Using question prompt lists during pediatric asthma visits to increase child involvement

Research project

Description

Active adolescent participation during medical visits is an important way for adolescents who have chronic diseases such as asthma to address self-management problems. Prior research has found that adolescents are not actively involved during their medical visits. In fact, our prior work found that only 13% of teens asked questions about asthma management during their medical visits (Sleath et al. 2011). Also, we found that 78% of teens expressed one or more asthma medication problems yet only 11% asked a question about their medications during their medical visits. One potential way to increase adolescent participation and ultimately asthma self-management behaviors is through the use of “question prompt lists”. A question prompt list is a list of common questions an adolescent might want to ask their doctor about their condition. We developed our asthma “question prompt list” using the actual questions asked by children/teens ages 8 through 16 during 296 asthma visits between 2006 and 2009. We then showed the prompt list to 20 children/teens with asthma in 2012; 80% of the children/teens with asthma said the “question prompt list” would be very useful to help them ask more questions during their visits. This research is of interest to adolescents with asthma, their parents, and stakeholders because it helps encourage adolescents to actively participate during their medical visits, allowing them to learn how to better manage their asthma. When adolescents manage their asthma better, this can result in improve asthma control, fewer missed schools days, and better quality of life. OBJECTIVES Our objectives are to: (1) conduct focus groups with providers, parents, and adolescents to: a) determine how to encourage parents to have adolescents actively use the question prompt list during their asthma visits and b) identify ways to improve the question prompt list intervention, (2) develop and pilot test a brief video educational program for parents and adolescents on the importance of encouraging adolescents to ask questions about their asthma, and (3) conduct a randomized controlled trial to compare the effectiveness of an “asthma question prompt list” intervention with an usual care group. The long term objective is to develop an intervention that can be used in diverse pediatric settings to actively involve adolescents more during their asthma visits. METHODS We will conduct focus groups with providers and parents and adolescents from diverse cultural backgrounds, to determine how to involve adolescents during pediatric asthma visits and how to improve the question prompt list. Thematic analysis of qualitative focus groups transcripts will be used to identify methods to encourage active adolescent participation and ways to improve the prompt list. The themes will be incorporated into a short video educational program that emphasizes the importance of engaging adolescents in meaningful conversation during their medical visits. We will enroll 360 adolescents ages 11 through 17 with asthma from 4 pediatric practices in North Carolina. Adolescents will be randomized to the intervention or control group. If an adolescent is in the intervention group: (a) the adolescent and parent will view the brief educational program on encouraging adolescent question asking and involvement during visits and (b) adolescents will receive the prompt lists. We will stratify enrollment and enroll equal numbers of African American, Hispanic, and White children at each clinic. The adolescents in the intervention group will be compared with adolescents who receive usual care. Adolescents' medical visits will be audio-tape recorded and adolescents will be interviewed after the baseline visit and 6 and 12 months later. PATIENT OUTCOMES (PROJECTED)Our primary outcomes are asthma control, adolescent self-efficacy in managing asthma, and adolescent quality-of-life. Our secondary outcomes are the number of questions adolescents ask during visits, whe
StatusFinished
Effective start/end date12/1/1411/30/17

Funding

  • Patient-Centered Outcomes Research Institute (PCORI)

Fingerprint

Asthma
Pediatrics
Parents
Focus Groups
Self Care
Quality of Life