A feasibility study of a patient-centered educational strategy for rampant inhaler misuse among minority children with asthma

Volerman, Anna; Toups, Madeleine; Hull, Ashley; Press, Valerie G.

doi:10.1016/j.jaip.2019.01.044

Cited by 14 publications

(9 citation statements)

References 7 publications

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“…Then, the educator assessed inhaler technique by asking the child to show how they use an inhaler using a placebo MDI and spacer with mouthpiece, as previously described. 8 Technique was assessed with a validated 12-step checklist (reliability: kappa=0.94), with one point given per step performed correctly. 9 Child and parent confidence were dichotomized as "confident" or "not confident" (child: 1-2 versus 3-4; parent: 1-5 versus 6-10).…”

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confidence: 99%

Does inhaler technique align with confidence among African-American children and their parents?

Volerman

Toups

Hull

et al. 2019

Annals of Allergy, Asthma & Immunology

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Asthma prevalence and its related morbidity is two to three times higher among African-American children compared to white youth. 1 A key method for reducing asthma-related morbidity is quick-relief and controller medications delivered through respiratory inhaler devices. However, few children use inhalers correctly, which results in negative effects on asthma control, quality of life, and morbidity, 2 thus, inhaler education is critical. Inhaler technique education should occur at every opportunity, according to national asthma guidelines; however this education rarely occurs. 3 Many barriers exist in clinical settings, including time-pressured schedules, limited staff training, inadequate knowledge, and lack of demonstration supplies. 4 As a result, healthcare professionals may ask children or parents about technique, utilizing confidence as a proxy to determine if education is needed. Selfassessment has potential for inaccuracies because children and parents overestimate inhaler skills, as evidenced by studies of non-Hispanic white children 5 and parents of African-American children. 6 However, correlation between child and parent confidence has not been examined. Further, because this overestimation of skills can result in poor self-management, it is important to examine inhaler technique relative to both child and parent confidence. This observational study was conducted over one year (2016-2017) in four Chicago public charter schools with a predominately African-American (97%) and low-income (82%) student population. Students with physician-diagnosed asthma identified during schoolbased screening were recruited. 7 Written consent and assent was obtained. University of Chicago's Institutional Review Board approved the study.

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confidence: 99%

Does inhaler technique align with confidence among African-American children and their parents?

Volerman

Toups

Hull

et al. 2019

Annals of Allergy, Asthma & Immunology

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“…As with the Press paper, the other half of included studies had methods, which were very basic and essentially aligned with her definition of 'Brief-Intervention' . Root et al [19] and Volerman et al [20] are the only two that mention TTG specifically but neither are in preschool children.…”

Section: Educational Methods Used Primary Conceptmentioning

confidence: 99%

How we teach children with asthma to use their inhaler: a scoping review

et al. 2022

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Background One reason that asthma remains poorly controlled in children is poor inhaler technique. Guidelines recommend checking inhaler technique at each clinical visit. However, they do not specify how best to train children to mastery of correct inhaler technique. Many children are simply shown how to use inhalers which results in less than 50% with correct inhaler technique. The aim of this scoping review is to explore published literature on teaching methods used to train children to master correct inhaler technique. Methods We searched (from inception onwards): Medline, Embase, Scopus, Web of Science, CINAHL and the Cochrane library. We included quantitative studies, (e.g. randomised controlled trials, cohort studies and case-control studies), published from 1956 to present, on teaching inhaler technique to children with asthma. Data was extracted onto a data charting table to create a descriptive summary of the results. Data was then synthesised with descriptive statistics and visual mapping. Results Thirty-three papers were identified for full text analysis. Educational interventions were found to be taking place in a variety of clinical areas and by a range of healthcare professional disciplines. ‘Brief-Instruction’ and ‘Teach-Back’ were identified as two primary methods of providing inhaler technique training in the majority of papers. Secondary themes identified were; use of written instruction, physical demonstration, video demonstrations and/or use of inhaler devices to augment inhaler technique training. Conclusion There are a variety of means by which inhaler technique has been taught to children. These methods are likely applicable to all inhaler types and often involve some form of physical demonstration. Children of all ages can be trained to use their inhaler correctly and by a range of healthcare professionals. We have not analysed the effectiveness of these different interventions, but have described what has been trialled before in an attempt to focus our attentions on what may potentially work best. The majority of these methods can be dichotomised to either ‘Brief-Intervention’ or ‘Teach-Back’. Based on our analysis of this scoping review, we consider the following as areas for future research; how many times does a given intervention have to be done in order to have the desired effect? For what duration does the intervention need to continue to have a long-lasting effect? And, what is the best outcome measure for inhaler technique?. Trial registration Systematic review registration: Open Science Framework (osf.io/n7kcw).

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“…As with the Press paper, the other half of included studies had methods, which were very basic and essentially aligned with her de nition of 'Brief-Intervention'. Root et al (41) and Volerman et al (42) are the only two that mention TTG speci cally but neither are in preschool children.…”

Section: Conceptmentioning

confidence: 99%

How we teach children with asthma to use their inhaler: A scoping review

McCrossan

Mallon

Shields

et al. 2021

Preprint

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BackgroundOne reason that asthma remains poorly controlled in children is poor inhaler technique. Guidelines recommend checking inhaler technique at each clinical visit. However, they do not specify how best to train children to mastery of correct inhaler technique. Many children are simply shown how to use inhalers which results in less than 50% with correct inhaler technique. The aim of this scoping review is to explore published literature on teaching methods used to train children to master correct inhaler technique.MethodsWe searched (from inception onwards): Medline, Embase, Scopus, Web of Science, CINAHL and the Cochrane library. We included quantitative studies, (e.g. randomised controlled trials, cohort studies and case-control studies), published from 1956 to present, on teaching inhaler technique to children with asthma. Data was extracted onto a data charting table to create a descriptive summary of the results. Data was then synthesised with descriptive statistics and visual mapping.ResultsTwenty-eight papers were identified for full text analysis. Educational interventions were found to be taking place in a variety of clinical areas and by a range of healthcare professional disciplines. ‘Brief-Instruction’ and ‘Teach-Back’ were identified as two primary methods of providing inhaler technique training in the majority of papers. Secondary themes identified were; use of written instruction, physical demonstration, video demonstrations and/or use of inhaler devices to augment inhaler technique training.ConclusionThere are a variety of means by which inhaler technique has been taught to children. We have not analysed the effectiveness of these different interventions, but have described what has been trialled before in an attempt to focus our attentions on what may potentially work best. The majority of these methods can be dichotomised to either ‘Brief-Intervention’ or ‘Teach-Back’. Based on our analysis of this scoping review, we consider the following as areas for future research; how many times does a given intervention have to be done in order to have the desired effect? For what duration does the intervention need to continue to have a long-lasting effect? And, what is the best outcome measure for inhaler technique? Systematic review registration: Open Science Framework (osf.io/n7kcw).

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A feasibility study of a patient-centered educational strategy for rampant inhaler misuse among minority children with asthma

Cited by 14 publications

References 7 publications

Does inhaler technique align with confidence among African-American children and their parents?

Does inhaler technique align with confidence among African-American children and their parents?

How we teach children with asthma to use their inhaler: a scoping review

How we teach children with asthma to use their inhaler: A scoping review

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