Paper
Wednesday, 19 July 2006
This presentation is part of : Child and Adolescent Health Initiatives
Testing an Intervention to Promote Children's Adherence to Recommended Asthma Self-Management
Patricia Vernal Burkhart, PhD, RN, Mary Kay Rayens, PhD, Marsha G. Oakley, MSN, RN, and Ashleigh B. Ohlmann, BSN. College of Nursing, University of Kentucky, Lexington, KY, USA
Learning Objective #1: Identify successful strategies for promoting children's adherence to asthma self-management.
Learning Objective #2: Assess adherence to daily peak flow monitoring over time for children with asthma.
Purpose: To test the hypothesis that compared with the control group, school-age children with asthma who received asthma education and a behavioral protocol would show higher adherence to peak expiratory flow [PEF] monitoring, recommended as part of asthma self-management.
Methods: Children with persistent asthma, recruited primarily from pediatric practices, participated in the randomized controlled trial. Both the intervention (n = 38) and control groups (n = 39) were instructed on PEF monitoring. Only the intervention group received comprehensive asthma education and contingency management, guided by cognitive social learning theory that included self-monitoring, contingency contracting, tailoring, cueing, and reinforcement. At home adherence to daily PEF monitoring during the 16-week study was assessed by a hand-held computerized monitor, the AccuTrax Personal Diary Spirometer, which internally records the date, time, and PEF value. Adherence was measured as a proportion (expressed as a percentage) of actual versus prescribed daily PEF monitoring.
Results:  During baseline, there was no difference between the intervention and control groups for adherence to twice daily monitoring (Mdn = 43%; U = .1, p = .8). At Week 16, the intervention group adherence rate (Mdn = 71%) for daily PEF monitoring was higher than that of the control group (Mdn = 57%; U = 3.8, p = .05); and children who were more adherent to PEF monitoring were less likely to have an asthma episode than those who were less adherent (x2 = 4.3, p =  .04).
Conclusions: Children receiving the nurse-administered asthma education and contingency management intervention demonstrated higher adherence to PEF monitoring than control group children. This research is significant in the evaluation of effective interventions for teaching children to manage their asthma at home.
This study was supported by a grant from the National Institute of Nursing Research, National Institutes of Health, Grant # R15 NR08106-01.

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