Coping Peer Intervention for Adherence
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      Inner-city African American and Hispanic adolescents suffer from disproportionately high
      rates of emergency room visits and hospitalizations for acute exacerbations of asthma. This
      study proposes the use of a coping peer support intervention, enhanced by a technology-based
      platform that infuses peer support throughout adolescents' daily routines, to increase
      adherence to daily controller medications and ultimately reduce asthma exacerbation risk in
      this important population subgroup.
    

Detailed description: 
      High rates of asthma morbidity and mortality among inner-city African American and Hispanic
      adolescents demand urgent intervention. To address this disparity, the investigators have
      designed a culturally sensitive intervention aimed at improving adherence to daily controller
      medications for asthma, and ultimately reduce asthma exacerbation risk, that fits easily into
      adolescents' chaotic lifestyles.

      The proposed study is a behavioral randomized controlled trial that tests if a coping peer
      intervention can increase adherence to asthma controller medications among urban African
      American and Hispanic adolescents 11 to 16 years of age. To ensure the project's success, the
      principal investigator has assembled a multi-disciplinary team of researchers, including
      behavioral and social science experts. The Specific Aims propose to: (1) evaluate the impact
      of a 10-week coping peer support intervention on adherence and knowledge, compared to an
      attention control; (2) evaluate the ability of a 10-week coping peer support intervention to
      achieve sustained post-treatment improvements in adherence and knowledge, compared to an
      attention control; and (3) to develop estimates needed for the design of a subsequent R01
      behavioral controlled trial testing the efficacy of this intervention to decrease risk of
      asthma exacerbations. The study's primary outcome is adherence to daily asthma controller
      medications, measured using an objective electronic monitor. Study participants will be
      randomized to receive equal asthma supervision and music tracks plus either: (1) group
      support, coping peer group problem solving, and peer delivered asthma messages (intervention
      group); or (2) study team developed and recorded asthma health messages (attention control
      group) between music tracks, on a portable MP3 player. The group support and coping peer
      group problem solving consists of: putting subjects together in a small group to discuss
      barriers to adherence and ways to overcome these barriers; then having group members record
      messages to each other about overcoming barriers that will be played on their MP3 player,
      between music tracks, during the course of their daily routines. This effectively brings the
      coping peer support from the group into the course of the adolescents' day-to-day lives. The
      investigators hypothesize that it is the ability of the MP3 player to facilitate ongoing peer
      support that will be the basis for improved adherence. The long term goal is to apply the
      data from this research to submit an R01 grant application to conduct a behavioral randomized
      trial evaluating the effectiveness of this coping peer intervention to improve adherence, and
      ultimately reduce asthma exacerbations, in urban African American and Hispanic adolescents
      with asthma.
    

Intervention name(s): Coping Peer Support; Doctor Asthma Messages; Coping Peer Asthma Messages; Asthma Supervision; Music Tracks
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): The Coping Peer Support is delivered at weekly group meetings over the 10 week active treatment phase. The Coping Peer Support consists of: group support, coping peer group problem solving, and development and recording of Coping Peer Asthma Messages. More specifically, a social worker facilitates a peer group discussion of barriers to taking their daily inhaled steroids, and ways to overcome these barriers. The social worker also facilitates peer recording of messages by the participants encouraging each other to take their daily inhaled steroid medication.; The attention control group will receive Doctor Asthma Messages delivered during the 10 week active treatment phase. The content and number of these messages will be equivalent to those received by the intervention group. These messages are developed and recorded by an Allergist/Immunologist. The participants in the attention control group will listen to these Doctor Asthma Messages, between their favorite music tracks on their MP3 player, as they go about their day-to-day activities.; The Coping Peer Asthma Messages developed and recorded by study participants for each other at the weekly coping peer group meetings will be placed on intervention group participants' MP3 players. These Coping Peer Asthma Messages will be played on their MP3 players, between their favorite music tracks, during the course of their daily routines. This infuses the coping peer support from the coping peer group meetings into the adolescents' daily routines.; A member of the study team meets individually with each participant at baseline to teach proper use of a peak flow meter and spacer.; Participants receive an MP3 player (iPod Shuffle) in the baseline period. Participants receives clean, radio-edited music tracks of their choice in the baseline period and 10 week active treatment period.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: adherence; asthma; pediatrics; behavioral intervention; inner city