Youth of color have poorer asthma status than Caucasian youth, even after controlling for socioeconomic variables. Proper use of asthma controller medications is critical in reducing asthma mortality and morbidity. The clinical consequences of poor asthma management include increased illness complications, excessive functional morbidity, and fatal asthma attacks. There are significant limitations in research on interventions to improve asthma management in minority populations, particularly minority adolescents and young adults, though illness management tends to deteriorate after adolescence during emerging adulthood, the unique developmental period beyond adolescence but before adulthood. Because few interventions have specifically targeted this age group, we are currently conducting several small feasibility studies to inform this proposal. Building on the knowledge gained from the feasibility studies, this pilot study's goal is to develop and preliminarily test a technology-based intervention to improve asthma medication adherence in urban African American emerging adults (ages 18-25). The proposed study will collect pilot data with a sample of 80 African American emerging adults with asthma with suboptimal medication adherence recruited from clinic settings. Half of the sample will be randomized to receive a multi-component technology-based intervention (MCTI) targeting adherence to daily controller medication. The MCTI consists of two components: 1) 2 sessions of computer-delivered motivational interviewing targeting medication adherence, and 2) individualized text messaging focused on medication adherence between the sessions. Text messages will be individualized based on Ecological Momentary Assessment (EMA). The remaining half of participants will complete a series of computer-delivered asthma education modules matched for length, location, and method of delivery of the intervention session. Control participants will also receive text messages between intervention sessions. Message content will be the same for all control participants and contain general facts about asthma (not tailored). Youth will be recruited from the Detroit Medical Center, the only university affiliated medical center in Detroit, Michigan, as well as the Campus Health Center at Wayne State University also in Detroit. The goal of this project is to establish initial proof of conceptof MCTI through assessing viability, identifying technical issues, and establishing overall future research direction, as well as providing feedback for budgeting for a R01-level RCT. Although the scientific literature may provide the rationale for conducting a larger RCT, this pilot will provide critical information about the implementation of the intervention and recruitment strategies necessary to design a successful RCT. It is hypothesized that youth randomized to MCTI for adherence will show improvements in motivation to adhere to asthma medications and self-reported adherence compared to the comparison condition at 1- and 3- month follow up.
Older adolescents and young adults have largely been ignored in the asthma intervention literature, though they are at highest risk for poor illness management and health outcomes. The proposed project will test a brief, technology-based intervention specifically targeting adherence to asthma controller medications in an under-researched population, urban African American emerging adults. If successful, our multi-component technology intervention aimed at improving adherence to asthma medications has the potential to improve quality of life of minority emerging adults with asthma at relatively low cost. Further, it could be eventually be integrated into clinic settings and practice to reach a large number of emerging adults with asthma.