Asthma
Conditions
Keywords
Adolescents, Peer leader program, asthma camp, asthma control, quality of life, self-efficacy, knowledge, attitudes, barrier perceptions
Brief summary
Aims of this study are: 1. To determine the feasibility of implementing the intervention using a peer-assisted asthma day camp for adolescents with asthma. 2. To determine patterns of change in knowledge, attitudes toward asthma, self-efficacy, perception of barriers, and self-management behaviors, asthma control and quality of life over time among peer leaders. 3. To test the following hypothesis: * Adolescents participating in a peer-assisted asthma camp program will report improved knowledge, attitudes toward asthma, self-efficacy, and self-management behaviors, decreased perception of barriers, and increased asthma control and quality of life at 3-, 6- and 9-months post-intervention compared with the adult-led camp group. 4. To examine the moderating effect of personal factors (e.g., age, sex, socioeconomic status, race, illness status, family support) on intervention outcomes such as self-management behaviors, asthma control and quality of life in adolescents with asthma. 5. To examine the effect of the peer-assisted camp program on self-reported health care utilization including emergency department visits, days of hospitalization, outpatient visits by comparing between baseline and 9-months post-camp data and between the peer-led camp and the adult-camp programs.
Interventions
BEHAVIORALPeer-assisted asthma self-management program
Intervention group: An asthma self-management program (Power Breathing™) was implemented by trained peer leaders at an asthma day camp. The program consisted of 3 sessions (appx. 45-60 min/session): basic asthma education (pathophysiology, triggers); psychosocial issues of asthma; and asthma self-management (peak flow monitoring and medication). The program was delivered by trained peer leaders paired for each small group of 6-8 teens. Group activities involved discussion, strategic thinking, knowledge-testing games and role plays.
BEHAVIORALAdult-led asthma self-management program
Control group: The group attended an adult-led day camp where 2 NPs and a MD offered didactic asthma education based on the Power Breathing™ program.
Sponsors
University of Rochester
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
13 Years to 20 Years
Healthy volunteers
No
Inclusion criteria
1. age between 13-18 years 2. mild, moderate or severe persistent asthma specified by the NHLBI Asthma guidelines 3. asthma diagnosis \> 1 year 4. no other major chronic/emotional health concerns 5. ability to understand spoken and written English. Participants were recruited from the communities through flyers, newspaper ads, and referrals from clinics and schools. Eligibility criteria for peer leaders included: 1. age between 16-20 years 2. nomination from school teachers/nurses or health care providers 3. average grade point B or above in the past school year 4. fulfillment of eligibility criteria (2)-(5) prescribed for adolescent participants.
Exclusion criteria
* learning disabilities based on reports from parents, teachers or clinicians
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pediatric Asthma Quality of Life Questionnaire (PAQLQ) | 9 months post camp | Twenty-three items cover problems identified as being most important and troublesome in children's everyday lives due to asthma. This scale is effective in evaluating and discriminating because of its high sensitivity to changes in asthma status within and between individuals with varying severity of asthma. Respondents are asked to recall impairments experienced during the previous week. The scale consists of three subdomains including symptoms (10 items), emotional function (8 items) and activity limitation (5 items). Each item was measured on a 7-point scale; 1 indicates maximum impairment, and 7 indicates no impairment. Higher total scores indicate better levels of functioning. Total scores were computed by summing responses from all items (range:24-161) |
| Asthma Control Questions | 9 months post camp | This measure assesses the frequencies of the limitation of daily activity, asthma symptoms (daytime and nighttime) and use of rescue medication in the past 4 weeks on a 5-point scale (0-4). Total summed scores were computed (range: 4-16). Higher total scores indicate better controlled asthma. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Attitude Toward Illness Scale | 9 months post camp | This 13-item scale was designed to assess children's attitude toward their health condition. The scale includes questions such as how good or bad do you feel it is that you have \_\_\_? and, how often do you feel that your \_\_\_ is your fault? Respondents answer each question on a 5-point Likert-type scale (1-5). Total summed scores (range: 25-65) was constructed to reflect respondents' overall attitudes. Higher scores indicated positive attitudes. |
| Asthma Knowledge Questionnaire | 9 months post camp | This 30-item instrument was developed to measure children's knowledge on triggers and symptom identifications, and asthma management procedures (i.e., what to do and how to do it) in a true/false format. Total scores (range: 14-30) were computed by summing the number of items correctly answered. The higher scores indicate greater knowledge levels. |
| Asthma Self-Efficacy | 9 months post camp | This 14-item scale was developed to measure the child's confidence in attack prevention (e.g., learn asthma self-management skills, correct use of medication) and attack management (e.g., control symptoms, decide which medication to use). Total summed scores were computed (range: 21-70). Higher total scores indicate greater degree of self-efficacy. |
| Health Care Utilization Events | 9-months postcamp | Participants report the following information for the prior 3-month period; their emergency department visits for asthma; hospitalization for asthma; urgent office visit for worsening asthma; routine office visit; specialist visit. A cumulative number of events were computed by adding # of visits and # of days (for hospitalization) occurred in the past 3 months . |
| Forced Expiratory Volume in 1 Second (FEV1) % Predicted | 9 months post camp | Maximal amount of air one can forcefully exhale in one second. It is then converted to a percentage of normal. Range: 55-124 for the current sample. |
| Illness Management Survey | 9 months post camp | This 29-item scale was developed to assess perception of barriers and to predict risk for poor self-management in adolescents with chronic illness. This scale categorizes barriers based on internal processes (e.g., cognitive skills, denial, pessimistic thinking) and contextual forces (e.g., illness-related factors, peer/family influences). Total summed scores were computed (range: 28-91). Higher scores indicate the high levels of perceived barriers to self-management. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intervention Group This is the group who participated in a peer-led asthma self-management program. This group attended an asthma self-management program led by peer leaders in a camp setting. Afterward, the group received monthly phone contacts from their peer leaders who offered continuous support, encouragement and reminder throughout the 9-month study period. Follow-up assessments (including quality of life, asthma control, healthcare utilization, asthma knowledge, self-efficacy and attitude toward asthma) were completed every 3 months for 9 months. | 59 |
| Control Group This is the group who participated in an adult-led asthma self-management program. This group attended an asthma self-management program offered by healthcare professionals (physician and nurse practitioner) in a camp setting. Follow-up assessments (including quality of life, asthma control, healthcare utilization, asthma knowledge, self-efficacy and attitude toward asthma) were completed every 3 months for 9 months. | 53 |
| Peer Leader Group Teens who participated in the study as peer leaders. This group attended 3-day intense training program (a total of 12 hours) offered by a nurse practitioner. The training program covered not only asthma-related content but also leadership training. Then, each peer leader pair facilitated the peer-led asthma self-management program for a small group of 6-8 teens in the camp and made monthly contacts for 9 months. Follow-up assessments (including quality of life, asthma control, healthcare utilization, asthma knowledge, self-efficacy and attitude toward asthma) were completed every 3 months for 9 months. | 14 |
| Total | 126 |
Baseline characteristics
| Characteristic | Intervention Group | Control Group | Peer Leader Group | Total |
|---|---|---|---|---|
| Age, Continuous | 15.31 years STANDARD_DEVIATION 1.36 | 14.97 years STANDARD_DEVIATION 1.29 | 18.28 years STANDARD_DEVIATION 1.9 | 15.50 years STANDARD_DEVIATION 1.71 |
| Region of Enrollment United States | 59 participants | 53 participants | 14 participants | 126 participants |
| Sex: Female, Male Female | 33 Participants | 31 Participants | 11 Participants | 75 Participants |
| Sex: Female, Male Male | 26 Participants | 22 Participants | 3 Participants | 51 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 59 | 0 / 53 | 0 / 14 |
| serious Total, serious adverse events | 0 / 59 | 0 / 53 | 0 / 14 |
Outcome results
Primary
Asthma Control Questions
This measure assesses the frequencies of the limitation of daily activity, asthma symptoms (daytime and nighttime) and use of rescue medication in the past 4 weeks on a 5-point scale (0-4). Total summed scores were computed (range: 4-16). Higher total scores indicate better controlled asthma.
Time frame: 9 months post camp
Population: the number of participants analyzed includes only those who stayed in the study and completed the 9-months assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Asthma Control Questions | 14.84 units on a scale | Standard Deviation 1.86 |
| Control Group | Asthma Control Questions | 14.19 units on a scale | Standard Deviation 1.83 |
| Peer Leader Group | Asthma Control Questions | 14.89 units on a scale | Standard Deviation 1.05 |
Primary
Pediatric Asthma Quality of Life Questionnaire (PAQLQ)
Twenty-three items cover problems identified as being most important and troublesome in children's everyday lives due to asthma. This scale is effective in evaluating and discriminating because of its high sensitivity to changes in asthma status within and between individuals with varying severity of asthma. Respondents are asked to recall impairments experienced during the previous week. The scale consists of three subdomains including symptoms (10 items), emotional function (8 items) and activity limitation (5 items). Each item was measured on a 7-point scale; 1 indicates maximum impairment, and 7 indicates no impairment. Higher total scores indicate better levels of functioning. Total scores were computed by summing responses from all items (range:24-161)
Time frame: 9 months post camp
Population: The number of participants analyzed includes only those who stayed in the study and completed the 9-months assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Pediatric Asthma Quality of Life Questionnaire (PAQLQ) | 140.30 units on a scale | Standard Deviation 21.04 |
| Control Group | Pediatric Asthma Quality of Life Questionnaire (PAQLQ) | 125.12 units on a scale | Standard Deviation 25.95 |
| Peer Leader Group | Pediatric Asthma Quality of Life Questionnaire (PAQLQ) | 138.11 units on a scale | Standard Deviation 16.44 |
Secondary
Asthma Knowledge Questionnaire
This 30-item instrument was developed to measure children's knowledge on triggers and symptom identifications, and asthma management procedures (i.e., what to do and how to do it) in a true/false format. Total scores (range: 14-30) were computed by summing the number of items correctly answered. The higher scores indicate greater knowledge levels.
Time frame: 9 months post camp
Population: the number of participants analyzed includes only those who stayed in the study and completed the 9-months assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Asthma Knowledge Questionnaire | 25.86 units on a scale | Standard Deviation 3.11 |
| Control Group | Asthma Knowledge Questionnaire | 25.02 units on a scale | Standard Deviation 3.57 |
| Peer Leader Group | Asthma Knowledge Questionnaire | 28.11 units on a scale | Standard Deviation 1.45 |
Secondary
Asthma Self-Efficacy
This 14-item scale was developed to measure the child's confidence in attack prevention (e.g., learn asthma self-management skills, correct use of medication) and attack management (e.g., control symptoms, decide which medication to use). Total summed scores were computed (range: 21-70). Higher total scores indicate greater degree of self-efficacy.
Time frame: 9 months post camp
Population: the number of participants analyzed includes only those who stayed in the study and completed the 9-months assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Asthma Self-Efficacy | 56.19 units on a scale | Standard Deviation 10.02 |
| Control Group | Asthma Self-Efficacy | 51.93 units on a scale | Standard Deviation 9.09 |
| Peer Leader Group | Asthma Self-Efficacy | 57.44 units on a scale | Standard Deviation 3.84 |
Secondary
Attitude Toward Illness Scale
This 13-item scale was designed to assess children's attitude toward their health condition. The scale includes questions such as how good or bad do you feel it is that you have \_\_\_? and, how often do you feel that your \_\_\_ is your fault? Respondents answer each question on a 5-point Likert-type scale (1-5). Total summed scores (range: 25-65) was constructed to reflect respondents' overall attitudes. Higher scores indicated positive attitudes.
Time frame: 9 months post camp
Population: the number of participants analyzed includes only those who stayed in the study and completed the 9-months assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Attitude Toward Illness Scale | 50.05 units on a scale | Standard Deviation 7.3 |
| Control Group | Attitude Toward Illness Scale | 47.12 units on a scale | Standard Deviation 794 |
| Peer Leader Group | Attitude Toward Illness Scale | 45.44 units on a scale | Standard Deviation 5.9 |
Secondary
Forced Expiratory Volume in 1 Second (FEV1) % Predicted
Maximal amount of air one can forcefully exhale in one second. It is then converted to a percentage of normal. Range: 55-124 for the current sample.
Time frame: 9 months post camp
Population: the number of participants analyzed includes only those who stayed in the study and completed spirometry at 9-months assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Forced Expiratory Volume in 1 Second (FEV1) % Predicted | 100.77 percentage of predicted FEV1 | Standard Deviation 13.75 |
| Control Group | Forced Expiratory Volume in 1 Second (FEV1) % Predicted | 97.67 percentage of predicted FEV1 | Standard Deviation 11.03 |
| Peer Leader Group | Forced Expiratory Volume in 1 Second (FEV1) % Predicted | 102.11 percentage of predicted FEV1 | Standard Deviation 16.04 |
Secondary
Health Care Utilization Events
Participants report the following information for the prior 3-month period; their emergency department visits for asthma; hospitalization for asthma; urgent office visit for worsening asthma; routine office visit; specialist visit. A cumulative number of events were computed by adding # of visits and # of days (for hospitalization) occurred in the past 3 months .
Time frame: 9-months postcamp
Population: the number of participants analyzed includes only those who stayed in the study and completed the 9-months assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Health Care Utilization Events | 0.53 average number of events | Standard Deviation 1.12 |
| Control Group | Health Care Utilization Events | 0.78 average number of events | Standard Deviation 1.27 |
| Peer Leader Group | Health Care Utilization Events | 0.77 average number of events | Standard Deviation 1.28 |
Secondary
Illness Management Survey
This 29-item scale was developed to assess perception of barriers and to predict risk for poor self-management in adolescents with chronic illness. This scale categorizes barriers based on internal processes (e.g., cognitive skills, denial, pessimistic thinking) and contextual forces (e.g., illness-related factors, peer/family influences). Total summed scores were computed (range: 28-91). Higher scores indicate the high levels of perceived barriers to self-management.
Time frame: 9 months post camp
Population: the number of participants analyzed includes only those who stayed in the study and completed the 9-months assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Illness Management Survey | 56.74 units on a scale | Standard Deviation 16.95 |
| Control Group | Illness Management Survey | 64.61 units on a scale | Standard Deviation 13.11 |
| Peer Leader Group | Illness Management Survey | 60.55 units on a scale | Standard Deviation 10.31 |