Promoting Adherence: Theory-based Asthma Education
Objective: To determine the effectiveness of an audiotaped asthma education program that incorporates components of Protection Motivation Theory (PMT) on asthma knowledge, asthma medication adherence, asthma control, asthma self-efficacy, and asthma quality of life.
Design: This study utilizes a 2 x 2 factorial design with 40 adult asthmatics who are randomly assigned to one of three intervention groups or standard provider education. The intervention groups include audiotape alone, audiotape plus NHLBI brochure, or brochure alone.
Population, Sample, Setting, Years: The study is being conducted in the research office at the College of Nursing. Adult males and females of all ethnic backgrounds have been recruited into the study. Participants must be English speaking and must have been prescribed an asthma preventive medication such as an inhaled corticosteroid within the past year. Participants will be excluded if they report daily oral steroid use or diagnoses of COPD or symptomatic cardiac disease. Recruitment has been conducted in clinical settings and in African American churches in an effort to approximate the ethnicity of Alachua County which is 19% African American.
Intervention and Outcome Variables: The experimental intervention "Bob's Lung Story" is a 30 minute audiotape developed to incorporate the five components described by National heart Lung and Blood Institute (NHLBI, 1997) as critical to asthma self-management. "Bob's Lung Story" utilizes a story line that models behavior through a character's experience with an acute asthma episode and subsequent efforts to manage his symptoms. The inclusion of alternate lyrics set to popular tunes emphasizes key points of asthma management. The story line incorporates Protection Motivation Theory components (vulnerability, severity, self-efficacy, and treatment efficacy) as Bob moves through diagnosis, confusion with treatment, and finally mastery of asthma care. A published Protection Motivation theorist substantiated the inclusion of key components of PMT within the audiotaped program.
Outcome variables include asthma medication adherence (self-reported and pharmacist verified), asthma self-efficacy, asthma control, and asthma quality of life. Asthma self-efficacy (PCAQ), asthma control (ACQ) and asthma quality of life (mini-AQLQ) are determined using validated, reliable questionnaires that utilize Likert scales. The ACQ also includes objective lung function measured by in-office spirometry. Changes of 0.5 are considered clinically significant for the ACQ and AQLQ; a change of 6 is considered significant for the PCAQ. Asthma knowledge is determined with a researcher-developed 33-item true-false test based on NHLBI learning domains. Content validity was determined for this instrument by expert clinicians and initial internal consistency was .723 using KR-20.
Preliminary power calculations were carried out for the PCAQ, ACQ, and mini-AQLQ since these instruments have published reliability and validity data on which to base the variance parameter. For all power calculations it was assumed that the audiotaped intervention would result in the published clinically significant change score, the brochure alone would result in 50% of the clinically significant change score, combined audiotape and brochure and brochure would be 50% above the clinically significant change score, and there would be no difference in the standard intervention group. For N=40, the ACQ yields a power of 0.38 for the brochure and 0.88 for the audiotape. The PCAQ yields a power of 0.42 for the brochure and 0.90 for the audiotape. The mini-ACLQ yields a power of 0.17 for the brochure and 0.41 for the audiotape.
Methods: Participants will be evaluated at baseline, and at three and six months. Hypotheses will be tested using summary statistics for demographic data and with analysis of variance for PCAQ, ACQ, mini-AQLQ, and treatment adherence scores. The ANOVA model is appropriate for these scores since the range of the scales is such that the change scores will be approximately normally distributed. The analysis of change scores will be carried out using a standard analysis of variance (ANOVA) model with the main effects as described and an interaction term crossing audiotaped intervention with educational brochure. All tests will be two-sided and tested at level alpha=0.05.
Findings/Conclusion/Implications: This study will be completed by August 2002. Knowledge gained by this study will provide direction for further research in the use of theoretical models of adherence to develop cost-effective asthma education.
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