Children and adolescents who are unable to adhere to their medical regimen for the management of chronic illness present considerable challenges to health care providers and researchers. Pediatric asthma is a chronic illness where the consequences of non-adherence are particularly detrimental and widespread, especially among economically disadvantaged minority children and their families. Studies of intervention of asthma management are needed for this population. While some controlled intervention research that address barriers to asthma care has yielded promising results, research has been limited by weakness in methodology and generalizability. Non-randomized designs, small sample sizes, lack of objective outcome measures, lack of diversity in patient populations, modest, short-lived improvements in adherence have been limitations. Moreover, research has not evaluated tailored intervention strategies to specific barriers to adherence experienced by economically disadvantaged minority children and families, which may be necessary to develop powerful, clinically relevant interventions. Consequently, new models of behavioral interventions are needed to promote and sustain long-term adherence to asthma treatment among diverse patient populations. To address this need, the primary aim of the proposed study is to test the efficacy of a problem solving intervention that is tailored to the observed adherence behaviors and identified barriers to increasing adherence in African American children and adolescents with asthma, and families. Patients will be randomized to either a Tailored Problem Solving Intervention, or a control group who will receive Family Education Intervention. The primary study outcome will be adherence with prescribed therapy as measured by electronic monitors throughout the study period. Secondary measures will include disease specific morbidity, and symptoms, pulmonary functioning and functional outcomes including health-related quality of life, days of hospitalization, and school absences We hypothesize that adherence with prescribed treatment regimens for pediatric asthma will be enhanced by the use of a problem solving intervention that focuses on reducing barriers to adherence with therapy. The data that will be generated from this study will improve scientific understanding of interventions that are effective in promoting adherence to treatment in pediatric asthma in economically disadvantaged minority children and families.
