The Impact of Peer Support and mp3 Messaging on Adherence to Inhaled Corticosteroids in Minority Adolescents with Asthma: A Randomized, Controlled Trial

Abstract

Background Poor adherence to inhaled corticosteroids (ICS) is a critical risk factor contributing to asthma morbidity among low-income minority adolescents. Objective This trial tested whether peer support group meetings and peer asthma messages delivered via mp3 players improved adherence to ICS. Methods Low-income African American and/or Hispanic adolescents, ages 11–16, with persistent asthma, and poor (≤ 48%) adherence to prescription ICS during the 3-week run-in were randomized to intervention or attention control groups (ATG) for the 10-week treatment. During treatment, the intervention arm participated in weekly coping peer group support sessions and received mp3 peer-recorded asthma messages promoting adherence. The ATG participated in weekly meetings with a research assistant and received an equivalent number of mp3 doctor-recorded asthma messages. Adherence was measured using self-report and the DoserCT, (Meditrac, Inc.), an electronic dose counter. The primary outcome was the difference in adherence at 10 weeks between the two arms. Results Thirty-four subjects were randomized to each arm. At 10 weeks, no statistical difference in objectively measured adherence could be detected between the two arms adjusting for baseline adherence (P = 0.929). Adherence declined in both groups over the course of the active treatment period. Participants’ in both study arms self-reported adherence was significantly higher than their objectively measured adherence at week 10 (P < 0.0001). Conclusion Improving medication adherence in longitudinal studies is challenging. Peer support and mp3-delivered peer asthma messages may not be of sufficient dose to improve outcomes.

Factors associated with levels of adherence to inhaled corticosteroids in minority adolescents with asthma

“…Pediatric studies using both self-report and objective measures to capture adherence to ICS demonstrate significant overestimation of adherence by the former approach. 10,36,37 It is crucial to have accurate adherence data in order to draw reliable conclusions between levels of adherence and potentially associated factors.…”

“…Results of the trial have been published previously. 10 Prior to randomization, participants completed a 3-week run-in period to assess baseline characteristics and determine eligibility for participation in a 10-week active treatment phase. Adherence to ICS was measured over the last 14 days of the 21 day run-in period using an objective electronic adherence monitor.…”

Medication adherence in pediatric asthma: A systematic review of the literature

“…There are few studies focusing on the influences of peers on medication adherence of youth diagnosed with asthma. The use of peer asthma educators is associated with increases in adherence; however, using a peer support group is not effective in improving adherence compared to control . Heightened asthma stigma (eg, feeling embarrassed to take asthma medications at school) is linked to decreased adherence …”

An Electronic Asthma Self-Management Intervention for Young African American Adults

“…A careful review of the literature reveals that among minority populations with asthma, only 11 randomized controlled trials using different forms of electronic media have been reported. [25][26][27][28][29][30][31][32][33][34][35] All but one of the previously reported studies was conducted in children or adolescents, and the study performed in adults was not successful. 32 The duration of these studies ranged from 1 month to 1 year, and nearly all required special staffing (ie, nurses, asthma counselors, or asthma coaches) for completion.…”