The goals of this project are to develop, implement and evaluate a multiple-componenet intervention to reduce asthma morbidity amond underserved and disadvantaged 5-12 year old inner city children with asthma. The intervention will focus on (1) improving asthma self- management by children with asthma and their caretakers (2) changing behavior/compliance through the use of a novel supernintendo asthma video game and asthma hotline service and (3) improving quality of health care services through facilitated referral to an asthma specialist. The project is a randomized clinical trial of a behavioral, educational and medical intervention to attempt to reduce morbidity among high-risk school-age children with asthma. Asthmatic subjects will be identified from inner city clinic populations at four local sites and from the community and randomized to participate in the intervention or to receive their usual care (placebo group). the components of the intervention include: (1) Asthma deucation by a skilled asthma counselor (nurse specialist), (2) use of the super nintendo asthma video game (3) an asthma hotline and (4) facilitated referral to an asthma specialist. Intervention group subjects will be followed by regular telephone contact over 6 months with scheduled assessment 6 and 12 months after enrollment. The intervention components targeting children with asthma and their parents/caretakers are intended to promote adoption of asthma self- management behaviors of appropriate asthma care behaviors. Our proposal to integrate multiple interventions, to provide appropriate asthma teaching, to target and alter the behavior/compliance of children and parents/caretakers in the context of appropriate medical management will be based on the principles of social cognitive theory (see background). All four processes, Attention, Retention, Production and Motivation, will be emphasized in all elements of all behavior change components of the intervention, and will guide the macro and micro development and implementation of all behavior change components of the overall program. The patient population will be urban underserved children ages 5-12 years with chronic moderate to severe asthma, a 6 month history of episodic wheezing, breathlessness, cough or chest pain, FEV1 65-90% predicted at the time of enrollment, exacerbations of asthma occuring at least twice weekly, or asthma symptoms occuring 3 or more days a week, or daily use of a beta2-agonist to control symptoms, or interrupted sleep or activity, and at least one prior hospitalization for asthma in the past 12 months or 2 er/acute care/unscheduled MD visits for asthma in the previous 12 months. Children who cannot learn to play Nintendo games or are visually hadicapped, or who are unable to speak either English of Spanish, or who have a history of other chronic lung disease including CF, bronchiectasis, immune deficiency, ABFA, congenital lung anomaly or other chronic cardiac, GI, neurologic or renal disease, or children currently under specialty asthma care by an allergist or pulmonogist or who have received such care in the previous 6 months will be excluded. The primary outcome variable is the prevalence of Asthma """"""""Sick Days"""""""" during the four two week intervals following enrollment. This is calculated for each subject each day of the diary record as a score of 3 (""""""""severe"""""""") or 2 (""""""""moderate"""""""") for any asthma symptom interfering with daily activity, OR school day missed due to asthma OR night awakening due to asthma OR disrupted activity due to asthma. The primary objective of the proposed intervention is to decrease the prevalence of Asthma """"""""Sick Days"""""""" to a degree that has clinical or policy significance. How well this objective is achieved will be assessed by comparing the treatment and control groups over the first year of their participation. The analytic approach described for the primary outcome measure will also be applied to all secondary outcomes: (a) asthma-realted utilization of emergency department/Acute care, hospital admissions and inpatient days; (b) objective measures of asthma status including peak flow measurement from the sick day diaries, and Pulmonary function testing (FEV1); (c) functional health status from the AAP Children's Health survey for asthma; (d) asthma knowledge and self-management behaviors among children with asthma and their caretakers, (e) direct and indirect cost of asthma care and (f) caretaker satisfaction with asthma care.
Showing the most recent 10 out of 589 publications
