Feasibility and preliminary outcomes of a school-based intervention for inner-city, ethnic minority adolescents with undiagnosed asthma

Abstract

Objective-To describe and test the feasibility of Asthma Self-Management for Adolescents with Undiagnosed Asthma (ASMA-Undx), an eight-week school-based intervention for urban adolescents comprised of three group and five individual coaching sessions, and academic detailing for their primary care providers (PCPs).Methods-Thirty high school students (mean age 15.9; 92% female; 72% Latino/a) who reported symptoms of persistent asthma, but no diagnosis were randomized to ASMA-Undx or a notreatment control group. Interviews were conducted pre-and post-intervention.Results-All intervention students participated in the three group sessions; 64% received all five individual coaching sessions. Academic detailing telephone calls made by a pediatric pulmonologist reached 83% of the students' PCPs. Relative to controls, a significantly greater proportion of ASMA-Undx students were diagnosed (79% versus 6%, respectively), and prescribed asthma medication (57% versus 6%, respectively). Barriers to diagnosis and treatment included students' and parents' lack of knowledge about asthma.Conclusion-ASMA-Undx is a feasible and promising intervention to assist urban adolescents with undiagnosed asthma obtain a diagnosis and treatment.Practice Implications-ASMA-Undx has the potential to reach many adolescents because it is school-based. It can serve as a model for interventions targeting other pediatric illnesses.

Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

“…19,20 Both were positive studies, focused on poor urban African American and Hispanic adolescents and conducted in the school setting. 19,20 The intervention had several components: group sessions promoting asthma education and self-management skills outlined in the asthma guidelines; 14 individual coaching sessions promoting goal setting, problem solving, and communication skills with their health care provider; and academic detailing for the adolescents’ primary care provider (e.g. asthma specialist made in-person or telephone presentations to primary care providers about guideline 14 based changes in therapy).…”

“…asthma specialist made in-person or telephone presentations to primary care providers about guideline 14 based changes in therapy). 19,20 …”

“…19 Neither study used objective measurement of asthma outcomes. In contrast to the first study, 19 the second had a large sample size (n=345), robust follow up period (12 months), and a control group. 20 …”

Psychological Factors Influencing the Decision of Urban Adolescents With Undiagnosed Asthma to Obtain Medical Care

“…Data were part of the baseline assessment of adolescents who participated in a randomized controlled trial (RCT) testing the efficacy of a school-based intervention to help adolescents who report symptoms consistent with moderate to severe persistent asthma, but no diagnosis, obtain a clinical evaluation, diagnosis, and medication, if appropriate [15]. The institutional review boards of the New York University School of Medicine, Columbia University, and the New York City Department of Education approved study procedures.…”

My Child is Diagnosed With Asthma, Now What?

“…Patients must see themselves as vulnerable, change their core beliefs about the chronic nature of asthma and value of medication, and change their identity from self-doubting to self-efficacious. Stage-specific asthma educational messages have been found to enhance the effectiveness of pediatric behavioral interventions (Bonner et al, 2002; Bruzzese et al, 2004; Bruzzese et al, In press). Using educational messages at the appropriate stages helps parents gather and use information, and motivates them to act on the health needs of their child.…”