The impact of asthma in adults is substantial, and recently a number of interventions have been initiated to promote self-management skills in adults with asthma. The proposed project is a new phase of one of these research initiatives, the Asthma Self-Management Program of the University of Alabama at Birmingham (UAB). The heart of this program is a patient self-help workbook combined with a specific protocol for training patients in its use and for providing continuing encouragement to maintain self-management skills. This """"""""Special Intervention"""""""" approach has been compared with a """"""""usual Care"""""""" approach in which subjects receive a standard set of routinely available asthma education pamphlets. Because such pamphlets frequently are a part of normal care, it is important that interventions be compared to them, not the complete absence of patient education. Preliminary results were encouraging. however, the UAB self- Management Program (like other similar efforts) has a number of characteristics that stimulated the proposed project. It is information rich and professional labor intensive and evaluation efforts to date have involved only a single sample and a relatively short follow-up period (12 months). Interventions that are more applicable in community practice settings and research with new samples, and longer follow-up periods are needed. Accordingly, in the proposed study a third approach, the """"""""Core Elements Intervention,"""""""" will be developed. The intent is to provide an intervention that is readily exportable to community-based practice settings. Therefore, the development will be guided by the literature on the diffusion of innovations, using information obtained in """"""""Focus Groups"""""""" composed of physicians from community-based practices. the goal also will be to include only those points that are essential to intervention success. Procedures for enhancing medication adherence and appropriate self-monitoring with peak flow meters will be stressed, and the protocol will include systematic follow-up procedures for encouraging and sustaining self-management skills. A prospective randomized control study will be used to compare the three approaches over a two-year follow-up period. Outcomes in the following areas will be assessed: (a) functional status, (b) knowledge of asthma, (c) adherence to recommended treatment regimens, (d) psychological influences on and reactions to asthma, and (e) health care utilization.
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