Participant Perspectives on the Implementation of a School-Linked Text-Message Intervention to Improve Pediatric Asthma Medication Adherence

Background: Poor adherence to inhaled corticosteroids (ICS) is a significant challenge in pediatric asthma, contributing to health inequities. Text-message reminders for ICS therapy are an evidence-based approach that improves pediatric asthma medication adherence, yet has not been widely adopted into practice, partly due to lack of (1) participant input on design and implementation and (2) use of sustainable community linkages. Remote Asthma Link™ (RAL) seeks to fill this gap as a school-linked text-message intervention wherein parents of children with poorly controlled asthma received daily, 2-way text-message reminders for preventive inhaler use. Responses were shared with school nurses who conducted remote check-ins with families. Enrolled children, largely from underserved backgrounds, experienced improvements in medication adherence and asthma health outcomes. While initial results were promising, we have yet to elicit participant input to refine the protocol for more widespread implementation. Objective: Examine participant perspectives on barriers and facilitators of RAL implementation. Methods: Semistructured interviews were conducted May-June 2022 with intervention participants: 10 parents, 7 school nurses, and 4 pediatric providers (n = 21) until thematic saturation was reached. Interview transcripts were coded using thematic analysis. Results: Several facilitators for RAL implementation were identified, including ease of use and accessibility, personal connection to the school nurse, and receipt of a visual notification for habit formation. Barriers included challenges with school nurses reaching parents, poor understanding of program expectations, and lack of reimbursement structure. Participant-proposed solutions to barriers included utilizing alternate communication methods (eg, social media), educational sessions, and meeting with payors to consider reimbursement models. Conclusion: RAL is a school-linked text-message intervention demonstrating promise in improving outcomes and equity in asthma care. Key implementation facilitators, barriers, and proposed solutions will inform protocol adaptations to promote successful implementation of this and other text-message interventions into clinical practice.

School-supervised Asthma Therapy is Associated with Improved Long-Term Asthma Outcomes for Underrepresented Minority Children

Asthma morbidity disproportionately impacts children from low-income and racial/ethnic minority communities. School-supervised asthma therapy improves asthma outcomes for up to 15 months for underrepresented minority children, but little is known about whether these benefits are sustained over time. We examined the frequency of emergency department (ED) visits and hospital admissions for 83 children enrolled in Asthma Link, a school nurse-supervised asthma therapy program serving predominantly underrepresented minority children. We compared outcomes between the year preceding enrollment and years one-four post-enrollment. Compared with the year prior to enrollment, asthma-related ED visits decreased by 67.9% at one year, 59.5% at two years, 70.2% at three years, and 50% at four years post-enrollment (all p-values< 0.005). There were also significant declines in mean numbers of total ED visits, asthma-related hospital admissions, and total hospital admissions. Our results indicate that school nurse-supervised asthma therapy could potentially mitigate racial/ethnic and socioeconomic inequities in childhood asthma.

Effects of diet and exercise on the density and composition of the fat-free mass in obese women

PURPOSE

The purpose of this study was to determine whether the density (D(FFM)) and composition of the fat-free mass (FFM) and the accuracy of estimates of body composition from body density (%Fat(d)) are affected by diet and exercise.

METHODS

Twenty-nine obese women (body mass index (BMI) = 25.0-43.7 kg x m(-2) and %Fat(d) = 35.7-47.1%) were assigned to one of three groups: diet only (DO, N = 9); diet and aerobic exercise (DE, N = 9); or control (C, N = 11). Measures of body density by hydrostatic weighing, body water by deuterium dilution, and bone mineral by whole-body dual-energy x-ray absorptiometry, and estimates of body composition from body density and from a four-component model were obtained before and after a 16-wk diet and exercise intervention.

RESULTS

Mean (+/- SD) changes in body mass were -7.2 +/- 7.4, -3.9 +/- 3.3, and +1.2 +/- 2.8 kg for the DO, DE, and C, respectively. The density and composition of the FFM did not change significantly (P > 0.05) in any of the groups. Individual changes in D(FFM) (-0.011 to +0.011 g x mL(-1)), and differences between changes in %Fat estimated using a four-component model and %Fat(d) (-2.1 to +2.7% body mass) were not related to changes in body mass (r = -0.08). Individual changes in D(FFM) were most strongly related to changes in water fraction (r = -0.95) and protein fraction (r = +0.88), and were unrelated to changes in the mineral fraction (r = +0.04) of the FFM.

CONCLUSIONS

We conclude that in obese women, the density and composition of the FFM are unaltered and densitometry correctly assesses group mean changes in body composition with moderate weight loss induced by diet or diet and aerobic exercise. However, individual deviations in D(FFM) from the assumed value of 1.1 g x mL(-1) are substantial, and a multi-component model in which body water is measured is needed to accurately assess individual body composition changes resulting from diet and exercise.

Body-composition changes with diet and exercise in obese women: a comparison of estimates from clinical methods and a 4-component model

BACKGROUND

Most methods available to clinicians for estimating body-composition changes have been validated against estimates from densitometry, based on a 2-component (fat mass and fat-free mass) model.

OBJECTIVE

Estimates of changes in percentage body fat (%BF) from dual-energy X-ray absorptiometry (DXA), skinfold thicknesses (SFTs), bioelectrical impedance analysis (BIA), and body mass index (BMI; in kg/m2) were compared with estimates from a 4-component (fat, water, mineral, and protein) model (%BFd,w,m), a more accurate method.

DESIGN

Determinations of body density from hydrostatic weighing, body water from deuterium dilution, bone mineral and %BF from whole-body DXA, resistance from BIA, and anthropometric measures were made in 27 obese women (BMI: 31.1 +/- 4.9) assigned to 1 of 3 groups: control (C; n = 9), diet only (DO; n = 9), or diet plus aerobic exercise (DE; n = 9).

RESULTS

After the 16-wk intervention, changes in body mass (BM) averaged 0.5 +/- 2.0, -7.2 +/- 7.4, and -4.0 +/- 3.3 kg and changes in %BFd,w,m averaged 2.1 +/- 1.0%, -1.2 +/- 1.4%, and -2.4 +/- 1.6% in the C, DO, and DE groups, respectively. Compared with changes in %BFd,w,m, the errors (SD of bias) for estimates of changes in %BF by DXA, BIA, SFTs, and BMI were similar (range: +/-2.0-2.4% of BM). BIA, SFTs, and BMI provided unbiased estimates of decreases in %BFd,w,m, but DXA overestimated decreases in %BF in the DO and DE groups.

CONCLUSIONS

DXA, BIA, SFTs, and BMI are comparably accurate for evaluating body-composition changes induced by diet and exercise interventions; however, small changes in %BF may not be accurately detected by these clinical methods.