Increasing Adherence to Asthma Medication in Urban Teens
Increasing Adherence to Asthma Medication in Urban Teens
The purpose of this study is to determine the effectiveness of two home-based asthma
 interventions in increasing adherence to daily asthma controller medication.
BACKGROUND:

 Low-income, minority teenagers have disproportionately high rates of asthma morbidity,
 including excess risk of emergency department (ED) care, hospitalization, and death from
 asthma, compared to white adolescents. Research by this group and others has documented that
 non-adherence with asthma treatment regimens is common among high-risk, inner city families
 with asthma, and that this poor adherence with prescribed therapies plays a significant
 contributing role in asthma morbidity. Inner-city adolescents with asthma are at particular
 risk of non-adherence, yet this population remains understudied. While asthma self-management
 training has shown promise in achieving some improvement in adherence with asthma, there are
 few intervention studies explicitly targeting adolescents, particularly those in the
 inner-city. Urban children typically assume primary control over their asthma management
 during late childhood/early adolescence. At the same time, adolescents' efforts to achieve
 autonomy and peer-acceptance may result in increased health risk behaviors, including poor
 asthma self-management. Developmentally-appropriate asthma self-management interventions are
 needed that target the unique challenges of adolescence. Motivational Interviewing (MI) is a
 promising interventional approach that uses a client-centered, non-directive approach for
 enhancing motivation to change health behaviors. MI techniques are developmentally consistent
 with the needs of early adolescents. MI does not assume that health will be the most
 important factor motivating the teen, but rather acknowledges and incorporates other
 motivators that are within the context of the teen's life, thus this intervention strategy
 has the flexibility to adapt to the unique life circumstances and stressors faced by urban
 adolescents. We propose to evaluate the relative effectiveness of a MI-focused
 self-management intervention (MI+SM) compared to a self-management (SM) intervention
 containing asthma education and self-monitoring strategies in a sample of 226 children age
 10-15 years treated for asthma in the ED. Our primary hypothesis is that the MI+SM, as
 compared to SM alone, will result in greater improvement in medication adherence at 3- and
 6-months post-randomization, as measured by electronic medication monitoring. Secondary
 outcomes include self-reported medication adherence, symptoms free days, urgent health care
 utilization for asthma, and caregiver/adolescent quality of life.

 DESIGN NARRATIVE:

 Participants will be randomly assigned to 1) Self-Management (SM; Standard Care Group) or 2)
 Motivational Interviewing plus Self-Management Training (MI+SM; Intervention Group). The
 duration of the intervention condition will be 5 home visits over 2 months. Follow-up
 measures will be collected from families at 3- and 6-months post-randomization.
Inclusion Criteria:

 -  Resident of Baltimore City

 -  Diagnosis of asthma or reactive airway disease

 -  Current emergency department visit or hospitalization for asthma

 -  Prescribed a daily asthma controller medication

 Exclusion Criteria:

 -  Plans to move outside of the Baltimore City area within 1 year from study entry

 -  Current participation in another asthma education study

 -  Families unwilling or unable to participate

 -  Families who were enrolled and participated in the pilot study