Chronic diseases, such as asthma, disproportionately affect African American (AA) children. A key recommendation of the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma is partnership between healthcare providers and patients (and their parents, for children). Facilitating parents'open communication with providers regarding healthcare status and concerns can equip them to more effectively partner with their child's primary care provider (PCP). Thus, improving the health communication skills of African American (AA) parents could improve parent's adherence to treatment recommendations including utilization of the primary care for asthma care, and ultimately improve their child's asthma health outcomes. Our team recently completed a randomized controlled trial of an in- person health communication intervention that resulted in more partnerships with PCPs for asthma care and lower urgent care usage, but effects were not sustained past 2 months post-intervention. Mobile technology, such as Short Message Service (SMS, "text messaging"), is a low-cost means of extending the dosage and scope of this intervention and may be particularly useful among AAs, for whom the use of SMS is widespread. The proposed study involves a SMS-enhanced healthcare communication intervention (Text2Breathe) designed to equip urban, low-income AA parents with tools/techniques to empower parents to more effectively communicate with their children's PCP. 268 AA parents of children attending an emergency department asthma education clinic will be randomized to usual care or Text2Breathe. The Text2Breathe group will receive ongoing individualized text messages providing instruction about asthma care communication during the year- long intervention period. Outcome data on parental self-efficacy and outcome expectations, adherence to asthma care treatment recommendations (e.g., primary care utilization), and child asthma outcomes will be collected via structured telephone interviews at 3, 6, 12, 18, and 24 months post-enrollment. This trial can reduce pediatric health disparities by verifying the efficacy of a SMS-enhanced healthcare communication intervention that can extend to other chronic conditions and have health and policy implications.
The goal of this text messaging intervention is to equip African American parents to effectively communicate with primary care providers about their child's asthma care needs. Increasing parents'self-efficacy is expected to enhance their adherence to treatment recommendations, specifically utilization of primary care and self- management, and thus improve children's asthma health outcomes. Results of the trial of this intervention can have broad impact on reducing pediatric health disparities because, if efficacious, this SMS-enhanced healthcare communication intervention can be extended to other chronic disease contexts where parent- provider communication is important.