Using pictorial asthma action plans to promote self-management and health in rural youth with asthma
Grantee: West Virginia University Research Corporation
Principal Investigator: Christina Duncan
Project Number: R40MC28320
Project Date: 04/01/2015
Age group(s)
- Middle Childhood (6-11 years)
- Adolescence (12-18 years)
Abstract
Non-adherence to asthma medications has the potential to result in frequent visits to the emergency room and even death. Rural families are at particular risk for health disparities, partly as a function of low literacy. National guidelines recommend that standard care for asthma patients include an individualized, written asthma action plan (AAP) to guide families through the problem-solving process of increasing treatment for symptom exacerbation and then reducing treatment once symptoms improve. Indeed, regular use of AAPs has been associated with a range of positive outcomes (e.g., better medication adherence, fewer school absences). Nevertheless, written AAPs have not been fully utilized by health care practitioners and vary significantly with regard to their content, level of detail, and literacy requirements. Practitioners question the utility of written AAPs with many patients, due to literacy demands, and patients sometimes report a lack of confidence in using them. Given that research has shown that the use of pictures in health education improves recall of information, it is expected that a pictorial AAP will enhance family understanding of the child's AAP, which in turn should improve adherence, health outcomes, and satisfaction with healthcare. Our long-term goal is to develop evidence-based, practical strategies to help families of children with asthma effectively manage their disease. The objective for this R40 MCH Research Program application (HRSA-15-062) is to establish the feasibility, efficacy, and acceptability of a symptom-based, computer-generated pictorial AAP relative to usual care (written AAP). Our central hypothesis is that a pictorial AAP will significantly surpass a written AAP with regard to a variety of clinically relevant outcomes. We will pursue two specific aims: (1) Determine the relative impact of two AAP formats (pictorial vs. written) on family knowledge of their AAP, medication adherence, asthma symptom control, and lung functioning; (2) Evaluate provider and family satisfaction and acceptability of the pictorial AAP, relative to a written AAP. As a secondary aim, we also will assess the role that parental health literacy and youth literacy potentially explain and impact our treatment outcome. A total of 100 families of youth (ages 10-17) with persistent asthma will be recruited from a rural geographic area and randomized to one of two groups, pictorial AAP or written AAP. Outcome variables will be analyzed statistically between groups and across time for this 6-month study. The objective of this project is consistent with MCH's Strategic Research Issues #1 (care efforts to eliminate health disparities and barriers) and # 2 (services to assure quality of care) that is, developing an asthma self-management tool that has potential to create a paradigm shift in how families in pediatric asthma are educated.Publications
Listed is descending order by year published.
Hynes L, Durkin K, Williford DN, Smith H, Skoner D, Lilly C, Kothari V, McSharry J, Duncan CL Protocol of a pilot randomized controlled trial comparing written versus pictorial asthma action plans to improve asthma management and health outcomes among youth. Journal of Medical Internet Research: Research Protocol
Hynes L, Durkin K, Williford DN, Smith H, Skoner D, Lilly C, Kothari V, McSharry J, Duncan CL. Protocol of a pilot randomized controlled trial comparing written versus pictorial asthma action plans to improve asthma management and health outcomes among youth. Journal of Medical Internet Research: Research Protocol. 2019.8(6).
Duncan CL, Walker HA, Brabson L, Williford DN, Hynes L, Hogan MB. Developing pictorial asthma action plans to promote self-management and health in rural youth with asthma: A qualitative study. J Asthma. 2017 Sep .55(8)915-923.
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