Increasing Adherence to Asthma Medication in Urban Teens
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The purpose of this study is to determine the effectiveness of two home-based asthma
      interventions in increasing adherence to daily asthma controller medication.
    

Detailed description: 
      BACKGROUND:

      Low-income, minority teenagers have disproportionately high rates of asthma morbidity,
      including excess risk of emergency department (ED) care, hospitalization, and death from
      asthma, compared to white adolescents. Research by this group and others has documented that
      non-adherence with asthma treatment regimens is common among high-risk, inner city families
      with asthma, and that this poor adherence with prescribed therapies plays a significant
      contributing role in asthma morbidity. Inner-city adolescents with asthma are at particular
      risk of non-adherence, yet this population remains understudied. While asthma self-management
      training has shown promise in achieving some improvement in adherence with asthma, there are
      few intervention studies explicitly targeting adolescents, particularly those in the
      inner-city. Urban children typically assume primary control over their asthma management
      during late childhood/early adolescence. At the same time, adolescents' efforts to achieve
      autonomy and peer-acceptance may result in increased health risk behaviors, including poor
      asthma self-management. Developmentally-appropriate asthma self-management interventions are
      needed that target the unique challenges of adolescence. Motivational Interviewing (MI) is a
      promising interventional approach that uses a client-centered, non-directive approach for
      enhancing motivation to change health behaviors. MI techniques are developmentally consistent
      with the needs of early adolescents. MI does not assume that health will be the most
      important factor motivating the teen, but rather acknowledges and incorporates other
      motivators that are within the context of the teen's life, thus this intervention strategy
      has the flexibility to adapt to the unique life circumstances and stressors faced by urban
      adolescents. We propose to evaluate the relative effectiveness of a MI-focused
      self-management intervention (MI+SM) compared to a self-management (SM) intervention
      containing asthma education and self-monitoring strategies in a sample of 226 children age
      10-15 years treated for asthma in the ED. Our primary hypothesis is that the MI+SM, as
      compared to SM alone, will result in greater improvement in medication adherence at 3- and
      6-months post-randomization, as measured by electronic medication monitoring. Secondary
      outcomes include self-reported medication adherence, symptoms free days, urgent health care
      utilization for asthma, and caregiver/adolescent quality of life.

      DESIGN NARRATIVE:

      Participants will be randomly assigned to 1) Self-Management (SM; Standard Care Group) or 2)
      Motivational Interviewing plus Self-Management Training (MI+SM; Intervention Group). The
      duration of the intervention condition will be 5 home visits over 2 months. Follow-up
      measures will be collected from families at 3- and 6-months post-randomization.
    

Intervention name(s): Self-Management Training; Motivational Interviewing (MI)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Asthma education and self-monitoring strategies; Motivational Interviewing (MI) is a promising interventional approach that uses a client-centered, non-directive approach for enhancing motivation to change health behaviors.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment