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Kemble H, Foster M, Blamires J, Mowat R. Children and young people's self-reported experiences of asthma and self-management nursing strategies: An integrative review. J Pediatr Nurs 2024; 77:212-235. [PMID: 38598994 DOI: 10.1016/j.pedn.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/16/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
AIM To explore children and young people's (CYP) (5-24 years of age) self-reported experiences of asthma self-management strategies (ASMS) with nursing involvement across various settings. BACKGROUND Childhood asthma is an increasingly significant health issue, highlighting the importance of acquiring self-management skills to optimise future health outcomes. Registered nurses play a pivotal role in delivering appropriate, personalized self-management support. METHODS This integrative review searched four electronic databases: Cumulated Index to Nursing and Allied Health Literature via Elton B. Stephens Company, Medical Literature Analysis and Retrieval System Online (MEDLINE), Object, View and Interactive Design (OVID), and PubMed, that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart. Included studies were critically appraised using the Joanna Briggs Institute critical appraisal tools. Braun and Clarks thematic analysis was used to generate themes, and sub-themes. FINDINGS Fifteen studies were included for review. Thematic analysis generated three themes being healthy literacy; health and wellbeing; and tools and working together. CONCLUSIONS Asthma continues to have negative physical, psychological, and social implications among CYP. CYP are both willing and capable of engaging in ASMS and learning self-management skills, however, continue to have unmet self-management needs. IMPLICATIONS TO PRACTICE Strategies must bolster health literacy, improve physical and psychological health, and harness interactive, youth-centric, and informative tools to facilitate communication and decrease the burden of self-management. Applications pose a promising avenue for self-management support. This age group remains under-explored and future research should enable meaningful engagement with CYP to better understand their perspectives and improve strategy success.
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Affiliation(s)
- H Kemble
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand; Auckland University of Technology, School of Clinical Sciences (Nursing), 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - M Foster
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand; Edith Cowan University, School of Nursing and Midwifery, Perth, Western Australia, Australia; Auckland University of Technology, School of Clinical Sciences (Nursing), 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand.
| | - J Blamires
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand; Auckland University of Technology, School of Clinical Sciences (Nursing), 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand.
| | - R Mowat
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand; Auckland University of Technology, School of Clinical Sciences (Nursing), 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand.
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Dinç F, Yıldız D, Ercan N. The effectiveness of an education program based on healthcare transition in adolescents with asthma: A randomized controlled trial. Pediatr Allergy Immunol 2024; 35:e14101. [PMID: 38456636 DOI: 10.1111/pai.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Adolescents diagnosed with asthma make a transition to adult care when they reach a certain age. Besides, these adolescents need specialized education for them to become autonomous, competent, and adult patients and gain the necessary knowledge and skills related to their disease. In this study, by using a prospective randomized controlled trial design, we evaluated the effectiveness of an education program based on healthcare transition provided to adolescents diagnosed with asthma. METHODS After obtaining the consent of adolescents and their parents, 52 adolescents aged between 14 and 18 years who were diagnosed with asthma were randomly assigned to the intervention group (individual four face-to-face and six online education sessions) or the control group (standard care). The primary outcome was the differences between the Transition Readiness Assessment Questionnaire (TRAQ) scores of the two groups. The secondary outcomes included the differences between the Self-Efficacy Scale for Children and Adolescents with Asthma and Mind the Gap scores of the two groups. The outcomes were measured at two different time points: baseline (first assessment; Week 0) and immediately after the intervention (last assessment; Week 12). RESULTS In the initial evaluations, there was no significant difference between the groups in terms of the primary or secondary outcomes (p > .05). In the final assessments, the TRAQ (Z = -4.740, p < .001) and Self-Efficacy Scale for Children and Adolescents with Asthma (t = 6.344, p < .001) scores of the intervention group were found to be significantly higher than the scores of the control group, while their Mind the Gap Scale scores were significantly lower (t = 6.146, p < .001). CONCLUSION It was determined that the educational intervention integrated with pediatric care based on readiness for transition from pediatric care to adult care was effective in increasing the transition readiness and self-efficacy of the adolescents. The study was registered at ClinicalTrials.gov with the ID code NCT05550922.
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Affiliation(s)
- Fatma Dinç
- Department of Nursing, Faculty of Health Sciences, Bartın University, Bartın, Turkey
| | - Dilek Yıldız
- Department of Pediatric Nursing, Gülhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
| | - Nazli Ercan
- Division of Pediatric Immunology and Allergy, Department of Pediatrics, Gülhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
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Rhee H, Batek L, Rew L, Tumiel-Berhalter L. Parents' Experiences and Perceptions of Healthcare Transition in Adolescents with Asthma: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1510. [PMID: 37761471 PMCID: PMC10527731 DOI: 10.3390/children10091510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Adolescence marks a significant transition from pediatric to adult healthcare, and parents play critical roles in supporting their adolescents with chronic conditions through this process. However, little is known about parents' experiences, perceptions, and needs during this healthcare transition. This qualitative study explores the experiences and perceptions of parents regarding the care transition of their 16-17-year-old adolescents with asthma. Nineteen mothers participated in either a focus group or individual interviews, and a content analysis was conducted on the data. Parents expressed negative emotions and various concerns about their teens' transition readiness and asthma management. A need for early transition training for both adolescents and parents was discussed. Overall, the complexity and challenges associated with the healthcare transition of adolescents with asthma take a toll on parents, particularly when their teens are not adequately prepared to manage asthma independently. Parents need appropriate anticipatory guidance regarding the transition and skills to navigate changing roles and negotiate asthma care responsibilities with their teens. Timely interventions and support strategies for both adolescents and parents are needed to ensure the successful healthcare transition of adolescents with asthma.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
| | - Lynn Rew
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14203, USA;
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Rhee H, Choi Y, Tumiel-Berhalter L. Transition readiness in middle and older adolescents with asthma and associated factors: a descriptive study. J Asthma 2023; 60:991-999. [PMID: 36040871 PMCID: PMC10011012 DOI: 10.1080/02770903.2022.2119864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Asthma is the leading chronic health condition in adolescents, yet little is known about adolescents' readiness to transition into adult-focused care. This study examines transition readiness in middle and late adolescents with asthma. METHODS This cross-sectional descriptive study was conducted in 2019 with 41 adolescents (16-20 years old) with asthma. Transition readiness was measured with the 20-item Transition Readiness Assessment Questionnaire (TRAQ), which comprises five subscales. RESULTS Slight majorities of the sample comprised females (58.5%) and minority adolescents (56%). The sample's overall mean score on the TRAQ was 3.89 (±0.63; possible range 1-5). Managing daily activities was associated with talking with providers subscale (r = 0.36; p < 0.01), but not with other TRAQ subscales. Females reported greater scores for managing medications than did males, with mean = 4.2 vs. 3.6 (t = -2.15, p = 0.04). Transition readiness did not differ by race or health insurance type. However, scores on arranging transportation to medical appointments were lower among minority adolescents than whites (4.17 vs. 4.8, t = 2.56, p = 0.01). Better asthma control was associated with higher scores on talking with providers (r = -0.42; p < 0.01), but not with other subscale domains. CONCLUSIONS Overall transition readiness is suboptimal in middle to late adolescents with asthma. Adolescents' capacity to manage daily activities is not a valid indicator of transition readiness in disease self-management. It is important to consider gender, race, and asthma control in understanding transition readiness in adolescents with asthma.
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Affiliation(s)
- Hyekyun Rhee
- University of Texas at Austin School of Nursing, 1710 Red River St. Austin, TX 78712
| | - Yuri Choi
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY 14642
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Lewis G, Milnes L, Adams A, Schwarze J, Duff A. Influences on indoor environmental trigger remediation uptake for children and young people with asthma: A scoping review. Health Expect 2022; 26:87-97. [PMID: 36478049 PMCID: PMC9854302 DOI: 10.1111/hex.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/21/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Children and young people (CYP) with asthma can benefit from reduced exposure to indoor environmental allergens and triggers but may not consistently have avoidance strategies implemented. To inform future interventions to increase trigger and allergen avoidance and enhance asthma control, a greater understanding of the influences on avoidance behaviours is necessary. METHODS A systematic scoping review was selected to summarize evidence on what influences family uptake of indoor environmental asthma trigger avoidance strategies for CYP with asthma and identify research gaps. Primary studies of any design, including CYP (≤18 years) with asthma, and/or parent-carers, available in English and conducted since 1993, were eligible. Searches included nine databases, hand-searching reference lists and citation searching. FINDINGS Thirty-three articles were included and are summarized narratively due to heterogeneity. Influences appear complex and multifactorial and include barriers to strategy uptake, health beliefs and personal motivation. Research specifically related to family understanding of allergic sensitisation status and exposure risks, and how these may inform avoidance implementation is required. Patient and public involvement (PPI) was not reported in included articles, although two studies used participatory methods. CONCLUSION There is limited research on family asthma trigger management, particularly what influences current management behaviours. Variation in families' ability to identify important triggers, understand exposure risk and consistently reduce exposures warrants further exploratory research to explain how families reach avoidance decisions, and what future interventions should aim to address. Further PPI-informed research to address such gaps, could enable theory-based, person-centred interventions to improve the uptake of asthma trigger remediation. PATIENT OR PUBLIC CONTRIBUTION An asthma-specific PPI group contributed to the decision-making for the funding for the wider project this review sits within. The findings of this scoping review have informed the subsequent phases of the project, and this was discussed with PPI groups (both adult and CYP groups) when proposing the next phases of the project.
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Affiliation(s)
- Grace Lewis
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK,Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK
| | - Linda Milnes
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK,Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK
| | - Alexandra Adams
- Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK,Paediatric Respiratory UnitLeeds Children's HospitalLeedsUK
| | - Jürgen Schwarze
- Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK,Child Life and Health, Centre for Inflammation ResearchThe University of EdinburghEdinburghUnited Kingdom
| | - Alistair Duff
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK,Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK,Paediatric Respiratory UnitLeeds Children's HospitalLeedsUK
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McTague K, Prizeman G, Shelly S, Eustace‐Cook J, McCann E. Youths with asthma and their experiences of self-management education: A systematic review of qualitative evidence. J Adv Nurs 2022; 78:3987-4002. [PMID: 36239214 PMCID: PMC9827903 DOI: 10.1111/jan.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/17/2022] [Accepted: 09/29/2022] [Indexed: 01/12/2023]
Abstract
AIMS To identify and synthesize the available evidence of youths with asthma and their experience of self-management education. DESIGN Systematic literature review of qualitative studies with meta-synthesis of findings. DATA SOURCES We searched five databases, CINAHL Complete, Embase, MEDLINE (EBSCO) PsycINFO, ASSIA and the Global Index Medicus (formerly the WHOLIS). Initial search in September 2019 and updated in July 2020 and July 2022. REVIEW METHODS The systematic review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. Qualitative data were extracted, meta-summarized and then meta-synthesized. RESULTS Eighteen studies were identified for inclusion in this review and three themes were identified: The theory and practice gap, contemporary health-seeking preferences and the psychosocial impacts of living with asthma. CONCLUSION The needs of youths with asthma are specific and must be measurable against the change in asthma outcomes for this group. They have unmet self-management educational needs that stakeholders, involved in their care and support, should address. Education and practice policy should focus on youth-centric approaches. Through meaningful engagement with youths, stakeholders can identify their support needs, requirements and preferences to successfully underpin the theory and practice of self-management education. IMPACT This review synthesized evidence of youths with asthma and their experiences of self-management education, highlighting their specific self-management information needs. The findings highlight several implications for healthcare professionals in education, practice and research. This age profile is under-explored and further research into this population would work towards filling the theory and practice gap and highlighting the identified psychosocial issues faced by this group.
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Affiliation(s)
- Karen McTague
- School of Nursing and MidwiferyTrinity CollegeDublinIreland
| | - Geraldine Prizeman
- Trinity Centre for Practice and Healthcare InnovationSchool of Nursing and Midwifery, Trinity CollegeDublinIreland
| | - Stephen Shelly
- Department of RespiratorySt James's HospitalDublinIreland
| | | | - Edward McCann
- School of Health and PsychologyCity University of LondonLondonUK
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Blaakman SW, Fagnano M, Borrelli B, Riekert KA, Halterman JS. Self-Determination Theory and Preventive Medication Adherence: Motivational Considerations to Support Historically Marginalized Adolescents With Asthma. J Pediatr Health Care 2022; 36:560-569. [PMID: 35788313 PMCID: PMC9805470 DOI: 10.1016/j.pedhc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Using self-determination theory, we explored relationships between autonomous motivation (AM) and perceived competence (PC) with previously validated measures of motivation and adolescent-reported asthma medication adherence. METHOD Data were from adolescents (n = 260) enrolled in the School-Based Asthma Care for Teens study and taking preventive medication at baseline. Eligible adolescents (aged 12-16 years) had physician-diagnosed persistent asthma or poor control. RESULTS Adolescents taking daily preventive medicine reported higher AM and PC for adherence, whereas adolescents likely to miss ≥1 dose in the next 2 weeks had lower AM and PC. Adolescents taking medicines as prescribed, with plans to continue, and those feeling able to follow provider care plans, had higher AM and PC. Findings remained significant in regressions with control variables. DISCUSSION Many factors interfere with adolescent medication-taking. Clinicians' efforts to build AM and PC with patients and caregivers may be key to promoting adherence in this group.
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Affiliation(s)
- Susan W Blaakman
- Susan W. Blaakman, Professor of Clinical Nursing, University of Rochester School of Nursing, Rochester, NY.
| | - Maria Fagnano
- Maria Fagnano, Associate Director of Clinical Research, General Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Belinda Borrelli
- Belinda Borrelli, Professor of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA
| | - Kristin A Riekert
- Kristin A. Riekert, Professor of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary & Critical Care Medicine, Baltimore, MD
| | - Jill S Halterman
- Jill S. Halterman, Elizabeth R. McAnarney Professor in Pediatrics, University of Rochester Medical Center, General Pediatrics, Rochester, NY
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Rhee H, Batek L, Wallace-Farquharson T, Tumiel-Berhalter L. Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1573. [PMID: 36291509 PMCID: PMC9600616 DOI: 10.3390/children9101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16-20 years with asthma. Forty-one adolescents participated in a focus group or individual interview, and content analysis was conducted to analyze the data. The mean age of participants was 17.7 years, the majority (56%) of whom were Black. Themes that emerged included concerns about becoming an adult with asthma and its self-management, parental involvement, and communication with providers. Adolescents felt burdened by asthma, few considered becoming adults with asthma, and their future outlook was pessimistic with concerns related to worsening symptoms, inadequacy in symptom self-management and limitations on career choices due to asthma. Deficiencies in self-management were noted, parents still played major roles in adolescents' asthma care, and transition of care was seldom discussed with the providers. Mid-to-late adolescents with asthma are inadequately prepared for transition of care, and parents and providers insufficiently engage adolescents in the preparation. Parent, provider, and adolescent partnership is critical to achieve adolescent readiness for independence in asthma management and to ensure proper asthma care continuity post transition.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY 14642, USA
| | | | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, 77 Goodell St., Buffalo, NY 14203, USA
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Deschildre A, Abou-Taam R, Drummond D, Giovannini-Chami L, Labouret G, Lejeune S, Lezmi G, Lecam MT, Marguet C, Petat H, Taillé C, Wanin S, Corvol H, Epaud R. [Update of the 2021 Recommendations for the management of and follow-up of adolescent asthmatic patients (over 12 years) under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version]. Rev Mal Respir 2022; 39:e1-e31. [PMID: 35148929 DOI: 10.1016/j.rmr.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- A Deschildre
- Université Lille, CHU Lille, service de pneumologie et allergologie pédiatriques, hôpital Jeanne de Flandre, 59000 Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019, CNRS UMR9017, équipe OpinFIELD: Infections opportunistes, Immunité, Environnement et Maladies Pulmonaires, Institut Pasteur de Lille, 59019 Lille cedex, France.
| | - R Abou-Taam
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - D Drummond
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - L Giovannini-Chami
- Service de Pneumo-Allergologie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - G Labouret
- Service de Pneumo-allergologie pédiatrique, Hôpital des Enfants, CHU Toulouse, 31000 Toulouse, France
| | - S Lejeune
- Université Lille, CHU Lille, service de pneumologie et allergologie pédiatriques, hôpital Jeanne de Flandre, 59000 Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019, CNRS UMR9017, équipe OpinFIELD: Infections opportunistes, Immunité, Environnement et Maladies Pulmonaires, Institut Pasteur de Lille, 59019 Lille cedex, France
| | - G Lezmi
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - M T Lecam
- Service de pathologies professionnelles et de l'environnement. Centre Hospitalier Inter Communal de Créteil, 94000 Créteil, France
| | - C Marguet
- Université de Normandie, UNIROUEN, EA 2456, CHU Rouen, maladies respiratoires et allergiques, CRCM, département de Pédiatrie, et de Médecine de l'adolescent, 76000 Rouen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN,UNIROUEN, EA2656, 14033 Caen, France
| | - H Petat
- Université de Normandie, UNIROUEN, EA 2456, CHU Rouen, maladies respiratoires et allergiques, CRCM, département de Pédiatrie, et de Médecine de l'adolescent, 76000 Rouen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN,UNIROUEN, EA2656, 14033 Caen, France
| | - C Taillé
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des maladies pulmonaires rares ; Inserm UMR1152, Paris, France
| | - S Wanin
- Service d'allergologie pédiatrique, hôpital universitaire Armand Trousseau, 75012 Paris, France; Unité Transversale d'éducation thérapeutique Sorbonne Université, Paris, France
| | - H Corvol
- Service de pneumologie pédiatrique, Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm UMRS938, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Trousseau, Paris, France
| | - R Epaud
- Centre hospitalier intercommunal de Créteil, service de pédiatrie générale, 94000 Créteil, France; Université Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France; FHU SENEC, Créteil, France
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Ramdzan SN, Khoo EM, Liew SM, Cunningham S, Kendall M, Sukri N, Salim H, Suhaimi J, Lee PY, Cheong AT, Hussein N, Hanafi NS, Mohd Ahad A, Pinnock H. How young children learn independent asthma self-management: a qualitative study in Malaysia. Arch Dis Child 2020; 105:819-824. [PMID: 32620567 PMCID: PMC7456543 DOI: 10.1136/archdischild-2019-318127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We aimed to explore the views of Malaysian children with asthma and their parents to enhance understanding of early influences on development of self-management skills. DESIGN This is a qualitative study conducted among children with asthma and their parents. We used purposive sampling and conducted focus groups and interviews using a semi-structured topic guide in the participants' preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo and analysed using a grounded theory approach. SETTINGS We identified children aged 7-12 years with parent-reported, physician-diagnosed asthma from seven suburban primary schools in Malaysia. Focus groups and interviews were conducted either at schools or a health centre. RESULTS Ninety-nine participants (46 caregivers, 53 children) contributed to 24 focus groups and 6 individual interviews. Children mirrored their parents' management of asthma but, in parallel, learnt and gained confidence to independently self-manage asthma from their own experiences and self-experimentation. Increasing independence was more apparent in children aged 10 years and above. Cultural norms and beliefs influenced children's independence to self-manage asthma either directly or indirectly through their social network. External influences, for example, support from school and healthcare, also played a role in the transition. CONCLUSION Children learnt the skills to self-manage asthma as early as 7 years old with growing independence from the age of 10 years. Healthcare professionals should use child-centred approach and involve schools to facilitate asthma self-management and support a smooth transition to independent self-management. TRIAL REGISTRATION NUMBER Malaysian National Medical Research Register (NMRR-15-1242-26898).
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Affiliation(s)
- Siti Nurkamilla Ramdzan
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Steven Cunningham
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Marilyn Kendall
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Nursyuhada Sukri
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hani Salim
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Department of Family Medicine, Universiti Putra Malaysia Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia
| | - Julia Suhaimi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping Yein Lee
- Department of Family Medicine, Universiti Putra Malaysia Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Universiti Putra Malaysia Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia
| | - Norita Hussein
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nik Sherina Hanafi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Hilary Pinnock
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Vazquez‐Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Gore C, Hox V, Jensen B, Pite H, Santos AF, Sanchez S, Alviani C, Garriga‐Baraut T, Knibb R, Mortz CG, Gowland MH, Timmermans F, Roberts G. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review. Allergy 2020; 75:1850-1880. [PMID: 32141620 DOI: 10.1111/all.14258] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions. METHODS A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken. RESULTS A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life-impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors-asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence-suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management-facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships-families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals. CONCLUSIONS We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.
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Affiliation(s)
- Marta Vazquez‐Ortiz
- Department of Paediatrics Faculty of Medicine Imperial College London London UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Department of Paediatrics Imperial College London London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Claudia Gore
- Department of Paediatrics Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Valérie Hox
- Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital Lisbon Portugal
- CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children’s Health (Paediatric Allergy) Faculty of Life Sciences and Medicine School of Life Course Sciences King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Silvia Sanchez
- Allergy Department Hospital Infantil Universitario del Niño Jesús Madrid Spain
| | - Cherry Alviani
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
| | - Teresa Garriga‐Baraut
- Unitat d'Al.lergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d’Investigació “Creixement i Desenvolupament” Institut de Recerca de l’Hospital Universitari Vall d’Hebron (VHIR) Barcelona Spain
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | | | - Frans Timmermans
- Frans Timmermans: Nederlands Anafylaxis Netwerk – European Anaphylaxis Taskforce Dordrecht The Netherlands
| | - Graham Roberts
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
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12
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De Keyser HH, Ramsey R, Federico MJ. They just don't take their medicines: Reframing medication adherence in asthma from frustration to opportunity. Pediatr Pulmonol 2020; 55:818-825. [PMID: 31944593 PMCID: PMC10187561 DOI: 10.1002/ppul.24643] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022]
Abstract
Assessing and addressing suboptimal adherence to asthma medications is a key component in the treatment of all children with asthma, particularly those with difficult-to-treat asthma. However, parents often overreport adherence to asthma medications. Increased medication adherence could lead to improved outcomes in the form of better asthma control and decreased asthma exacerbations, as well as decreased healthcare utilization costs. Yet there are many complex factors that affect medication adherence, and barriers are often different in each family. Social determinants of health, complex healthcare relationships, and patient-related factors may all affect medication adherence. Multicomponent patient-centered strategies, as well as strategies that utilize technology and habit formation strategies may be helpful in improving medication adherence. Further study is needed to reliably and sustainably improve medication adherence in children with asthma across the broader population; in some populations, alternate diagnoses, adjusting therapy, and other intervention may be required to improve asthma control and health.
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Affiliation(s)
- Heather Hoch De Keyser
- Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Monica J Federico
- Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
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13
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Margolis R, Bellin MH, Bookman JRM, Collins KS, Bollinger ME, Lewis-Land C, Butz AM. Fostering Effective Asthma Self-Management Transfer in High-Risk Children: Gaps and Opportunities for Family Engagement. J Pediatr Health Care 2019; 33:684-693. [PMID: 31253454 PMCID: PMC6815689 DOI: 10.1016/j.pedhc.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The process of self-management knowledge, behavior, and skill development in children with asthma from families with low income is understudied. METHOD Fifteen mothers of children with uncontrolled asthma participated in semistructured interviews exploring the transfer of asthma self-management responsibilities from parent to child. Team members performed thematic analysis of written transcripts. RESULTS All participants were all the biological mothers and were impoverished, with most (73%) reporting an annual family income of less than $30,000. Their children ranged from 5 to 15 years old, were African American (100%), and had uncontrolled asthma based on national guidelines. Themes showed that child asthma self-management is difficult to achieve, that the transfer of asthma responsibility from mother to child is variable, and that mothers overestimate their child's developmental capacities for independent asthma self-management and have poor understanding of what well-controlled asthma means. DISCUSSION Ongoing assessment and tailored guidance from health care providers are critical to support the pivotal role of mothers in their child's self-management development process.
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Affiliation(s)
- Rachel Margolis
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | - Melissa H. Bellin
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | | | - Kathryn S. Collins
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | | | - Cassie Lewis-Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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14
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Withers ALI, Green R. Transition for Adolescents and Young Adults With Asthma. Front Pediatr 2019; 7:301. [PMID: 31396495 PMCID: PMC6664046 DOI: 10.3389/fped.2019.00301] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Asthma is a complex, heterogenous medical condition which is very common in children and adults. The transition process from pediatric to adult health care services can be a challenge for young people with chronic medical conditions. The significant changes in physical and mental health during this time, as well as the many unique developmental and psychosocial challenges that occur during adolescence can complicate and impede transition if not adequately addressed and managed. The transition period can also be a challenging time for health professionals to assess readiness for transition and manage some of the complications which are particularly common during this time, including poor adherence to therapy, smoking, drug use, and emerging mental health conditions. The natural history, presentation, symptoms, and management of asthma is often significantly different when comparing pediatric and adult practice. In addition, management in infants, toddlers, school aged children, and adolescents differs significantly, offering an additional challenge to pediatric physicians managing asthmatic children and young people. Despite these challenges, if the transition process for young people with asthma is planned and performed in a formalized manner, many of these issues can be addressed, allowing the transition to occur smoothly despite changes that may occur in medical and psychosocial domains.
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Affiliation(s)
| | - Ruth Green
- Glenfield Hospital, Leicester, United Kingdom
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15
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Ödling M, Jonsson M, Janson C, Melén E, Bergström A, Kull I. Lost in the transition from pediatric to adult healthcare? Experiences of young adults with severe asthma. J Asthma 2019; 57:1119-1127. [PMID: 31328590 DOI: 10.1080/02770903.2019.1640726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Asthma is a multifaceted disease, and severe asthma is likely to be persistent. Patients with severe asthma have the greatest burden and require more healthcare resources than those with mild-to-moderate asthma. The majority with asthma can be managed in primary care, while some patients with severe asthma warrant referral for expert advice regarding management. In adolescence, this involves a transition from pediatric to adult healthcare. This study aimed to explore how young adults with severe asthma experienced the transition process.Methods: Young adults with severe asthma were recruited from an ongoing Swedish population-based cohort. Qualitative data were obtained through individual interviews (n = 16, mean age 23.4 years), and the transcribed data were analyzed with systematic text condensation.Results: Four categories emerged based on the young adults' experiences: "I have to take responsibility", "A need of being involved", "Feeling left out of the system", and "Lack of engagement". The young adults felt they had to take more responsibility, did not know where to turn, and experienced fewer follow-ups in adult healthcare. Further, they wanted healthcare providers to involve them in self-management during adolescence, and in general, they felt that their asthma received insufficient support from healthcare providers.Conclusions: Based on how the young adults with severe asthma experienced the transition from pediatric to adult healthcare, it is suggested that healthcare providers together with each patient prepare, plan, and communicate in the transition process for continued care in line with transition guidelines.
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Affiliation(s)
- Maria Ödling
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Marina Jonsson
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Anna Bergström
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
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16
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Jones MR, Frey SM, Riekert K, Fagnano M, Halterman JS. Transition Readiness for Talking With Providers in Urban Youth With Asthma: Associations With Medication Management. J Adolesc Health 2019; 64:265-271. [PMID: 30389202 PMCID: PMC6339852 DOI: 10.1016/j.jadohealth.2018.08.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Teen readiness assessments may provide a developmental indicator of the transfer of responsibility for health self-management from caregivers to teens. Among urban adolescents with asthma, we aimed to describe teen readiness for talking with providers and identify how readiness relates to responsibility for asthma management, medication beliefs, and clinical outcomes. METHODS Teens and caregivers enrolled in the school-based asthma care for teen's trial in Rochester, NY completed in-home surveys. We classified ready teens as those reporting a score of five on both items of the transition readiness assessment questionnaire talking with providers subscale. We performed bivariate analyses to detect differences between ready teens and other teens in teen- and caregiver-reported responsibility, teen medication beliefs, and clinical outcomes (medication adherence over the past 2 weeks, and healthcare use over the past year). RESULTS Among this sample of 251 adolescents (mean age: 13.4 years), 35% were classified as "Ready." Ready teens were more likely than other teens to want to use a controller medication independently (7.6 vs. 6.5 out of 10, p < .01) and to have confidence in this ability (8.4 vs. 7.6 out of 10, p = .02). Teens reported poor adherence (missed 52.9% of prescribed controller doses), with no differences in responsibility or clinical outcomes based on level of teen readiness for talking with providers. CONCLUSIONS In urban adolescents with poorly controlled asthma, a higher level of teen readiness for talking with providers is associated with higher perceptions of independence in medication taking, but does not appear to relate to clinical outcomes.
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Affiliation(s)
| | - Sean M. Frey
- University of Rochester Medical Center, Division of General Pediatrics, 601 Elmwood Ave, Box 777, Rochester, NY 14642,
| | - Kristin Riekert
- Johns Hopkins School of Medicine, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Circle, JHAAC 3B37, Baltimore, MD,
| | - Maria Fagnano
- University of Rochester Medical Center, Division of General Pediatrics, 601 Elmwood Ave, Box 777, Rochester, NY 14642,
| | - Jill S. Halterman
- University of Rochester Medical Center, Division of General Pediatrics, 601 Elmwood Ave, Box 777, Rochester, NY 14642,
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17
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Mammen J, Rhee H, Norton SA, Butz AM, Halterman JS, Arcoleo K. An integrated operational definition and conceptual model of asthma self-management in teens. J Asthma 2018; 55:1315-1327. [PMID: 29351005 PMCID: PMC6053334 DOI: 10.1080/02770903.2017.1418888] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/05/2017] [Accepted: 12/14/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES A previous definition of adolescent asthma self-management was derived from interviews with clinicians/researchers and published literature; however, it did not incorporate perspectives of teens or parents. Therefore, we conducted in-depth interviews with teens and parents and synthesized present findings with the prior analysis to develop a more encompassing definition and model. METHODS Focal concepts were qualitatively extracted from 14-day self-management voice-diaries (n = 14) and 1-hour interviews (n = 42) with teens and parents (28 individuals) along with concepts found in the previous clinical/research oriented analysis. Conceptual structure and relationships were identified and key findings synthesized to develop a revised definition and model of adolescent asthma self-management. RESULTS There were two primary self-management constructs: processes of self-management and tasks of self-management. Self-management was defined as the iterative process of assessing, deciding, and responding to specific situations in order to achieve personally important outcomes. Clinically relevant asthma self-management tasks included monitoring asthma, managing active issues through pharmacologic and non-pharmacologic strategies, preventing future issues, and communicating with others as needed. Self-management processes were reciprocally influenced by intrapersonal factors (both cognitive and physical), interpersonal factors (family, social and physical environments), and personally relevant asthma and non-asthma outcomes. CONCLUSION This is the first definition of asthma self-management incorporating teen, parent, clinician, and researcher perspectives, which suggests that self-management processes and behaviors are influenced by individually variable personal and interpersonal factors, and are driven by personally important outcomes. Clinicians and researchers should investigate teens' symptom perceptions, medication beliefs, current approaches to symptom management, relevant outcomes, and personal priorities.
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Affiliation(s)
- Jennifer Mammen
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
| | - Hyekyun Rhee
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
| | - Sally A Norton
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
| | - Arlene M Butz
- b Johns Hopkins University, Pediatrics , Freeland , USA
| | - Jill S Halterman
- c University of Rochester School of Medicine and Dentistry, Pediatrics , Rochester , USA
| | - Kimberly Arcoleo
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
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18
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Miles C, Arden-Close E, Thomas M, Bruton A, Yardley L, Hankins M, Kirby SE. Barriers and facilitators of effective self-management in asthma: systematic review and thematic synthesis of patient and healthcare professional views. NPJ Prim Care Respir Med 2017; 27:57. [PMID: 28993623 PMCID: PMC5634481 DOI: 10.1038/s41533-017-0056-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/09/2022] Open
Abstract
Self-management is an established, effective approach to controlling asthma, recommended in guidelines. However, promotion, uptake and use among patients and health-care professionals remain low. Many barriers and facilitators to effective self-management have been reported, and views and beliefs of patients and health care professionals have been explored in qualitative studies. We conducted a systematic review and thematic synthesis of qualitative research into self-management in patients, carers and health care professionals regarding self-management of asthma, to identify perceived barriers and facilitators associated with reduced effectiveness of asthma self-management interventions. Electronic databases and guidelines were searched systematically for qualitative literature that explored factors relevant to facilitators and barriers to uptake, adherence, or outcomes of self-management in patients with asthma. Thematic synthesis of the 56 included studies identified 11 themes: (1) partnership between patient and health care professional; (2) issues around medication; (3) education about asthma and its management; (4) health beliefs; (5) self-management interventions; (6) co-morbidities (7) mood disorders and anxiety; (8) social support; (9) non-pharmacological methods; (10) access to healthcare; (11) professional factors. From this, perceived barriers and facilitators were identified at the level of individuals with asthma (and carers), and health-care professionals. Future work addressing the concerns and beliefs of adults, adolescents and children (and carers) with asthma, effective communication and partnership, tailored support and education (including for ethnic minorities and at risk groups), and telehealthcare may improve how self-management is recommended by professionals and used by patients. Ultimately, this may achieve better outcomes for people with asthma.
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Affiliation(s)
- Clare Miles
- Academic Unit of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | | | - Mike Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK
| | - Anne Bruton
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Academic Unit of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | | | - Sarah E Kirby
- Academic Unit of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK.
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19
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Morsa M, Gagnayre R, Deccache C, Lombrail P. Factors influencing the transition from pediatric to adult care: A scoping review of the literature to conceptualize a relevant education program. PATIENT EDUCATION AND COUNSELING 2017; 100:1796-1806. [PMID: 28528694 DOI: 10.1016/j.pec.2017.05.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/24/2017] [Accepted: 05/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To give a comprehensive overview of the factors that influence the transition from pediatric services to adult care, and to conceptualize a relevant education program. METHOD An evaluation grid was used to analyze the literature and classify factors depending on whether they were related to the patients, to the health care organization, to health care personnel, to the interaction between medical staff and patient, or to the illness and its treatment. RESULTS We based our analysis on a selection of 20 publications. The following factors were identified and classified in an integrative framework: self-management skills, trust in adult care, the feeling of self-efficacy, social support, the patient's gender and social position, the trust between child carers and adult carers, interdisciplinary cooperation, and the medical staff's consideration of the patient's projects. CONCLUSIONS AND PRACTICE IMPLICATIONS The current analysis makes it possible to formulate educational aims and to design a way of integrating them to a transition plan. However, the collected studies mainly focus on knowledge of the illness, on treatment, and on the health care system. Psychosocial dimensions at play at the time of the transition - such as identity development - are not sufficiently explored in the research.
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Affiliation(s)
- Maxime Morsa
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France.
| | - Rémi Gagnayre
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France.
| | - Carole Deccache
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France.
| | - Pierre Lombrail
- Laboratory of Education and Health Practices (EA3412), University Paris 13, Bobigny, France; Department of Public Health, Paris Seine St-Denis hospital, AP-HP, France.
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20
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Bellin MH, Newsome A, Land C, Kub J, Mudd SS, Bollinger ME, Butz AM. Asthma Home Management in the Inner-City: What can the Children Teach us? J Pediatr Health Care 2017; 31:362-371. [PMID: 27955875 PMCID: PMC6407130 DOI: 10.1016/j.pedhc.2016.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Knowledge of asthma home management from the perspective of poor, minority children with asthma is limited. METHOD Convenience sampling methods were used to recruit families of low-income children who are frequently in the emergency department for uncontrolled asthma. Thirteen youths participated in focus groups designed to elicit reflections on asthma home management. Data were analyzed using grounded theory coding techniques. RESULTS Participants (Mean age = 9.2 years) were African American (100%), enrolled in Medicaid (92.3%), averaged 1.4 (standard deviation = 0.7) emergency department visits over the prior 3 months, and resided in homes with at least 1 smoker (61.5%). Two themes reflecting multifaceted challenges to the development proper of self-management emerged in the analysis. DISCUSSION Findings reinforce the need to provide a multipronged approach to improve asthma control in this high-risk population including ongoing child and family education and self-management support, environmental control and housing resources, linkages to smoking cessation programs, and psychosocial support.
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Affiliation(s)
| | | | - Cassie Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Joan Kub
- Johns Hopkins University School of Nursing, Medicine and Public Health
| | - Shawna S. Mudd
- Johns Hopkins University School of Nursing, Medicine and Public Health
| | | | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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21
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Valerio MA, Peterson EL, Wittich AR, Joseph CLM. Examining health literacy among urban African-American adolescents with asthma. J Asthma 2016; 53:1041-7. [PMID: 27359106 PMCID: PMC5056364 DOI: 10.1080/02770903.2016.1175473] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 03/31/2016] [Accepted: 04/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This exploratory study assessed health literacy among urban African-American high school students to improve understanding of the association between adolescent health literacy and asthma. METHODS We conducted a secondary data analysis of the control group (n = 181) of the Puff City randomized controlled trial (2006-2010), a web-based intervention to promote asthma management among students, grades 9 through 12. A validated self-report 3-item health literacy screening instrument was completed at final online follow-up survey. Logistic regression was used to explore the association between health literacy, demographic characteristics, quality of life, asthma management, and health care utilization. RESULTS Multivariate analysis revealed that an overall inadequate health literacy score was associated with students who were more likely to be younger (OR 0.61; 95% CI 0.44-0.84), not on Medicaid (OR 0.36; 95% CI 0.17-0.76), have at least one hospitalization (OR 1.29; 95% CI 1.07-1.56); and a lower overall quality of life (OR 0.75; 95% CI 0.59-0.95). Those lacking confidence in filling out medical forms, needing help reading hospital materials, and having difficulty understanding written information were more likely to not have a rescue inhaler (OR 0.49; 95% CI 0.25-0.94), have one or more emergency visits (OR 1.21 95% CI 1.02-1.43), and one or more hospitalizations (OR 1.19; 95% CI 1.01-1.41), respectively. CONCLUSIONS The findings indicate a significant association between inadequate health literary and suboptimal asthma management. It is important to advance understanding of adolescent health literacy, especially those at-risk, as they assume asthma self-management tasks and move toward independent adult self-care.
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Affiliation(s)
- Melissa A Valerio
- a Health Promotion and Behavioral Science, University of Texas School of Public Health, San Antonio Regional Campus , San Antonio , TX , USA
| | - Edward L Peterson
- b Department of Public Health Sciences , Henry Ford Health System , Detroit , MI , USA
| | - Angelina R Wittich
- a Health Promotion and Behavioral Science, University of Texas School of Public Health, San Antonio Regional Campus , San Antonio , TX , USA
| | - Christine L M Joseph
- c Department of Public Health Sciences , Health Disparities Research Collaborative, Henry Ford Health System , Detroit , MI , USA
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