Family stress has been identified as a mechanism by which low socioeconomic status may be linked to adverse asthma outcomes. Family and caregiver stress have a negative impact on children's asthma management behaviors and asthma outcomes, yet few asthma education interventions include a psychological component to assess and modify the impact of stress on asthma self-management. Given cultural variation in the experience of stress and the stigma associated with mental health problems, educational interventions with psychological components are best designed in collaboration with members of the target community, who can insure that program content and format will be responsive to their specific needs and culturally-influenced health beliefs. In collaboration with the American Lung Association - Southeast and our Community Advisory Board, we will design and pilot-test a home-based family intervention that integrates individually tailored asthma education with strategies to reduce the impact of caregiver and family stress on asthma management.
The aims of this treatment development proposal are to: (1) conduct focus groups with children with persistent asthma and their parents to refine the content of the family intervention, and (2) conduct a pilot study of the family intervention, evaluating its initial efficacy, feasibility, and acceptability for 25 families receiving the family intervention as compared to 25 families receiving enhanced treatment as usual (trigger control resources and a written asthma action plan). Primary treatment outcomes include measures of asthma self-management (self-reported management, observed MDI/spacer technique, urinary cotinine to assess exposure to environmental tobacco smoke) and morbidity (number of symptom days, school days missed for asthma, and urgent health care utilization for asthma). Secondary outcomes include parent-child relationship quality, family cohesion, and caregiver stress. A secondary aim of the study is to assess the cost effectiveness of the intervention from the perspective of a health services payer. If successful, the home-based family intervention can improve the asthma management of caregivers under stress and their children. We hope that this research will result in a replicable and sustainable model that can be adopted by community-based organizations to reduce the high asthma morbidity reported for low-income children with asthma living in urban, stressful environments. ? ? ?
|Celano, Marianne; Klinnert, Mary D; Holsey, Chanda Nicole et al. (2011) Validity of the Family Asthma Management System Scale with an urban African-American sample. J Pediatr Psychol 36:576-85|