Description
Intervention design: Following enrollment, participants randomized into the intervention group were separated into cohorts of approximately 7 individuals, and completed a six-week asthma intervention based on the social cognitive theory of behavioral change. The intervention consisted of 3 in-person group sessions along with 3 one-on-one telephone sessions. Group sessions were comprised of 7 participants along with a health educator who served as the leader. All group and telephone sessions were conducted by a health educator who had received a two-day training session on the principles of self-regulation as well as the basics of asthma management.
The personalized intervention followed a self-regulation process in which the participant first selected a specific asthma-related problem they would like to address, observed and esearched his/her routine to see how asthma was preventing resolution of this problem, and finally identified and developed a plan to achieve this objective. Each step of the intervention was self-directed, with personalized assistance from the health educator. The final step of the intervention focused on teaching participants how to deal with asthma problems that may arise in the future. During the observation phase, participants were provided a peak flow meter and asked to monitor peak flow readings along with asthma symptoms over a two-week period, to determine factors that may negatively impact their asthma.
Subjects randomized to the control group were provided a 30-minute asthma education session (which was also included in session 1 for the intervention group). Control group participants next were given a link to the American Academy of Allergy, Asthma and Immunology (AAAAI) patient asthma education website, available at www.aaaai.org/" target="_blank">www.aaaai.org/ conditions-and-treatments/asthma. To provide attention-control matching, subjects in the control group were called on 3 occasions to ask if they had any questions regarding the website.
People involved: Adult patients ≥ 55 years of age with persistent asthma were recruited from two large medical centers, in order to get a diverse representation of subjects. The first medical center was located in a predominantly, white, upper-middle class city (Ann Arbor, MI), whereas the second was located in an urban, predominantly African-American city with high rates of poverty (Detroit, MI). Persistent asthma was defined as the need for a controller medication every day for asthma, or the need for albuterol at least three times a week, in a patient with physician-diagnosed asthma.
Demonstration of airway reversibility or airway hyper-reactivity was not be required, as current NIH NAEPP guidelines specifically state that “chronic asthma may be associated with a loss of response to bronchodilators”, and this is especially true in those with long standing asthma such as the elderly.
172 people - G1: 95 people (control), G2: 77 people (intervention) G1: 66.0 (±7.5) years, G2: 65.9 (±7.1) years
Identified barriers: Nearly 20% who were randomized to the intervention group declined to participate once they learned more details of the number of sessions and phone calls. The target enrollment goal was not achieved, though a positive outcome was demonstrated even without reaching this goal. Additionally, the percent of subjects lost to follow-up in the intervention group was higher in the control group, which may indicate that the frequency or amount of the intervention was excessive.
Transferability: The study involved diverse groups of patients - upper middle class and people with high rates of poverty, as well as whites and African Americans. This practice can be transferred to different groups of people.