Investigation of the Role of Pictorial Asthma Action Plans to Promote Self-management in Rural Youth With Asthma
Investigation of the Role of Pictorial Asthma Action Plans to Promote Self-management in Rural Youth With Asthma
The aim of this study is to investigate the potential benefit of Pictorial versus Written
 Asthma Action Plans (AAPs) to support asthma management among young people with persistent
 asthma. Participants will be randomly allocated to the Pictorial or Written AAP group and
 followed up over a 6-month period. Qualitative and quantitative data will be collected from
 young people, parents and clinical teams involved in recruitment to assess the feasibility
 and acceptability of the Pictorial AAP (PAAP) software developed for this study, the PAAPs
 produced by the software, and the study procedures.
Asthma is the most common chronic health condition of childhood, and continues to be
 associated with morbidity and mortality. Many children with persistent asthma follow a
 treatment plan including a prescription to take a daily inhaled corticosteroid (controller),
 often in conjunction with a daily oral controller medication, and a dose of an albuterol
 (rescue) inhaler before activity or exercise. Young people with asthma must add to this
 treatment plan in response to a flare in symptoms by taking additional medication and
 contacting their asthma provider or getting to a hospital. Adherence to daily medications is
 essential for maintaining lung health and reducing symptom flares, but asthma treatment is
 complex, requiring regular decision-making in response to symptoms and environmental issues
 like symptom triggers. As a result consistent adherence is a challenge for families and young
 people. It is recommended to provide an Asthma Action Plan (AAP) to all people diagnosed with
 asthma, summarizing their treatment plan using a traffic light format; Green Zone for daily,
 symptom-free management, Yellow Zone for symptom flare, and Red Zone for extreme symptom
 flare. Despite evidence for the effectiveness of AAPs, they are often not prescribed for
 reasons including readability and accessibility for families and young people, and asthma
 provider perceptions of their utility and suitability. In this study, young people with
 persistent asthma will be given a Written (WAAP) or Pictorial Asthma Action Plan (PAAP) to
 compare the differential impact on AAP knowledge, adherence to daily inhaler use, and asthma
 control. Software developed for the study, in collaboration with providers, young people with
 asthma and their parents, will be used to generate personalized PAAPs. Quantitative and
 qualitative data will be collected to explore perceptions of providers, parents and young
 people of different versions of AAPs, the influence of AAPs on asthma understanding and
 management, and the experience of taking part in the study, as well as to assess the impact
 of different AAPs on the asthma and psychosocial outcomes mentioned. The findings will inform
 the development of the PAAP software and as the basis for a definitive Randomized Controlled
 Trial of the efficacy of PAAPs.
Inclusion Criteria:

 -  age 8-17 years

 -  new patient (to clinic) with a diagnosis of persistent asthma or an established
 patient with uncontrolled persistent asthma and a clinical need for a new treatment
 regimen

 -  no history of having received a written AAP

 -  prescribed an inhaled corticosteroid (i.e., daily controller medication).

 Exclusion Criteria:

 -  patients and caregivers who do not use English as their primary language

 -  has a significant developmental (e.g., autism, intellectual disability) or sensory
 (e.g., blindness) disorder that would preclude completion of study measures.