Low-income minority adults have excessively high rates of morbidity from asthma. Poor adherence has been documented in these patients and contributes to this high morbidity. We will conduct a randomized controlled trial of Problem Solving (PS) compared with Attention Control (AC) to improve and sustain asthma self-management deliverable in a clinical setting that includes strategies to address contextual factors related to adherence. PS is based on findings from our prospective cohort study of African Americans, which identified influences of adherence in the social context. We have extracted the context from our experiences with African Americans and applied it to Latinos, another group with significant asthma morbidity. In order to accomplish this, we explored such influences in focus groups of African American and Latino patients and ultimately piloted PS extensively in both patient groups. PS addresses and integrates solutions to a problem of the participants'choosing, tailoring problem-solving to participants'needs with ways to maintain or improve adherence using a simple four-step protocol.
Specific aims are to test whether: 1) PS improves adherence to ICS over AC among adults with moderate or severe persistent asthma receiving care from urban clinics serving low-income minority populations, 2) PS improves asthma control over AC, and 3) PS improves asthma-related quality of life over AC. We will recruit 450 adults from five clinics and randomize these participants to PS or A C, stratifying by site and type of ICS. Because there are no electronic monitors providing date-time adherence data with the most frequently used dry powder inhalers, we have developed and tested one and will be able to obtain date-time data on all participants. The intervention will take place over three months. Participants will be followed for an additional three months. In our cohort study, attitude (the weighing of risks and benefits of ICS), trust of and satisfaction with communication with the provider were associated with adherence. We will explore whether motivation variables such as improved knowledge of ICS, attitudes about ICS benefits, and self-efficacy provided by the intervention mediate the relationship between PS and adherence. We also will explore whether personal characteristics and contextual influences (e.g. ethnic group, educational attainment, asthma severity, etc), social interactions (e.g. trust of and satisfaction with communication with the provider, social support) and generative capabilities such as innate problem-solving ability and absence of depression moderate this relationship. We will estimate the incremental cost-effectiveness of PS.
| Apter, Andrea J; Wan, Fei; Reisine, Susan et al. (2013) The association of health literacy with adherence and outcomes in moderate-severe asthma. J Allergy Clin Immunol 132:321-7 |
| Krishnan, Jerry A; Schatz, Michael; Apter, Andrea J (2011) A call for action: Comparative effectiveness research in asthma. J Allergy Clin Immunol 127:123-7 |
| Apter, Andrea J; Wang, Xingmei; Bogen, Daniel K et al. (2011) Problem solving to improve adherence and asthma outcomes in urban adults with moderate or severe asthma: a randomized controlled trial. J Allergy Clin Immunol 128:516-23.e1-5 |
| Black, Heather L; Priolo, Chantel; Akinyemi, D'Jahna et al. (2010) Clearing clinical barriers: enhancing social support using a patient navigator for asthma care. J Asthma 47:913-9 |
| Apter, Andrea J; Garcia, Laura A; Boyd, Rhonda C et al. (2010) Exposure to community violence is associated with asthma hospitalizations and emergency department visits. J Allergy Clin Immunol 126:552-7 |
| Apter, Andrea J (2010) Advances in adult asthma diagnosis and treatment in 2009. J Allergy Clin Immunol 125:79-84 |
| Naimi, David R; Freedman, Tovia G; Ginsburg, Kenneth R et al. (2009) Adolescents and asthma: why bother with our meds? J Allergy Clin Immunol 123:1335-41 |
| Apter, Andrea J (2009) Advances in adult asthma diagnosis and treatment and health outcomes, education, delivery, and quality in 2008. J Allergy Clin Immunol 123:35-40 |
| Apter, Andrea J; Wang, Xingmei; Bogen, Daniel et al. (2009) Linking numeracy and asthma-related quality of life. Patient Educ Couns 75:386-91 |
| Apter, Andrea J; Casillas, Adrian M (2009) Eliminating health disparities: what have we done and what do we do next? J Allergy Clin Immunol 123:1237-9 |
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