood safety predicted family asthma management for the overall sample and for the NLW families. Additionally, for caregivers who endorsed higher levels of perceived discrimination, home and neighborhood safety predicted family asthma management. This study demonstrates the utility of considering caregivers' perceptions of home and neighborhood safety when examining urban families' day-to-day engagement with asthma management tasks.
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Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil 2013; 36:276-88. [PMID: 23614359 PMCID: PMC3934376 DOI: 10.3109/09638288.2013.785605] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 02/08/2013] [Accepted: 03/11/2013] [Indexed: 11/13/2022]
Abstract
PURPOSE Evidence shows that effective self-management behaviors have the potential to improve health outcomes, quality of life, self-efficacy and reduce morbidity, emergency visits and costs of care. A better understanding of self-management interventions (i.e. programs that help with managing symptoms, treatment, physical and psychological consequences) is needed to achieve a positive impact on health because most children with a disability now live well into adulthood. METHOD A systematic review of self-management interventions for school age youth with physical disabilities was undertaken to assess their effectiveness. Comprehensive electronic searches using international web-based reference libraries were conducted for peer-reviewed and gray literature published between 1980 and January 2012. Eligible studies examined the effectiveness of self-management interventions for children and youth between 6 and 18 years of age with congenital or acquired physical disabilities. Studies needed to include a comparison group (e.g. single group pre/post-test design) and at least one quantifiable health-related outcome. RESULTS Of the 2184 studies identified, six met the inclusion criteria; two involved youth with spina bifida and four with juvenile arthritis. The majority of the interventions ran several sessions for at least 3 months by a trained interventionist or clinician, had one-to-one sessions and meetings, homework activities and parental involvement. Although outcomes varied between the studies, all of the interventions reported at least one significant improvement in either overall self-management skills or a specific health behavior. CONCLUSIONS While self-management interventions have the potential to improve health behaviors, there were relatively few rigorously designed studies identified. More studies are needed to document the outcomes of self-management interventions, especially their most effective characteristics for children and youth with physical disabilities. Implications for Rehabilitation There is some evidence to suggest that self-management interventions for children and youth with spina bifida and arthritis can improve self-management behaviors and health outcomes. Parents' involvement should be considered in encouraging self-management behaviors at different stages of their child's development. Much work is needed to explore the longer term implications of self-management interventions for youth with physical disabilities as well as the impact on health care utilization.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation HospitalToronto, ONCanada
- Department of Occupational Science and Occupational Therapy, Graduate Department of Rehabilitation Sciences, University of TorontoToronto, ONCanada
| | | | - Carolyn Mcdougall
- Department of Occupational Science and Occupational Therapy, Graduate Department of Rehabilitation Sciences, University of TorontoToronto, ONCanada
- Centre for Participation and Inclusion, Holland Bloorview Kids Rehabilitation HospitalONCanada
| | - Heather Keating
- Centre for Participation and Inclusion, Holland Bloorview Kids Rehabilitation HospitalONCanada
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Abstract
The purpose of this study was to describe the demographic characteristics of low-income parents who perceive financial burden in managing their child's asthma and related associations with their children's asthma outcomes and clinical characteristics. We hypothesized that (1) identifiable differences between parents who do and do not report burden; (2) regardless of access to care, asthma outcomes would be worse for children whose parents perceive financial burden in obtaining care for their child's condition. Baseline data from a randomized trial evaluating the effect of a school-based asthma intervention were analyzed for this research. Eight hundred thirty-five parents were interviewed by telephone regarding their child's asthma management. Associations between demographic and clinical factors and perception of financial burden were examined using bivariate analysis. Multivariate regression analyses were used to examine associations between perceptions of financial burden and asthma outcomes, including emergency department visits, hospitalizations, and missed school days. Perceived financial burden was evident in 10% (n = 79) of parents. Female heads of household (χ2 (3) = 7.41; p < 0.05), those at the lowest income levels (χ2 (3) = 12.14; p < 0.01), and those whose child's asthma was poorly controlled (χ2 (2) = 49.42; p < 0.001) were most likely to perceive financial burden. In models controlling for level of asthma control, income, and having a usual source of asthma care, parents who perceived financial burden were more likely to have children who had at least one emergency department visit (OR = 1.95; 95% CI = 1.15 to 3.29), hospitalization (OR = 3.99; 95% CI = 2.03 to 7.82), or missed school days due to asthma (OR = 3.26; 95% CI = 1.60 to 6.67) in the previous year. Our results supported our hypotheses. Among low-income parents of children with asthma, the majority do not perceive financial burden to obtaining care. However, among parents that do perceive burden, urgent care use and missed school days due to asthma for their child were significantly higher, regardless of family income and having a usual source of asthma care. Mothers and grandmothers heading families and those caring for children with uncontrolled asthma were most likely to report burden. These findings have implications for clinical practice in that health care providers may be able to take simple actions to determine patients' financial-related perceptions, correct misconceptions, and help patients consider their full range of options to manage their child's asthma.
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Affiliation(s)
- Minal R Patel
- Center for Managing Chronic Disease, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
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