A randomized clinical trial of a culturally responsive intervention for African American women with asthma. Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community Goal-setting intervention in patients with active asthma: protocol for a pilot cluster-randomised controlled trial Impact of Goal Setting and Goal Attainment Methods on Asthma Outcomes Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma A randomized controlled trial of a self-regulation intervention for older adults with asthma. Home-based family intervention for low-income children with asthma: a randomized controlled pilot study. Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial. Motivational training improves self-efficacy but not short-term adherence with asthma self-management: a randomized controlled trial. PELICAN: a cluster-randomized controlled trial in Dutch general practices to assess a self-management support intervention based on individual goals for children with asthma PELICAN: A quality of life instrument for childhood asthma: Study Protocol of two Randomized Controlled Trials in Primary and Specialized Care in the Netherlands
BACKGROUND Few interventions have focused on the difficulties that African American women face when managing asthma . OBJECTIVE To evaluate a telephone-based self-regulation intervention that emphasized African American women 's management of asthma in a series of 6 sessions . METHODS A total of 422 African American women with persistent asthma were r and omly assigned to either an intervention or control group receiving usual care .  Behavioral factors , symptoms and asthma control , asthma-related quality of life , and health care use at baseline and 2 years after baseline were assessed . Generalized estimating equations were used to assess the long-term effect of the intervention on outcomes . RESULTS Compared with the control group , those who completed the full intervention ( 6 sessions ) had significant gains in self-regulation of their asthma ( B estimate , 0.73 ; 95 % CI , 0.17 - 1.30 ; P < .01 ) , noticing changes to their asthma during their menstrual cycle ( B estimate , 1.42 ; 95 % CI , 0.69 - 2.15 ; P < .001 ) , and when having premenstrual syndrome ( B estimate , 1.70 ; 95 % CI , 0.67 - 2.72 ; P < .001 ) . They also had significant reductions in daytime symptoms ( B estimate , -0.15 ; 95 % CI , -0.27 to -0.03 ; P < .01 ) , asthma-related hospitalization ( B estimate , 0.51 ; 95 % CI , 0.00 - 1.02 ; P < .05 ) , and improved asthma control ( B estimate , 1.34 ; 95 % CI , 0.57 - 2.12 ; P < .001 ) . However , neither grouped changed over time in outcomes . CONCLUSION Despite high comorbidity , African American women who completed a culturally responsive self-management program had improvements in asthma outcomes compared with the control group . Future work should address significant comorbidities and psychosocial issues alongside asthma management to improve asthma outcomes in the long term . TRIAL REGISTRATION clinical trials.gov Identifier NCT01117805 Background : Despite national disease management plans , optimal asthma management remains a challenge in Australia . Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current st and ards of best practice . The impact of the Pharmacy Asthma Care Program ( PACP ) on asthma control was assessed using a multi-site r and omised intervention versus control repeated measures study design . Methods : Fifty Australian pharmacies were r and omised into two groups : intervention pharmacies  implemented the PACP ( an ongoing cycle of assessment , goal setting , monitoring and review )  to 191 patients over 6 months , while control pharmacies gave their usual care to 205 control patients . Both groups administered question naires and conducted spirometric testing at baseline and 6 months later . The main outcome measure was asthma severity/control status . Results : 186 of 205 control patients ( 91 % ) and 165 of 191 intervention patients ( 86 % ) completed the study . The intervention result ed in improved asthma control : patients receiving the intervention were 2.7 times more likely to improve from “ severe ” to “ not severe ” than control patients ( OR 2.68 , 95 % CI 1.64 to 4.37 ; p<0.001 ) . The intervention also result ed in improved adherence to preventer medication ( OR 1.89 , 95 % CI 1.08 to 3.30 ; p = 0.03 ) , decreased mean daily dose of reliever medication ( difference −149.11 μg , 95 % CI −283.87 to −14.36 ; p = 0.03 ) , a shift in medication profile from reliever only to a combination of preventer , reliever with or without long-acting β agonist ( OR 3.80 , 95 % CI 1.40 to 10.32 ; p = 0.01 ) and improved scores on risk of non-adherence ( difference −0.44 , 95 % CI −0.69 to −0.18 ; p = 0.04 ) , quality of life ( difference −0.23 , 95 % CI −0.46 to 0.00 ; p = 0.05 ) , asthma knowledge ( difference 1.18 , 95 % CI 0.73 to 1.63 ; p<0.01 ) and perceived control of asthma question naires ( difference −1.39 , 95 % CI −2.44 to −0.35 ; p<0.01 ) . No significant change in spirometric measures occurred in either group . Conclusions : A pharmacist-delivered asthma care programme based on national guidelines improves asthma control . The sustainability and implementation of the programme within the healthcare system remains to be investigated Background Supporting self-management behaviours is recommended guidance for people with asthma . Preliminary work suggests that a brief , intensive , patient-centred intervention may be successful in supporting people with asthma to participate in life roles and activities they value . We seek to assess the feasibility of undertaking a cluster-r and omised controlled trial ( c RCT ) of a brief , goal - setting intervention delivered in the context of an asthma review consultation . Methods / design A two armed , single-blinded , multi-centre , cluster-r and omised controlled feasibility trial will be conducted in UK primary care . R and omisation will take place at the practice level . We aim to recruit a total of 80 primary care patients with active asthma from at least eight practice s across two health boards in Scotl and ( 10 patients per practice result ing in ~40 in each arm ) . Patients in the intervention arm will be asked to complete a novel goal - setting tool immediately prior to an asthma review consultation . This will be used to underpin a focussed discussion about their goals during the asthma review . A tailored management plan will then be negotiated to facilitate achieving their prioritised goals . Patients in the control arm will receive a usual care guideline -based review of asthma . Data on quality of life , asthma control and patient confidence will be collected from both arms at baseline and 3 and 6 months post-intervention . Data on health services re source use will be collected from all patient records 6 months pre- and post-intervention . Semi-structured interviews will be carried out with healthcare staff and a purposive sample of patients to elicit their views and experiences of the trial . The outcomes of interest in this feasibility trial are the ability to recruit patients and healthcare staff , the optimal method of delivering the intervention within routine clinical practice , and acceptability and perceived utility of the intervention among patients and staff . Trial registration IS RCT Optimal use of goal - setting strategies in self-management efforts with high-risk individuals with asthma is not well understood . This study aim ed to describe factors associated with goal attainment in an asthma self-management intervention for African American women with asthma and determine whether goal attainment methods proved beneficial to goal achievement and improved asthma outcomes . Data came from 212 African American women in the intervention arm of a r and omized clinical trial evaluating a telephone-based asthma self-management program . Telephone interview data were collected to assess goals and goal attainment methods identified , asthma symptoms , asthma control , and asthma-related quality of life at baseline and 2-year follow-up . Generalized estimating equations were used to assess the long-term impact of goal setting and goal attainment methods on outcomes .  The average age of the sample was 42.1 years ( SD = 14.8 ) . Factors associated with goal attainment included higher education ( p < .01 ) and fewer depressive symptoms ( p < .01 ) . Using a goal attainment method also result ed in more goals being achieved over the course of the intervention ( Estimate [ SE ] = 1.25 [ 0.18 ] ; p < .001 ) when adjusted for clinical and demographic factors . Use of and types of goal attainment methods and goals were not found to significantly affect asthma control , quality of life , or frequency of nighttime asthma symptoms at follow-up . Using a method to achieve goals led to greater goal attainment . Goal attainment alone did not translate into improved asthma outcomes in our study sample . Further studies are warranted to assess the challenges of self-management in chronic disease patients with complex health needs and how goal setting and goal attainment methods can be strategically integrated into self-management efforts to improve health endpoints Background Despite being a core component of self-management , goal setting is rarely used in routine care . We piloted a primary care , nurse-led intervention called Achieving Good Outcomes for Asthma Living ( GOAL )  for adults with asthma . Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review . Methods The 18-month mixed methods feasibility cluster pilot trial stratified and then r and omised practice s to deliver usual care ( UC ) or a goal - setting intervention ( GOAL ) . Practice asthma nurses and adult patients with active asthma were invited to participate . The primary outcome was asthma-specific quality of life . Semi-structured interviews with a purposive patient sample ( n = 14 ) and 10 participating nurses explored GOAL perception . The constructs of normalisation process theory ( NPT ) were used to analyse and interpret data . Results Ten practice s participated ( five in each arm ) , exceeding our target of eight . However , only 48 patients ( target 80 ) were recruited ( 18 in GOAL practice s ) . At 6 months post-intervention , the difference in mean asthma-related quality of life ( mAQLQ ) between intervention and control was 0.1 ( GOAL 6.20 : SD 0.76 ( CI 5.76–6.65 ) versus UC 6.1 : SD 0.81 ( CI 5.63–6.57 ) ) , less than the minimal clinical ly important difference ( MCID ) of 0.5 . However , change from baseline was stronger in the intervention group : at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control . Costs were higher in the intervention group by £ 22.17.Routine review with goal setting was considered more holistic , enhancing rapport and enabling patients to become active rather than passive participants in healthcare . However , time was a major barrier for nurses , who admitted to screening out patient goals they believed were unrelated to asthma . Conclusions The difference in AQLQ score from baseline is larger in the intervention arm than the control , indicating the intervention may have impact if appropriately strengthened . The GOAL intervention changed the review dynamic and was well received by patients , but necessitated additional time , which was problematic in the confines of the traditional nurse appointment . Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster r and omised controlled trial . Trial registration IS RCT N18912042 . Registered on 26 June 2012 OBJECTIVES To evaluate a self-regulation intervention for asthma for older adults . DESIGN A blinded r and omized controlled trial . SETTING Single-center tertiary care academic center . PARTICIPANTS Seventy older adults aged 65 and older with persistent asthma r and omized to an intervention or control group . INTERVENTION Participants participate in a six-session program conducted over the telephone and in group sessions . Participants selected an asthma-specific goal , identified problems , and addressed potential barriers . MEASUREMENTS Outcomes were assessed at 1 , 6 , and 12 months and included the mini-Asthma Quality of Life Question naire ( mAQLQ ) , Asthma Control Question naire ( ACQ ) , healthcare utilization , exhaled nitric oxide ( FENO ) , and percentage of predicted forced expiratory volume in 1 second ( FEV1 % ) . RESULTS The mAQLQ score was significantly higher in the intervention group at 1 , 6 , and 12 months , even after controlling for confounding factors . The between-group difference decreased over time , although at 12 months , it remained greater than 0.5 points . The ACQ was better in the intervention group than in the control group at 1 , 6 , and 12 months . At 12 months , those in the intervention group were 4.2 times as likely as those in the control group to have an ACQ score in the controlled range . Healthcare utilization was lower in the intervention group , although no difference was observed in FENO or predicted FEV1 % . CONCLUSION A self-regulation intervention can improve asthma control , quality of life , and healthcare utilization in older adults Low-income African American children have disproportionately higher asthma morbidity and mortality . Education alone may not address barriers to asthma management due to psychosocial stress . This study evaluated the efficacy of a home-based family intervention integrating asthma education and strategies to address stress using a community-based participatory research model . Children age 8 to 13 with poorly controlled asthma and their caregivers were recruited from an urban hospital and an asthma camp . Caregivers with elevated scores on a stress measure were enrolled . Forty-three families were r and omized to the 4- to 6-session Home Based Family Intervention ( HBFI ) or the single session of Enhanced Treatment as Usual ( ETAU ) . All families received an asthma action plan and dust mite covers ; children performed spirometry and demonstrated MDI/spacer technique at each home visit . The HBFI addressed family-selected goals targeting asthma management and stressors . Asthma management , morbidity , family functioning , and caregiver stress were assessed at baseline , postintervention , and 6 months after the intervention . ED visits and hospitalizations were ascertained by medical record review for a year after intervention completion . Only one child ( 5 % ) in HBFI had an asthma-related hospitalization compared to 7 patients ( 35 % ) in ETAU in the year following intervention . Participants in both groups demonstrated improved asthma management and family functioning , and reduced ED visits , symptom days , missed school days , and caregiver stress , but there were no differential treatment effects . The results suggest that a home-based intervention addressing medical and psychosocial needs may prevent hospitalizations for children with poorly controlled asthma and caregivers under stress BACKGROUND Adopting healthy behaviors is critical for secondary stroke prevention , but many patients fail to follow national guidelines regarding diet , exercise , and abstinence from risk factors . Compliance often decreases with time after hospital discharge , yet few studies have examined programs promoting long-term adherence to health behaviors . Goal setting and telephone follow-up have been proven to be effective in other areas of medicine , so this study evaluated the effectiveness of a guideline -based , goal - setting telephone follow-up program for patients with ischemic stroke . METHODS This was a multicenter , assessor-blinded , parallel-group , r and omized controlled trial . Ninety-one stroke patients were r and omized to either a control group or an intervention group . Intervention consisted of predischarge education and 3 goal - setting follow-up sessions conducted by phone . Data were collected at baseline and during the third and sixth months after hospital discharge . RESULTS Six months after discharge , patients in the intervention group exhibited significantly higher medication adherence than patients in the control group . There were no statistically significant differences in physical activity , nutrition , low-salt diet adherence , blood pressure monitoring , smoking abstinence , unhealthy use of alcohol , and modified Rankin Scale ( mRS ) scores between the 2 groups . CONCLUSIONS Goal - setting telephone follow-up intervention for ischemic stroke patients is feasible and leads to improved medication adherence . However , the lack of group differences in other health behavior subcategories and in themRS score indicates a need for more effective intervention strategies to help patients reach guideline -recommended targets BACKGROUND Adherence to self-management in asthma is poor . AIM To investigate the effect of disease-unspecific motivational training on self-management adherence in addition to asthma-specific patient education . METHODS We r and omized patients with partly controlled asthma to asthma education , with or without the Zurich Re source Model ( ZRM ) training .  Main elements of the ZRM training are development of action-oriented personal goals and activation of re sources to achieve and practice them in daily life . The primary outcome was adherence to self-monitoring and to a written personal action plan  during three months . Secondary outcomes included patient-reported self-efficacy . RESULTS As control patients ( n=30 ) were younger , mostly male and had better asthma control compared with the intervention group ( n=30 ) , we adjusted the analyses for these imbalances . Both groups showed excellent adherence to self-monitoring over three months [ 27 patients ( 90.0 % ) in intervention and 25 patients ( 83.3 % ) in control group , adjusted odds ratio : 1.28 ( 0.24 - 6.78 ) , P=0.78 ) ] . Patients in the ZRM group tended to adjust their medication more often [ median 36 % days with action ( IQR 11 - 62 % ) ] than control patients [ 9 % ( 0 - 43 ) , P=0.18 ] . In both groups , actions were rarely in accordance with the action plan [ median 20 % of actions appropriate ( IQR 0 - 37 ) in intervention and 11 % ( IQR 0 - 56 ) in control group , P=0.92 ] . After three months , self-efficacy was significantly better with ZRM ( adjusted difference on self-efficacy scale 2.31 , 95 % CI 0.31 - 4.31 , P=0.02 ) . CONCLUSION Unspecific self-management training had no short-term effect on self-management adherence in asthma patients .  Self-efficacy improved , but it is uncertain whether this translates into better long-term outcomes Abstract Objective : Insufficient asthma management leads to impaired health-related quality of life ( HRQL ) . The aim of this study is to assess whether individualized self-management ( ISM ) support will improve HRQL in children with asthma compared to enhanced usual care ( EUC ) in Dutch general practice s. Methods : A cluster-r and omized controlled trial with 9-month follow-up . ISM is a nurse-led intervention that is optimized to the needs of children , leading to a written action plan . Power calculation dem and ed inclusion of 170 children ( aged 6–11 years ) diagnosed with asthma and active medication use . Results : Outcomes were HRQL of the child ( Paediatric Asthma Quality of Life Question naire , PAQLQ-s ) and several secondary outcomes . Data of 29 children ( mean age 8.6 years , SD 1.7 ) were analyzed ; ISM ( n = 15 ) or EUC ( n = 14 ) . Logistic regression analysis ( minimal clinical important difference ; MCID ≥ 0.5 ) and descriptive analyses were performed . Despite high PAQLQ-s score at baseline ( median ISM 6.35 , EUC 6.02 ) , a substantial number of subjects from both groups showed MCID of HRQL ( ISM 33 % , EUC 57 % ) . Treatment differences on HRQL were not significant ( OR 0.38 , 95 % CI 0.08 , 1.69 ) . Secondary outcomes did not show significant differences either , with exception of PAQLQ-s symptoms domain score in favor of EUC . Conclusion : Due to recruitment problems and underpowered analyses , no firm conclusions on the effectiveness of ISM support for childhood asthma in primary care could be drawn . Still , this study can be considered a valuable pilot study and in the future , there might be better capacity in general practice s to commit to such treatment Background Asthma is one of the major chronic health problems in children in the Netherl and s. The Pelican is a paediatric asthma-related quality of life instrument for children with asthma from 6–11 years old , which is suitable for clinical practice in primary and specialized care . Based on this instrument , we developed a self-management treatment to improve asthma-related quality of life .  The Pelican intervention will be investigated in different health care setting s. Results of intervention studies are often extrapolated to other health care setting s than originally investigated . Because of differences in organization , disease severity , patient characteristics and care provision between health care setting s , extrapolating research results could lead to unnecessary health costs without the desired health care achievements . Therefore , interventions have to be investigated in different health care setting s when possible . This study is an example of an intervention study in different health care setting s. In this article , we will present the study protocol of the Pelican study in primary and specialized care . Method / design This study consists of two r and omized controlled trials to assess the effectiveness of the Pelican intervention in primary and specialized care . The trial in primary care is a multilevel design with 170 children with asthma in 16 general practice s. All children in one general practice s are allocated to the same treatment group . The trial in specialized care is a multicentre trial with 100 children with asthma . Children in one outpatient clinic are r and omly allocated to the intervention or usual care group . In both trials , children will visit the care provider four times during a follow-up of nine months . This study is registered and ethically approved . Discussion This article describes the study protocol of the Pelican study in different health care setting s. If the Pelican intervention proves to be effective and efficient , implementation in primary and specialized care for paediatric asthma in the Netherl and s will be recommended . Trial registration This study is registered by clinical trial.gov ( NCT01109745
Background Asthma self-management education combining with behavior therapy is considered to be more effective .
Goal setting is a common behavior change technique used to help patients self-manage their symptoms .
However , empirical evidence around its effectiveness on asthma management lacks clarity .
Aims To systematic ally integrate and appraise the evidence for effectiveness of goal setting interventions on asthma outcomes .