Adolescents' practical knowledge of asthma self-management and experiences in the context of acute asthma: a qualitative content analysis

OBJECTIVE

To characterize adolescents' practical knowledge of asthma self-management and experiences during acute asthma episodes, and compare practical knowledge between minority and non-minority groups.

METHODS

We conducted a secondary analysis using a qualitative descriptive design of textual data collected from 126 adolescents that participated in a randomized controlled trial of an asthma self-management program. Directed content analysis was conducted using four constructs of asthma self-management including symptom prevention, symptom monitoring, acute symptom management, and symptom communication.

RESULTS

Most of the adolescents knew how to prevent exercised-induced bronchoconstriction, but had limited understanding about how to assess and monitor the severity of acute symptoms, appropriately use bronchodilators, seek timely medical help, and communicate acute symptoms to caregivers or healthcare providers during a slow-onset and rapid-onset asthma attack. More minority participants monitored asthma using peak expiratory flow than non-minority participants, who often relied on symptom-based monitoring. Minority adolescents more frequently mentioned bronchodilator use to manage asthma attacks, while non-minority adolescents often reported use of complementary and alternative approaches. Minority youth mentioned accessing healthcare services for acute episodes more often than their non-minority counterparts. Minority participants mentioned communicating acute symptoms to their providers, or family members less frequently than non-minority youth.

CONCLUSIONS

Adolescents have insufficient practical knowledge about ways to prevent and manage acute asthma. Periodic assessment of learning needs related to asthma attacks should be considered a routine part of clinical visits for adolescents to provide targeted information support to address their identified needs.

Implementation of standardized asthma management programs in outpatient settings

PURPOSE OF REVIEW

This article reviews new approaches, facilitators, barriers, and opportunities to increasing adoption of standardized asthma management programs in the outpatient care setting.

RECENT FINDINGS

Primary care clinicians providing asthma care in the outpatient setting are challenged by the complexity of guidelines and want standardization of tools that are easy to use and that can be integrated within their practice's workflow. Programs that integrate clinical decision support tools within a practice's electronic health record and provide support from specialists may enhance uptake of asthma management programs in the outpatient setting and reduce asthma morbidity. Lack of an implementation science framework, consideration for organizational context, and clinician buy-in are recently recognized barriers to adoption of asthma programs and improved asthma outcomes. In addition, many of these interventions are labor intensive, costly, and may not be capable of wide dissemination because of the EHR interoperability problem.

CONCLUSION

Programs that simplify the guidelines, integrate clinical decision support within the EHR, and ground their approach with an implementation science framework may improve the quality of asthma care provided in the outpatient setting.

Psychometric properties and predictive validity of the PP-ACT

OBJECTIVE

The Parent Proxy Asthma Control Test (PP-ACT) is a self-report measure of asthma control completed by caregivers on behalf of a child. We examined the psychometric properties and the reliability and predictive validity of the PP-ACT.

METHODS

We conducted two studies (one cross-sectional, one longitudinal over three months) that surveyed caregivers (N = 1622) of children with asthma. Caregivers completed the PP-ACT and a variety of other measures, including child health outcomes.

RESULTS

We found clear evidence that the five-item PP-ACT assesses two distinct constructs: Items 1-4 (which we call the PP-ACT4) assess symptoms, impairment, and use of a short acting beta-2 blocker (albuterol); Item 5 assesses caregivers' global subjective assessment of their child's asthma control. In addition, the two constructs function as unique predictors of asthma outcomes. Both the PP-ACT4 and Item 5 predicted unique variance in ED visits, the number of symptom-free days, and child quality of life. Only the PP-ACT4 predicted frequency of ICS use and only at Time 1 in Study 1. Conversely, Item 5 predicted exacerbation frequency whereas the PP-ACT4 did not.

CONCLUSION

Our findings suggest that researchers and clinicians should treat the PP-ACT4 and Item 5 as distinct indicators of asthma control because they differentially predict asthma outcomes and likely have distinct meanings to caregivers.

Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2022.2036755 .

Examining commonsense epidemiology: The case of asthma

Commonsense epidemiology-how lay people think about diseases and their causes and consequences-can influence how people respond. We examined three lay epidemiological beliefs about 20 triggers and 19 symptoms among 349 caregivers of children with asthma. Our findings contradicted the prevalence-seriousness hypothesis (perceived prevalence and seriousness correlate negatively). The data partially supported the prevalence-control hypothesis (perceived prevalence and asthma control correlate negatively). We found weak support for the seriousness-control hypothesis (perceived seriousness and asthma control correlate negatively). These findings suggest boundary conditions on the application of commonsense epidemiological beliefs.

Sleep and asthma management in youth with poorly-controlled asthma and their caregivers: a qualitative approach

OBJECTIVE

Youth with poorly-controlled asthma are at increased risk for sleep disturbances caused by nocturnal symptoms like coughing. Asthma-related sleep disturbances can have downstream consequences for youth with asthma and their families. This study aims to describe (1) sleep disturbances in adolescents with poorly-controlled asthma and their caregivers and (2) the relationship between sleep and asthma management.

METHODS

Adolescents with poorly-controlled asthma and their caregivers completed the Family Asthma Management System Scale (FAMSS), a semi-structured interview that assesses youth asthma management within the family context. Interviews were audio-recorded and transcribed. Two authors coded each transcript for sleep-related data in NVivo using descriptive content analysis.

RESULTS

Thirty-three adolescents ages 12-15 years old (M = 13.2, SD = 1.2) with poorly-controlled asthma and their caregivers participated in this study. Four main themes emerged: sleep difficulties, sleep environment, sleep and self-management, and fatigue and self-management. 42% of youth and caregivers reported worse nocturnal asthma symptoms (e.g. coughing) that caused frequent nighttime awakening. Approximately 27% of caregivers expressed distress over their child's nocturnal asthma and described their management strategies (e.g. co-sleeping, nighttime symptom monitoring). Adolescents described sleepiness as a barrier to asthma self-management tasks (e.g. medication adherence, response to exacerbation).

CONCLUSION

Interview responses demonstrated the considerable interrelationship of sleep and asthma management in adolescents with poorly-controlled asthma. Asthma providers should consider discussing sleep difficulties with their adolescent patients and their families. Addressing these difficulties may help adolescents improve their asthma self-management and help caregivers better cope with their child's disease.

Meta-Analysis of Adherence Promotion Interventions in Pediatric Asthma

BACKGROUND

Youth with asthma commonly have suboptimal adherence to inhaled corticosteroids (ICS). It is critical to systematically evaluate the effectiveness of ICS adherence promotion interventions and discern which techniques are most effective.

OBJECTIVE

This study aims to (1) quantify the extent to which interventions improve ICS adherence in pediatric asthma, (2) explore differences in effect size estimates based on intervention and study characteristics, and (3) characterize the risk of bias across interventions.

METHODS

We conducted literature searches across five databases. Included studies quantitatively measured ICS adherence as an intervention outcome among youth (<18 years old) diagnosed with asthma and were published after 1997. We analyzed aggregate effect sizes and moderator variables using random-effects models and characterized risk of bias using the Cochrane Collaboration tool.

RESULTS

Thirty-three unique studies met inclusion criteria. At post-intervention, the aggregate effect size for pediatric ICS adherence promotion interventions was small but significant (n = 33, g = 0.39, 95% confidence interval [CI] = 0.24-0.54); however, the aggregate effect size at follow-up was not statistically significant (n = 6, g = 0.38, 95% CI = -0.08 to 0.83). Method of adherence measurement and intervention format were significant moderators. Most interventions had a high risk of performance bias and an unclear risk of bias in one or more domains.

CONCLUSIONS

ICS adherence promotion interventions are effective among youth with asthma. Additional longitudinal research is needed to quantify a more precise measure of intervention effectiveness over time, and moderators of intervention effectiveness should be reassessed as the literature base expands.

Qualitative Interviews to Determine Preferences of mHealth Early Childhood Feeding Guidance for Mothers and Fathers by Income Status

Objectives

Responsive feeding of young children is associated with optimal nutrient intake and long-term regulation of child weight, and is a critical target of interventions aiming to prevent early childhood obesity. The objective of this qualitative study was to explore differences in parents’ preferred content and features (e.g., Goal setting) in an mHealth app (BabyByte) designed to support responsive feeding, based on sex (mothers vs. fathers) and income status (low-income vs. non-low income).

Methods

Parents were interviewed individually by a trained researcher using a semi-structured script based on the Technology Acceptance Model (perceived usefulness, attitude & subjective norm), and the app prototype's content and features. Interviews were audio-recorded, transcribed verbatim, and coded by two researchers using an inductive thematic analysis approach. Qualitative cross-tab analysis was used to compare responses by sex and income status.

Results

Parents (n = 20 fathers, n = 20 mothers) were, on average, 33 years old, non-white (52%), with a Bachelor's degree or higher (63%). Fathers’ attitudes and subjective norms indicated that they were most interested in content related to first foods, choking hazards, and nutrition information, while mothers preferred content on breastfeeding, picky eating, and portion sizes. Fathers perceived features such as “Goals” and “Tracking Progress,” as most useful while mothers favored “Parent Connection.” When comparing parents’ attitudes and subjective norms by income status, low-income parents were interested in content related to nutrition guidelines, breastfeeding, and introducing solids. Non-low income parents preferred information related to food allergies, portion sizes, and picky eating. Low-income parents perceived features “Ask the Expert” and “Parent Connection,” as most useful while non-low income parents favored “Eating Milestones.”

Conclusions

Fathers and mothers have somewhat different preferences as it relates to the content and features of a child feeding app and these preferences also sometimes vary by income status. Thus, personalization based on gender and income level should be considered when developing mHealth tools to disseminate early childhood feeding information to parents.

Funding Sources

University of Florida CTSI.

Babybyte: Usability Testing of a mHealth App Prototype to Improve Responsive Feeding Practices in Parents of Infants and Toddlers

Objectives

With the recent addition of nutrition guidance for children under the age of 2 years to the 2020 Dietary Guidelines, new strategies are needed to communicate reputable feeding information to parents of infants and toddlers for optimal nutrition and prevention of early childhood obesity. The objective of this study was to determine usability of a mHealth app prototype (BabyByte) containing early childhood feeding guidance based on recommended responsive feeding practices for parents of children ages 0 to 2 years old.

Methods

Parents participated in one-on-one cognitive interviews about the basic use and navigation of BabyByte and were probed to locate specific sections within the app, read the information on each page, and complete interactive tasks. Interviews were conducted by a trained research assistant and recorded via Zoom software. Each participant also completed the mHealth App Usability Questionnaire (MAUQ) to rate overall usability, ease of use, interface satisfaction, and usefulness based on a 7-point Likert Scale. Mean MAUQ scores were calculated, with higher scores indicating higher usability of the app. Interview audio files were transcribed verbatim and response themes were aggregated using a content analysis approach.

Results

Parents (n = 20) were, on average, 30.7 years old with the majority self-reporting as white (95%), Hispanic (55%), having a bachelor's degree or higher (65%), working full-time (55%), and currently married (80%). On average, parents agreed or strongly agreed (6.5 ± 0.7 out of 7) that the app had high usability based on the MAUQ results. Ease of use (6.64 ± 0.6), interface and satisfaction (6.4 ± 0.9), and usefulness (6.3 ± 1.0) of the app received high ratings. Interview responses indicated that parents found the app prototype to be user-friendly and intuitive. Suggestions included minor changes in delivery, layout, and addition of supplemental and interactive content thus demonstrating the fit of the mHealth app with parent needs and preferences.

Conclusions

Parents of children ages 0 to 2 years old favorably rated the usability of BabyByte. With further revisions and expansion, BabyByte may be a feasible intervention tool to improve responsive practices by parents and prevent early childhood obesity.

Funding Sources

University of Florida CTSI

BabyByte: Formative Research to Inform the Development of an App to Improve Responsive Feeding Practices in Parents of Infants and Toddlers

Objectives

Responsive feeding is associated with reduced risk of early childhood obesity. The objective of this qualitative study was to determine parents’ preferred content and features for a mHealth app designed to improve responsive feeding practices.

Methods

Parents of 0–2 year old children completed individual semi-structured interviews with a trained researcher. Interview questions were informed by the Technology Acceptance Model and parents provided feedback on preferred app content and features. An app prototype, BabyByte, was developed using the Marvel platform to discuss potential app features during the interview. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded by two researchers using a thematic analysis approach and major themes were summarized.

Results

Parents (n = 40) were, on average, 33.2 years old with the majority self-reporting as non-Hispanic white (53%), a bachelor's degree or higher education (62%), and low-income (53%). Half of the participants were fathers. Overall, the majority (85%) of parents indicated that they would be likely or very likely to use BabyByte. Themes revealed that parents were most interested in topics related to introducing new foods, feeding tips, example meals, recipes, and food allergy guidance. Features including personalized profile set-up, video content, goal setting, milestone tracking, ask an expert, discussion forum, and an app search box were noted as most important or helpful by parents. Convenient access, up-to-date content from a reputable and identifiable source, and incentives for completing modules were indicated as important benefits.

Conclusions

Findings of this study are important considerations for the development of future mHealth tools for parents of infants and toddlers to improve responsive feeding practices and prevent early childhood obesity. Usability testing of BabyByte is currently in progress.

Funding Sources

University of Florida CTSI.

Randomized Pilot Study: A Mobile Technology-based Self-management Intervention for Sickle Cell Pain

Little is known about the effects of self-managed relaxation interventions on pain, stress, and autonomic responses in patients with sickle cell disease (SCD). This pre-post randomized controlled pilot study was conducted to determine the feasibility of using computer tablets for relaxation intervention delivery; acceptability of study procedures; and intervention effects on pain, stress, and indicators of relaxation. The 30 research participants ranged in age from 22 years to 59 years. All were African American; 53% were male. They were randomized to an experimental group that watched a relaxation video or a control group that discussed their disease. All participants completed the study, indicating feasibility. Acceptability rates were also high. Data were obtained for the intervention's immediate effect on pain, stress, respiration, pulse, finger skin temperature, and self-reported relaxation. These preliminary findings will guide future, higher-powered studies to determine the intervention's efficacy and mechanism in SCD.The ClinicalTrials.gov Identifier: NCT02729363.

Protocol for the Development of a Behavioral Family Lifestyle Intervention Supported by Mobile Health to Improve Weight Self-Management in Children With Asthma and Obesity

BACKGROUND

Asthma is the most common chronic childhood illness and is a leading cause of emergency department visits in the United States. Obesity increases the risk of poor health outcomes, reduced quality of life, and increased health care expenditures among youth with asthma. Weight loss is crucial for improving asthma outcomes in children with obesity. Our study team developed the Childhood Health and Asthma Management Program (CHAMP), a 16-session behavioral family lifestyle intervention (BFI) for school-age children with asthma and obesity and evaluated CHAMP in a randomized controlled trial compared with attention control. There were medium effect sizes favoring CHAMP for changes in body mass index z-scores, asthma control, and lung function among completers (ie, those who attended ≥9 of 16 sessions). Despite high rates of satisfaction reported by families, attendance and trial attrition were suboptimal, which raised concerns regarding the feasibility of CHAMP. Qualitative feedback from participants indicated 3 areas for refinement: (1) a less burdensome intervention modality, (2) a more individually tailored intervention experience, and (3) that interventionists can better answer health-related questions.

OBJECTIVE

We propose to improve upon our pilot intervention by developing the Mobile Childhood Health and Asthma Management Program (mCHAMP), a nurse-delivered BFI, delivered to individual families, and supported by a mobile health (mHealth) app. This study aims to (1) identify structural components of mCHAMP and (2) develop and test the usability of our mCHAMP app.

METHODS

Participants will be recruited from an outpatient pediatric pulmonary clinic. We will identify the structural components of mCHAMP by conducting a needs assessment with parents of children with asthma and obesity. Subsequently, we will develop and test our mCHAMP app using an iterative process that includes usability testing with target users and pediatric nurses.

RESULTS

This study was funded in 2018; 13 parents of children with asthma and obesity participated in the needs assessment. Preliminary themes from focus groups and individual meetings included barriers to engaging in health-promoting behaviors, perceived relationships between asthma and obesity, facilitators to behavior change, and intervention preferences. Participatory design sessions and usability testing are expected to conclude in late 2019.

CONCLUSIONS

Outcomes from this study are expected to include an mHealth app designed with direct participation from the target audience and usability data from stakeholders as well as potential end users.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13549.

Surgeon eye lens dose monitoring in catheterization lab: A multi-center survey: Invited for ECMP 2018 Focus Issue

PURPOSE

To perform a multi-centre survey on the eye lens equivalent dose absorbed by primary interventionalist during catheterization procedures, using a personal dosimeter placed close to the eye lens.

METHODS

15 different cardiologists working in 3 different centers, for a total of 5 operating rooms were enrolled. All of them were provided with a single thermoluminescent dosimeter positioned on the inner side of the temples of eyeglasses. The dose monitoring, performed on a two-months basis, started in 2016 and is still running. All dose measurements were performed by a ISO 17025 standard accredited dosimetry service thus providing certified uncertainties as well. Correlation of eye lens and wrist dose with KAP was also investigated.

RESULTS

A total number of 101 eye lens measurements were performed. Annual eye lens dose estimation was obtained for all 15 surgeons (mean, mode, range, standard deviation: 10.8, 8, 4.9-27.3, 5.6  mSv, respectively). Uncertainties on annual eye lens dose estimations ranged between 10% and 20%. No significant correlation was found between eye lens dose and KAP.

CONCLUSIONS

Cardiologists involved in catheterization procedures may receive annual eye lens doses close to the ICRP 118 dose limit and thus individual monitoring with a dedicated dosimeter should be carried out. Uncertainty assessment play a relevant role in eye lens equivalent dose estimation to ensure not to exceed dose limit.

New-Onset Diabetes Educator to Educate Children and Their Caregivers About Diabetes at the Time of Diagnosis: Usability Study

Background

Diabetes self-management education is essential at the time of diagnosis. We developed the New-Onset Diabetes Educator (NODE), an animation-based educational web application for type 1 diabetes mellitus patients.

Objective

Our hypothesis is that NODE is a feasible, effective and user-friendly intervention in improving diabetes self-management education delivery to child/caregiver-dyads at the time of diagnosis.

Methods

We used a pragmatic parallel randomized trial design. Dyads were recruited within 48 hours of diagnosis and randomized into a NODE-enhanced diabetes self-management education or a standard diabetes self-management education group. Dyads randomized in the NODE group received the intervention on an iPad before receiving the standard diabetes self-management education with a nurse educator. The Diabetes Knowledge Test 2 assessed disease-specific knowledge pre- and postintervention in both groups, and was compared using t tests. Usability of the NODE mobile health intervention was assessed in the NODE group.

Results

We recruited 16 dyads (mean child age 10.75, SD 3.44). Mean Diabetes Knowledge Test 2 scores were 14.25 (SD 4.17) and 18.13 (SD 2.17) pre- and postintervention in the NODE group, and 15.50 (SD 2.67) and 17.38 (SD 2.26) in the standard diabetes self-management education group. The effect size was medium (Δ=0.56). Usability ratings of NODE were excellent.

Conclusions

NODE is a feasible mobile health strategy for type 1 diabetes education. It has the potential to be an effective and scalable tool to enhance diabetes self-management education at time of diagnosis, and consequently, could lead to improved long-term clinical outcomes for patients living with the disease.

Medication adherence in pediatric asthma: A systematic review of the literature

OBJECTIVE

To provide a systematic review of correlates of adherence to inhaled corticosteroids (ICS) in pediatric asthma across the individual, family, community, and healthcare system domains.

METHODS

Articles assessing medication adherence in pediatric asthma published from 1997 to 2016 were identified using PsychINFO, Medline, and CINAHL. Search terms included asthma, compliance, self-management, adherence, child, and youth. Search results were limited to articles: 1) published in the US; 2) using a pediatric population (0-25 years old); and 3) presenting original data related to ICS adherence. Correlates of adherence were categorized according to the domains of the Pediatric Self-Management Model. Each article was evaluated for study quality.

RESULTS

Seventy-nine articles were included in the review. Family-level correlates were most commonly reported (N = 51) and included socioeconomic status, race/ethnicity, health behaviors, and asthma knowledge. Individual-level correlates were second-most common (N = 37), with age being the most frequently identified negative correlate of adherence. Health care system correlates (N = 24) included enhanced asthma care and patient-provider communication. Few studies (N = 10) examined community correlates of adherence. Overall study quality was moderate, with few quantitative articles (26.38%) and qualitative articles (21.4%) referencing a theoretical basis for their studies.

CONCLUSIONS

All Pediatric Self-Management Model domains were correlated with youth adherence, which suggests medication adherence is influenced across multiple systems; however, most studies assessed adherence correlates within a single domain. Future research is needed that cuts across multiple domains to advance understanding of determinants of adherence.

Stereotactic Body Radiotherapy in Patients with Lung Oligometastases from Colorectal Cancer

AIM

To assess the role of stereotactic body radiotherapy (SBRT) in pulmonary metastases from colorectal cancer (CRC).

PATIENTS AND METHODS

Thirty-three consecutive patients with pulmonary metastases from CRC who received SBRT were included in the analysis. The primary endpoints were local and systemic progression-free survival, a secondary endpoint was the safety profile of SBRT.

RESULTS

A total of 56 lesions were treated with SBRT. A single nodule was treated in 15 patients, two in 13 and three in five. The radiotherapy dose and the adopted fractionations were 24-27 Gy as a single fraction for 40 lesions and 27-42 Gy in three fractions (2-3 times a week) for the other 16 lesions. After a median follow-up of 22.8 months (range=1.3-45.7 months), the median progression-free survival of the irradiated sites was 13.4 months.

CONCLUSION

SBRT can be considered as local therapy in patients with lung metastases from CRC.

The effects of media, self-esteem, and BMI on youth's unhealthy weight control behaviors

PURPOSE

Youth engage in a variety of methods to manage their weight, including unhealthy weight control behaviors (UWCBs). The purpose of this study was to examine factors associated with youth's engagement in UWCBs, including media influence, youth's BMI z-score and self-esteem.

METHODS

Participants were 179 youth, aged 10-17, attending a primary care clinic appointment. Youth completed questionnaires assessing frequency of UWCBs, global self-worth, and perception of media influence to lose weight. BMI z-score was calculated based on height and weight measurements obtained from medical charts. The SPSS macro, PROCESS, was used to conduct moderation analyses.

RESULTS

Over 40% of youth endorsed using at least one UWCB in the past year. Girls reported using more UWCBs and engaging in UWCBs more frequently than boys. For boys, media influence to lose weight was only related to UWCB frequency for those with a BMI z-score of 1.23 and above. For girls, media influence was only related to UWCB frequency for those with low to average levels of global self-worth.

CONCLUSIONS

Girls' and boys' use of UWCBs is impacted by different factors. Prevention efforts should consider targeting factors, such as weight status and self-esteem, which are uniquely associated with gender.