As outlined in the Healthy People 2000 guidelines, an important national health objective, especially for underserved populations, is to preserve functional status in patients with asthma. The goal of this randomized control trial is to assess the effectiveness of an intervention involving education, enhancement of self-efficacy, and telephone social support in preserving and improving functional status in 180 patients from diverse socio-demographic backgrounds with moderate asthma. The goal is also to design the intervention so that it is easy to implement and reinforce in day-to-day office practice. The hypotheses are that: 1) an intervention to increase self-efficacy, social support, and asthma education will be more effective in preserving and improving functional status over 2 years; 2) greater depressive symptoms, more comorbidity, and less access to asthma care will be associated with lower general self-efficacy and asthma self-efficacy; 3) education about asthma will result in increased knowledge and correct beliefs about asthma, realistic expectations about asthma, and greater satisfaction with asthma status and treatment, and 4) patients with higher self-efficacy, greater social support, and more education about asthma will have fewer hospitalizations, emergency room visits, and urgent doctor's office visits. For both control and experimental groups the intervention will involve dissemination to physicians of NHLBI Expert Panel recommendations for physician-provided patient education and a self-directed NHLBI patient asthma workbook. The experimental group also will receive a tailored intervention to increase asthma self-efficacy, asthma social support through telephone contact with study personnel, and in-person reinforcements or """"""""boosters"""""""" of the interventions. The main outcome will be within-patient change in the Activities domain of the Asthma Quality of Life Questionnaire at 2 years after enrollment. Additional outcomes will be to assess the effectiveness of the intervention by measuring within-patient change in functional status after 2 years with the physical function domain and the compost physical score of the SF-36, and to assess the effectiveness of the intervention by measuring resource utilization due to asthma over 2 years according to hospitalizations, emergency room visits, and urgent doctor office visits. The long-term objectives are to demonstrate that an intervention that builds on already established effective interventions can be easily administered and reinforced in daily practice and can promote functional improvement in patients with asthma.
| Mancuso, Carol A; Sayles, Wendy; Allegrante, John P (2010) Randomized trial of self-management education in asthmatic patients and effects of depressive symptoms. Ann Allergy Asthma Immunol 105:12-9 |
| Mancuso, Carol A; Sayles, Wendy; Allegrante, John P (2009) Development and testing of the Asthma Self-Management Questionnaire. Ann Allergy Asthma Immunol 102:294-302 |
