A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes. Evaluation of a web-based asthma self-management system: a randomised controlled pilot trial An internet-based interactive telemonitoring system for improving childhood asthma outcomes in Taiwan. Evidence-based behavioral medicine: What is it and how do we achieve it? The DAILY (Daily Automated Intensive Log for Youth) trial: a wireless, portable system to improve adherence and glycemic control in youth with diabetes. The Contribution of Social Networks to the Health and Self-Management of Patients with Long-Term Conditions: A Longitudinal Study A randomized trial to test the effectiveness of art therapy for children with asthma. Improving the Psychological Status of Children with Asthma: A Randomized Controlled Trial Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial Randomized controlled trial of an Internet-delivered family cognitive–behavioral therapy intervention for children and adolescents with chronic pain Effect of relaxation-breathing training on anxiety and asthma signs/symptoms of children with moderate-to-severe asthma: a randomized controlled trial. A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial Building Life Skills for Children With Cystic Fibrosis: Effectiveness of an Intervention An Internet-based Self-management Program with Telephone Support for Adolescents with Arthritis: A Pilot Randomized Controlled Trial Headstrong: a pilot study of a CD-ROM intervention for recurrent pediatric headache. Randomized Trial of Behavioral Family Systems Therapy for Diabetes Controlled evaluation of the STARBRIGHT CD-ROM program for children and adolescents with Cystic Fibrosis. An Internet-Based Program to Improve Self-Management in Adolescents With Type 1 Diabetes Efficacy of Psychosocial Group Intervention for Children With Chronic Illness and Their Parents A randomized, controlled pilot trial of a school intervention for children with sickle cell anemia. Breathe Easier Online: Evaluation of a Randomized Controlled Pilot Trial of an Internet-Based Intervention to Improve Well-being in Children and Adolescents With a Chronic Respiratory Condition Incorporating family therapy into asthma group intervention: a randomized waitlist-controlled trial. Peer-led Education for Adolescents With Asthma in Jordan: A Cluster-Randomized Controlled Trial Re-thinking the relationship between long-term condition self-management education and the utilisation of health services. A Randomized, Controlled Trial of an Interactive Educational Computer Package for Children With Asthma Efficacy of cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. An interdisciplinary intervention for undertreated pediatric asthma. A practitioner-based asthma intervention program with African American inner-city school children. Rural Children with Asthma: Impact of a Parent and Child Asthma Education Program Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes. Effectiveness of a multicomponent self-management program in at-risk, school-aged children with asthma. A randomized controlled trial of asthma self-management support comparing clinic-based nurses and in-home community health workers: the Seattle-King County Healthy Homes II Project. Benefits of an education programme on the self-management of aerosol and airway clearance treatments for children with cystic fibrosis A web-based, tailored asthma management program for urban African-American high school students. Internet-enabled interactive multimedia asthma education program: a randomized trial. A randomized controlled trial of telephone calls to young patients with poorly controlled type 1 diabetes. Effects of a peer-led asthma self-management program for adolescents. A problem-solving intervention for children with persistent asthma: A pilot of a randomized trial at a pediatric summer camp Chronic disease management: what will it take to improve care for chronic illness? Testing the transition preparation training program: A randomized controlled trial. Development and evaluation of an educational interactive CD-ROM for teens with cancer. Computer game for inner-city children does not improve asthma outcomes. Adherence to antiretroviral therapy in HIV-infected pediatric patients improves with home-based intensive nursing intervention. A pilot randomized control trial to evaluate the feasibility of an Internet-based self-management and transitional care program for youth with haemophilia. Motivational Enhancement System for Adherence (MESA): pilot randomized trial of a brief computer-delivered prevention intervention for youth initiating antiretroviral treatment.
AIMS To assess Sweet Talk , a text-messaging support system design ed to enhance self-efficacy , facilitate uptake of intensive insulin therapy and improve glycaemic control in paediatric patients with Type 1 diabetes . METHODS One hundred and twenty-six patients fulfilled the eligibility criteria ; Type 1 diabetes for > 1 year , on conventional insulin therapy , aged 8 - 18 years . Ninety-two patients were r and omized to conventional insulin therapy  ( n = 28 ) , conventional therapy and Sweet Talk ( n = 33 ) or  intensive insulin therapy and Sweet Talk ( n = 31 ) . Goal - setting at clinic visits was reinforced by daily text-messages from the Sweet Talk software system , containing personalized goal -specific prompts and messages tailored to patients ' age , sex and insulin regimen . RESULTS HbA(1c ) did not change in patients on conventional therapy without or with Sweet Talk ( 10.3 + /- 1.7 vs. 10.1 + /- 1.7 % ) , but improved in patients r and omized to intensive therapy and Sweet Talk ( 9.2 + /- 2.2 % , 95 % CI -1.9 , -0.5 , P < 0.001 ) . Sweet Talk was associated with improvement in diabetes self-efficacy  ( conventional therapy 56.0 + /- 13.7 , conventional therapy plus Sweet Talk 62.1 + /- 6.6 , 95 % CI + 2.6 , + 7.5 , P = 0.003 ) and self-reported adherence  ( conventional therapy 70.4 + /- 20.0 , conventional therapy plus Sweet Talk 77.2 + /- 16.1 , 95 % CI + 0.4 , + 17.4 , P = 0.042 ) . When surveyed , 82 % of patients felt that Sweet Talk had improved their diabetes self-management and 90 % wanted to continue receiving messages . CONCLUSIONS Sweet Talk was associated with improved self-efficacy and adherence ; engaging a classically difficult to reach group of young people . While Sweet Talk alone did not improve glycaemic control , it may have had a role in supporting the introduction of intensive insulin therapy . Scheduled , tailored text messaging offers an innovative means of supporting adolescents with diabetes and could be adapted for other health-care setting s and chronic diseases Background Asthma is the most common chronic condition of childhood and disproportionately affects inner-city minority children . Low rates of asthma preventer medication adherence is a major contributor to poor asthma control in these patients . Web-based methods have potential to improve patient knowledge and medication adherence by providing interactive patient education , monitoring of symptoms and medication use , and by facilitation of communication and teamwork among patients and health care providers . Few studies have evaluated web-based asthma support environments using all of these potentially beneficial interventions . The multidimensional website created for this study , BostonBreathes , was design ed to intervene on multiple levels , and was evaluated in a pilot trial . Methods An interactive , engaging website for children with asthma was developed to promote adherence to asthma medications , provide a platform for teamwork between caregivers and patients , and to provide primary care providers with up-to- date symptom information and data on medication use . Fifty-eight ( 58 ) children primarily from inner city Boston with persistent-level asthma were r and omised to either usual care or use of BostonBreathes . Subjects completed asthma education activities , and reported their symptoms and medication use . Primary care providers used a separate interface to monitor their patients ’ website use , their reported symptoms and medication use , and were able to communicate online via a discussion board with their patients and with an asthma specialist . Results After 6-months , reported wheezing improved significantly in both intervention and control groups , and there were significant improvements in the intervention group only in night-time awakening and parental loss of sleep , but there were no significant differences between intervention and control groups in these measures . Emergency room or acute visits to a physician for asthma did not significantly change in either group . Among the subgroup of subjects with low controller medication adherence at baseline , adherence improved significantly only in the intervention group . Knowledge of the purpose of controller medicine increased significantly in the intervention group , a statistically significant improvement over the control group . Conclusions This pilot study suggests that a multidimensional web-based educational , monitoring , and communication platform may have positive influences on pediatric patients ’ asthma-related knowledge and use of asthma preventer medications A r and omized , controlled trial was conducted to assess the effectiveness of Blue Angel for Asthma Kids , an Internet-based interactive asthma educational and monitoring program , used in the management of asthmatic children . One hundred sixty-four ( n = 164 ) pediatric patients with persistent asthma were enrolled and r and omized into two study groups for a 12-week controlled trial . The intervention group had 88  participants who were taught to monitor their peak expiratory flows ( PEF ) and asthma symptoms daily on the Internet . They also received an interactive response consisting of a self-management plan from the Blue Angel monitoring program . The control group had 76 participants who received a traditional asthma care plan consisting of a written asthma diary supplemented with instructions for self-management . Disease control was assessed by weekly averaged PEF values , symptom scores , and asthma control tests . Adherence measures were assessed by therapeutic and diagnostic monitoring . Outcome was assessed by examining quality of life and retention of asthma knowledge . The data were analyzed by comparing results before and after the trial . At the end of trial , the intervention group decreased nighttime ( -0.08 + /- 0.33 vs. 0.00 + /- 0.20 , p = 0.028 ) and daytime symptoms ( -0.08 + /- 0.33 vs. 0.01 + /- 0.18 , p = 0.009 ) ; improved morning ( 241.9 + /- 81.4 vs. 223.1 + /- 55.5 , p = 0.017 ) and night PEF ( 255.6 + /- 86.7 vs. 232.5 + /- 55.3 , p = 0.010 ) ; increased adherence rates ( p < 0.05 ) ; improved well-controlled rates ( 70.4 % vs. 55.3 % , p < 0.05 ) ; improved knowledge regarding self-management ( 93.2 % vs. 70.3 % , p < 0.05 ) ; and improved quality of life ( 6.5 + /- 0.5 vs. 4.3 + /- 1.2 on a 7-point scale , p < 0.05 ) when compared with conventional management . The Internet-based asthma telemonitoring program increases selfmanagement skills , improves asthma outcomes , and appears to be an effective and well-accepted technology for the care of children with asthma and their caregivers The goal of evidence -based medicine is ultimately to improve patient outcomes and quality of care .  Systematic review s of the available published evidence are required to identify interventions that lead to improvements in behavior , health , and well-being . Authoritative literature review s depend on the quality of published research and research reports . The Consoli date d St and ards for Reporting Trials ( CONSORT ) Statement ( www.consort-statement.org ) was developed to improve the design and reporting of interventions involving r and omized clinical trials ( RCTs ) in medical journals . We describe the 22 CONSORT guidelines and explain their application to behavioral medicine research and to evidence -based practice . Additional behavioral medicine-specific guidelines ( e.g. , treatment adherence ) are also presented . Use of these guidelines by clinicians , educators , policymakers , and research ers who design , report , and evaluate or review RCTs will strengthen the research itself and accelerate efforts to apply behavioral medicine research to improve the processes and outcomes of behavioral medicine practice Blood glucose ( BG ) monitoring ( BGM ) is an important component of diabetes management . New wireless technologies may facilitate BGM and help to optimize glycemic control . We evaluated an integrated wireless approach with and without a motivational game in youth with diabetes . Forty youth , 8 - 18 years old , each received a h and held device fitted with a wireless modem and diabetes data management software , plus a wireless-enabled BG monitor . Half were r and omized to receive the new technologies along with an integrated motivational game in which the participants would guess a BG level following collection of three earlier readings ( Game Group ) . BG data , insulin doses , and carbohydrate intake were displayed graphically prior to the glucose estimation . The other group received the new technologies alone ( Control Group ) . Both groups were instructed to perform BGM four times daily and transmit their data to a central server via the wireless modem . Feasibility of implementation and outcomes were ascertained after 4 weeks . Ninety-three percent of participants successfully transmitted their data wirelessly to the server . The Game Group transmitted significantly more glucose values than the Control Group ( P < 0.001 ) . The Game Group also had significantly less hyperglycemia ( glucose > /=13.9 mmol/L or > /=250 mg/dL ) than the Control Group ( P < 0.001 ) . Youth in the Game Group displayed a significant increase in diabetes knowledge over the 4-week trial ( P < 0.005 ) . Finally , there was a trend for more youth in the Game Group to maintain hemoglobin A1C values < /=8 % ( P = 0.06 ) . Thus a pediatric population with diabetes can successfully implement new technologies to facilitate BGM . Use of a motivational game appears to increase the frequency of monitoring , reduce the frequency of hyperglycemia , and improve diabetes knowledge , and may help to optimize glycemic control Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal . More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of re sources needed for long-term condition self-management to be effective . Aim To determine how the social networks of people with long-term conditions ( diabetes and heart disease ) are associated with health-related outcomes and changes in outcomes over time . Methods Patients with chronic heart disease ( CHD ) or diabetes ( n = 300 ) r and omly selected from the disease registers of 19 GP practice s in the North West of Engl and . Data on personal social networks collected using a postal question naire , alongside face-to-face interviewing . Follow-up at 12 months via postal question naire using a self-report grid for network members identified at baseline . Analysis Multiple regression analysis of relationships between health status , self-management and health-economics outcomes , and characteristics of patients ' social networks . Results Findings indicated that : ( 1 ) social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being ; ( 2 ) support work undertaken by personal networks exp and s in accordance with health needs helping people to cope with their condition ; ( 3 ) network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs . Health service costs were significantly ( p<0.01 ) reduced for patients receiving greater levels of illness work through their networks . Conclusions Support for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon . This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups and re sources for producing a more desirable and cost-effective way of supporting long term illness management BACKGROUND Art therapy has been used to help children cope with chronic illness but has not been specifically tested with children who have asthma . OBJECTIVE To test an art therapy intervention in a r and omized controlled trial in children with asthma . METHODS Twenty-two children with asthma were r and omized to an active art therapy or wait-list control group . Those in the active art therapy group participated in 60-minute art therapy sessions once a week for 7 weeks . Sessions included specific art therapy tasks design ed to encourage expression , discussion , and problem-solving in response to the emotional burden of chronic illness . Measures taken at baseline , immediately after , and 6 months after the final art therapy session included the Formal Elements Art Therapy Scale applied to the Person Picking an Apple from a Tree assessment , the parent and child versions of the Pediatric Quality of Life Asthma Module , and the Beck Youth Inventories . Those children assigned to the wait-list control group completed all evaluations at the same intervals as the children receiving art therapy but did not receive the art therapy interventions . RESULTS Score changes from baseline to completion of art therapy indicated ( 1 ) improved problem-solving and affect drawing scores ; ( 2 ) improved worry , communication , and total quality of life scores ; and ( 3 ) improved Beck anxiety and self concept scores in the active group relative to the control group . At 6 months , the active group maintained some positive changes relative to the control group including ( 1 ) drawing affect scores , ( 2 ) the worry and quality of life scores , and ( 3 ) the Beck anxiety score . Frequency of asthma exacerbations before and after the 6-month study interval did not differ between the 2 groups . CONCLUSION This was the first r and omized trial demonstrating that children with asthma receive benefit from art therapy that includes decreased anxiety and increased quality of life Children with asthma are at special risk for problems in psychological functioning , as are children with other chronic illnesses . We conducted a controlled trial of a combined education and stress management program among children ages 6 to 14 years with asthma . Eighty-one children were r and omly assigned to an  intervention  or a control group ; 56 children completed data collection , 29 intervention and 27 control . Psychological status was assessed by the Child Behavior Checklist ( CBCL ) before and after the intervention , as were children 's knowledge of asthma , stress ( as measured by children 's life events ) , and functional status ( as indicated by such activities as school attendance , time playing with friends , and daily chore performance ) . Children in the intervention group had a significant improvement in the total Behavior Problems score ( p < .04 ) and Internalizing scale ( p < .01 ) on the CBCL and a significant increase in daily chores ( p < .04 ) compared with the control group . Before intervention , the two groups had statistically significant positive relationships between negative life events and behavior problem scores . After intervention , children in the control group still demonstrated a significant relationship between negative life events and total and Internalizing Behavior Problem scores , although participation in the intervention group negated that relationship . Children in the intervention group whose knowledge of asthma increased were more likely to report an increase in daily chores ( p < .02 ) . We conclude that the intervention had a beneficial effect on psychological status and on children 's daily activities . The effect may have occurred in part by decreasing the likelihood that perceived stress from negative life events led to poorer adjustment Abstract Objective To determine the effects of age related , structured educational programmes on the management of  moderate to severe atopic dermatitis in childhood and adolescence . Design Multicentre , r and omised controlled trial . Setting Seven hospitals in Germany . Participants Parents of children with atopic dermatitis aged 3 months to 7 years ( n = 274 ) and 8 - 12 years ( n = 102 ) , adolescents with atopic dermatitis aged 13 - 18 years ( n = 70 ) , and controls ( n = 244 , n = 83 , and n = 50 , respectively ) . Interventions Group sessions of st and ardised intervention programmes for atopic dermatitis once weekly for six weeks or no education ( control group ) . Main outcome measures Severity of eczema ( scoring of atopic dermatitis scale ) , subjective severity ( st and ardised question naires ) , and quality of life for parents of affected children aged less than 13 years , over 12 months . Results Significant improvements in severity of eczema and subjective severity were seen in all intervention groups compared with control groups ( total score for severity : age 3 months to 7 years - 17.5 , 95 % confidence intervals - 19.6 to - 15.3 v - 12.2 , - 14.3 to - 10.1 ; age 8 - 12 years - 16.0 , - 20.0 to - 12.0 v - 7.8 , - 11.4 ; - 4.3 ; and age 13 - 18 years - 19.7 , - 23.7 to - 15.7 v - 5.2 , - 10.5 to 0.1 ) . Parents of affected children aged less than 7 years experienced significantly better improvement in all five quality of life subscales , whereas parents of affected children aged 8 - 12 years experienced significantly better improvement in three of five quality of life subscales . Conclusion Age related educational programmes for the control of atopic dermatitis in children and adolescents are effective in the long term management of the disease ABSTRACT Cognitive – behavioral therapy ( CBT ) interventions show promise for decreasing chronic pain in youth . However , the availability of CBT is limited by many factors including distance to major treatment centers and expense . This study evaluates a more accessible treatment approach for chronic pediatric pain using an Internet‐delivered family CBT intervention .  Participants included 48 children , aged 11–17 years , with chronic headache , abdominal , or musculoskeletal pain and associated functional disability , and their parents . Children were r and omly assigned to a wait‐list control group or an Internet treatment group . Primary treatment outcomes were pain intensity ratings ( 0–10 NRS ) and activity limitations on the Child Activity Limitations Interview , both completed via an online daily diary . In addition to their medical care , the Internet treatment group completed 8 weeks of online modules including relaxation training , cognitive strategies , parent operant techniques , communication strategies , and sleep and activity interventions . Youth r and omized to the wait‐list control group continued with the current medical care only . Findings demonstrated significantly greater reduction in activity limitations and pain intensity at post‐treatment for the Internet treatment group and these effects were maintained at the three‐month follow‐up . Rate of clinical ly significant improvement in pain was also greater for the Internet treatment group than for the wait‐list control group . There were no significant group differences in parental protectiveness or child depressive symptoms post‐treatment . Internet treatment was rated as acceptable by all children and parents . Findings support the efficacy and acceptability of Internet delivery of family CBT for reducing pain and improving function among children and adolescents with chronic pain BACKGROUND Emotional stress triggers and exacerbates asthma in children . Reducing anxiety in adults by relaxation-breathing techniques has been shown in clinical trials to produce good asthma outcomes . However , more evidence is needed on using this intervention with asthmatic children . OBJECTIVE To evaluate the effectiveness of combined self-management and relaxation-breathing training for children with moderate-to-severe asthma compared to self-management-only training . DESIGN Two-group experimental design . SETTING AND PARTICIPANTS Pediatric outpatient clinic of a medical center in central Taiwan . Participants were 48 children , ages 6 - 14 years , with moderate-to-severe asthma and their parents . METHODS Participants were r and omly assigned to an experimental or comparison group and matched by gender , age , and asthma severity . Both groups participated in an asthma self-management program . Children in the experimental group were also given 30 min of training in a relaxation-breathing technique and a CD for home practice . Data on anxiety levels , self-perceived health status , asthma signs/symptoms , peak expiratory flow rate , and medication use were collected at baseline and at the end of the 12-week intervention . Effects of group , time , and group-time interaction were analyzed using the Mixed Model in SPSS ( 12.0 ) . RESULTS Anxiety ( especially state anxiety ) was significantly lower for children in the experimental group than in the comparison group . Differences in the other four physiological variables were also noted between pre- and post-intervention , but these changes did not differ significantly between groups . CONCLUSIONS A combination of self-management and relaxation-breathing training can reduce anxiety , thus improving asthmatic children 's health . These results can serve as an evidence base for psychological nursing practice with asthmatic children OBJECTIVE . Suboptimal adherence to self-administered medications is a common problem . The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia , lymphoma , and soft-tissue sarcoma . METHODS . A r and omized trial with baseline and 1- and 3-month assessment s was conducted from 2004 to 2005 at 34 medical centers in the United States , Canada , and Australia . A total of 375 male and female patients who were 13 to 29 years old , had an initial or relapse diagnosis of a malignancy , and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were r and omly assigned to the intervention or control group . The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults . Outcome measures included adherence , self-efficacy , knowledge , control , stress , and quality of life . For patients who were prescribed prophylactic antibiotics  , adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices ( n = 200 ) . Adherence to 6-mercaptopurine was assessed through serum metabolite assays ( n = 54 ) . RESULTS . Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group . Self-efficacy and knowledge also increased in the intervention group compared with the control group . The intervention did not affect self-report measures of adherence , stress , control , or quality of life . CONCLUSIONS . The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy . The findings support current efforts to develop effective video-game interventions for education and training in health care Background : With improved survival and the transformation in the course of cystic fibrosis ( CF ) , there is a need to develop interventions to help children balance the physiologic and functional health dem and s of CF with psychosocial and developmental needs before the downward trajectory of CF intensifies in adolescence . Objective : The aim of this study was to test the effectiveness of an intervention to improve psychosocial adjustment , functional health , and physiologic health in children ( 8 - 12 years of age ) with CF by teaching them life skills for managing their chronic illness in their everyday lives . Methods : A two-group , experimental , repeated- measures design was used to compare 116 children with CF r and omly assigned to intervention and usual care groups at baseline and at 3 , 6 , and 9 months postintervention using repeated measures multivariate analysis of variance . Children received an individual , tailored intervention during a home visit and a structured group intervention . Four instruments were used to measure psychosocial health status : Perceived Illness Experience Scale , Self-Perception Profile for Children , Social Support Scale for Children , and Children 's Loneliness Scale . Functional health status was measured with the Functional Disability Inventory for Children . Physiologic status was assessed as pulmonary function ( FEV1 % ) and physical growth . Results : Compared with children in the usual care group , the participants demonstrated decreased perceived impact of illness ( p < .0001 ) and decreased loneliness ( p < .0001 ) . At 9 months , the improvements were maintained for impact of illness ( p = .01 ) and loneliness ( p = .01 ) , remaining significantly different from baseline . Conclusion : This developmentally appropriate , problem-solving , and social skills intervention has promise for decreasing the social consequences of chronic illness ( CF ) in children 's lives Objective . To determine the feasibility of a 12-week Internet-based self-management program of disease-specific information , self-management strategies , and social support with telephone support for youth with juvenile idiopathic arthritis ( JIA ) and their parents , aim ed at reducing physical and emotional symptoms and improving health-related quality of life ( HRQOL ) . Methods . A nonblind pilot r and omized controlled trial ( NCT01011179 ) was conducted to test the feasibility of the “ Teens Taking Charge : Managing Arthritis Online ” Internet intervention  across 4 tertiary-level centers in Canada . Participants were 46 adolescents with JIA , ages 12 to 18 years , and 1 parent for each participant , who were r and omized to the control arm ( n = 24 ) or the Internet intervention ( n = 22 ) . Results . The 2 groups were comparable on demographic and disease-related variables and treatment expectation at baseline . Attrition rates were 18.1 % and 20.8 % , respectively , from experimental and control groups . Ninety-one percent of participants r and omized to the experimental group completed all 12 online modules and weekly phone calls with a coach in an average of 14.7 weeks ( SD 2.1 ) . The control group completed 90 % of weekly attention-control phone calls . The Internet treatment was rated as acceptable by all youth and their parents . In posttreatment the experimental group had significantly higher knowledge ( p < 0.001 , effect size 1.32 ) and lower average weekly pain intensity ( p = 0.03 , effect size 0.78 ) . There were no significant group differences in HRQOL , self-efficacy , adherence , and stress posttreatment . Conclusion . Findings support the feasibility ( acceptability , compliance , and user satisfaction ) and initial efficacy of Internet delivery of a self-management program for improving disease-specific knowledge and reducing pain in youth with JIA OBJECTIVES To empirically evaluate a minimal therapist contact CD-ROM pain management program for recurrent pediatric headache developed as part of this study . METHODS Participants were 37 children aged 7 - 12 attending a pediatric neurology clinic for evaluation of recurrent headache .  Children who were r and omly assigned to the treatment group worked through the CD-ROM program on home computers for 4 weeks following baseline assessment , whereas those assigned to the wait-list group continued following the prescriptions of their neurologist . Data on daily headache activity and headache-related disability were collected at baseline and up to 3 months after treatment . RESULTS Children who received the adjunctive CD-ROM program had significant improvements in headache activity above and beyond those in the control group . Results provide initial support for the utility of adding an adjunctive CD-ROM psychological intervention to st and ard medical care for recurrent pediatric headache and potentially other chronic pain conditions in children OBJECTIVE — Studies showing that family communication and conflict resolution are critical to effective management of type 1 diabetes in adolescents have stimulated interest in evaluating psychological treatments targeting these processes . Previous trials have shown that Behavioral Family Systems Therapy ( BFST ) improved parent-adolescent relationships but not treatment adherence or glycemic control . This study evaluates a revised intervention , BFST for Diabetes ( BFST-D ) , modified to achieve greater impact on diabetes-related family conflict , treatment adherence , and metabolic control . RESEARCH DESIGN AND METHODS —A sample of 104 families of adolescents with inadequate control of type 1 diabetes was r and omized to either remain in st and ard care ( SC ) or to augmentation of that regimen by 12 sessions of either a multifamily educational support ( ES ) group or 12 sessions of BFST-D over 6 months . Pertinent measures were collected at baseline and at follow-up evaluations at 6 , 12 , and 18 months . RESULTS —BFST-D was significantly superior to both SC and ES in effects on A1C , while effects on treatment adherence and family conflict were equivocal . Improvement in A1C appeared to be mediated by improvement in treatment adherence . A significantly higher percentage of BFST-D youth achieved moderate or greater improvement ( > 0.5 SD ) in treatment adherence compared with the SC group at each follow-up and the ES group at 6 and 18 months . Change in treatment adherence correlated significantly with change in A1C at each follow-up . CONCLUSIONS —These results support the efficacy of BFST-D in improving A1C , but further research is needed to identify the mechanisms of this effect and to achieve cost-effective dissemination of the intervention OBJECTIVE To evaluate the effectiveness of the STARBRIGHT Fitting Cystic Fibrosis Into Your Life Everyday CD-ROM . Data were analyzed to evaluate the effectiveness of the program as an educational tool for children and adolescents with cystic fibrosis ( CF ) . METHODS Forty-seven children and adolescents with CF between the ages of 7 and 17 years were enrolled in the study . Participants completed an initial evaluation of CF-related knowledge and coping skills and were then r and omly assigned to one of two groups : the treatment group or the wait-list control group . Participants then viewed the CD-ROM , and research ers completed posttest measures . RESULTS Analyses indicated that both disease-related knowledge and coping strategies generated by children and adolescents with CF improved as a result of the intervention and that this effect was replicated in the wait-list group . CONCLUSIONS In sum , the results of the current study indicate that the STARBRIGHT CD-ROM program is a promising intervention for increasing CF-related knowledge and the competence of children 's and adolescents ' coping strategies . These positive results are enhanced by the brief , inexpensive , and portable nature of this educational program OBJECTIVE To report results from YourWay , an Internet-based self-management intervention for adolescents with type 1 diabetes . RESEARCH DESIGN AND METHODS A total of 72 adolescents with type 1 diabetes , ages 13–17 years , were r and omized to a  usual-care-plus-Internet support or a usual-care group . The intervention was design ed to enhance problem-solving barriers to self-management . A1C was obtained from medical records , and problem-solving and self-management were obtained via adolescent report . RESULTS Group differences were not statistically significant using intent-to-treat analyses . Using as-treated analyses , adolescents in the treatment condition showed statistically significant improvement in self-management ( d = 0.64 ; P = 0.02 ) and important improvements in problem-solving ( d = 0.30 ; P = 0.23 ) and A1C ( d = −0.28 ; P = 0.27 ) . Mean A1C for the intervention group remained constant ( −0.01 % ) , while the control group increased ( 0.33 % ) . CONCLUSIONS This brief trial suggests that self-management support delivered through a secure website may improve self-management and offset typical decreases in adolescent glycemic control OBJECTIVE : To investigate the efficacy of a cognitive-behavioral group intervention for children with chronic illnesses and to test the effect of an added parent component . METHODS : Children ( n = 194 ) and their parents participated in a multicenter r and omized clinical trial comparing a  child-only intervention and a  parent-child intervention to a wait-list control group . Primary outcomes were parent- and self-reported internalizing and externalizing problems ; secondary outcomes were child disease-related coping skills ( information seeking , relaxation , social competence , medical compliance , and positive thinking ) . Assessment s took place at baseline and at 6- and 12-month follow-ups . Intention-to-treat mixed-model analyses were performed to test the difference in change in outcomes . RESULTS : The intervention had a positive effect on changes in parent-reported internalizing problems , child-reported externalizing problems , information seeking , social competence , and positive thinking . The additional effect of parental involvement was observed on parent-reported internalizing problems , child-reported externalizing problems , information seeking , and social competence . Illness severity and illness type did not moderate the effects . There were no intervention effects on child-reported internalizing problems , parent-reported externalizing problems , relaxation , or medical compliance . Of the families in the wait-list control group , 74 % sought alternative psychological support during the intervention period . CONCLUSIONS : This RCT supports the efficacy of a protocol -based group intervention for children with chronic illnesses and their parents . Adding a parental component to the intervention contributed to the persistence of the effects . Future research should focus on moderating and mediating effects of the intervention OBJECTIVE To investigate the feasibility and efficacy of a r and omized clinical pilot trial comparing routine services ( RS ) with a school intervention program ( SIP ) for children with sickle cell anemia ( SCA ) . METHOD Twenty-four children ( ages 8 - 12 years ) with SCA were r and omized to RS or SIP .  General disease knowledge , consumer satisfaction , self-concept , and school absences were evaluated . RESULTS Compared with children receiving RS , children and teachers receiving SIP evidence d more accurate information about their disease , and children with SCA had significantly fewer absences . Teachers receiving SIP reported higher consumer satisfaction . CONCLUSIONS A modest educational curriculum can increase knowledge of SCA , is associated with lower absence rates , and yields high consumer satisfaction ratings Background Chronic respiratory illnesses are the most common group of childhood chronic health conditions and are overrepresented in socially isolated groups . Objective To conduct a r and omized controlled pilot trial to evaluate the efficacy of Breathe Easier Online ( BEO ) , an Internet-based problem-solving program with minimal facilitator involvement to improve psychosocial well-being in children and adolescents with a chronic respiratory condition . Methods We r and omly assigned 42 socially isolated children and adolescents ( 18 males ) , aged between 10 and 17 years to either a  BEO ( final n = 19 ) or a wait-list control  ( final n = 20 ) condition . In total , 3 participants ( 2 from BEO and 1 from control ) did not complete the intervention . Psychosocial well-being was operationalized through self-reported scores on depression symptoms and social problem solving . Secondary outcome measures included self-reported attitudes toward their illness and spirometry results .  Paper- and -pencil question naires were completed at the hospital when participants attended a briefing session at baseline ( time 1 ) and in their homes after the intervention for the BEO group or a matched 9-week time period for the wait-list group ( time 2 ) . Results The two groups were comparable at baseline across all demographic measures ( all F < 1 ) . For the primary outcome measures , there were no significant group differences on depression ( P = .17 ) or social problem solving ( P = .61 ) . However , following the online intervention , those in the BEO group reported significantly lower depression ( P = .04 ) , less impulsive/careless problem solving ( P = .01 ) , and an improvement in positive attitude toward their illness ( P = .04 ) compared with baseline . The wait-list group did not show these differences . Children in the BEO group and their parents rated the online modules very favorably . Conclusions Although there were no significant group differences on primary outcome measures , our pilot data provide tentative support for the feasibility ( acceptability and user satisfaction ) and initial efficacy of an Internet-based intervention for improving well-being in children and adolescents with a chronic respiratory condition . Trial registration Australian New Zeal and Clinical Trials Registry number : ACTRN12610000214033 ; http://www.anzctr.org.au/trial_view.aspx?ID=308074 ( Archived by WebCite at http://www.webcitation.org/63BL55mXH Asthma psychoeducational programs have been found to be effective in terms of symptom-related outcome . They are mostly illness-focused , and pay minimal attention to systemic/familial factors . This study evaluated a novel asthma psychoeducation program that adopted a parallel group design and incorporated family therapy . A r and omized waitlist-controlled crossover clinical trial design was adopted . Children with stable asthma and their parents were recruited from a pediatric chest clinic . Outcome measures included , for the patients : exhaled nitric oxide ( eNO ) , spirometry , and adjustment to asthma ; and for the parents : perceived efficacy in asthma management , Hospital Anxiety and Depression Scale anxiety subscale , Body Mind Spirit Well-being Inventory emotion subscale , and Short Form 12 health-related quality of life scale .  Forty-six patients participated in the study . Attrition rates were 13.0 % and 26.0 % for the active and control groups , respectively . Repeated- measures ANOVA revealed a significant decrease in airway inflammation , as indicated by eNO levels , and an increase in patient 's adjustment to asthma and parents ' perceived efficacy in asthma management . Serial trend analysis revealed that most psychosocial measures continued to progress steadily after intervention . Significant improvements in both symptom-related measures and mental health and relationship measures were observed . The findings supported the value of incorporating family therapy into asthma psychoeducation programs Objectives : To determine the impact of a peer-led education program , developed in Australia , on health-related outcomes in high school students with asthma in Jordan . Methods : In this cluster-r and omized controlled trial , 4 high schools in Irbid , Jordan , were r and omly assigned to receive the  Adolescent Asthma Action program or st and ard practice . Bilingual health workers trained 24 peer leaders from Year 11 to deliver asthma education to younger peers from Year 10 ( n = 92 ) , who in turn presented brief asthma skits to students in Years 8 and 9 ( n = 148 ) and to other members of the school community in the intervention schools . Students with asthma ( N = 261 ) in Years 8 , 9 , and 10 completed baseline surveys in December 2006 and 3 months after the intervention . Results : Students from the intervention group reported clinical ly significant improvements in health-related quality of life ( mean difference : 1.35 [ 95 % confidence interval : 1.04–1.76 ] ) , self-efficacy to resist smoking ( mean difference : 4.63 [ 95 % confidence interval : 2.93–6.35 ] ) , and knowledge of asthma self- management ( mean difference : 1.62 [ 95 % confidence interval : 1.15–2.19 ] ) compared with the control group . Conclusions : This trial demonstrated that the Adolescent Asthma Action program can be readily adapted to suit different cultures and context s. Adolescents in Jordan were successful in teaching their peers about asthma self-management and motivating them to avoid smoking . The findings revealed that peer education can be a useful strategy for health promotion programs in Jordanian schools when students are given the opportunity and training Encouraging self-management has been viewed as one means of reducing health service utilisation and contributing to improved dem and management . However , the processes and imputed relationship between self-management education skills and health service contact are poorly understood . This paper reports on data from an embedded qualitative study which ran alongside a r and omised controlled trial in Engl and design ed to test the clinical and cost effectiveness of a self-care support policy which found no statistically significant reductions in health service utilisation . Drawing on concepts from the sociology of chronic illness , analyses suggest that the biographical and social context relevant to individuals ' experience of living with a long-term condition , history of health service utilisation , and relationships with health professionals are relevant to underst and ing the impact of self-management education and related policies aim ed at bringing about changes in service use . Our study suggests that future health policy assumptions about utilisation in the context of chronic disease management and self-care support polices may benefit by acknowledging the complex , context ual and recursive nature of health service utilisation operating in the life worlds of patients ' experience of living with a long-term condition OBJECTIVE . The purpose of this study was to evaluate the impact and acceptability of an educational multimedia program design ed to promote self-management skills in children with asthma . METHODS . We conducted a r and omized , controlled trial with measures at baseline and 1- and 6-month follow-up . The trial was conducted in pediatric outpatient respiratory clinics in 3 United Kingdom hospitals . Participants included 101 children aged 7 to 14 years under the care of hospital-based asthma services . The children were r and omly assigned to receive an asthma information booklet alone or the booklet plus The Asthma Files , an interactive CD-ROM for children with asthma . Asthma knowledge was the primary outcome measure . Other measures included asthma locus of control , lung function , use of oral steroids , and school absence . RESULTS . At the 1-month follow-up ( n = 99 ) , children in the computer group had improved knowledge compared with the control group and a more internal locus of control . There were no differences in objective lung-function measures , hospitalizations , or oral steroid use . The study participants were positive in their evaluation of the intervention . At the 6-month follow-up ( n = 90 ) , significantly fewer children in the intervention group had required oral steroids and had had time off school for asthma in the previous 6 months . The difference did not reach statistical significance in the intention-to-treat analysis for both steroid use and school absence . CONCLUSION . The Asthma Files was found to be an effective and popular health education tool for promoting asthma self-management skills within pediatric care OBJECTIVE There are currently no controlled studies of behavioral interventions for juvenile primary fibromyalgia syndrome ( JPFM ) . In this small- sample r and omized study , we tested the efficacy of a behavioral intervention , i.e. , coping skills training ( CST ) , for the treatment of adolescents with JPFM . Outcomes tested in this study were functional disability , pain intensity , pain-coping efficacy , and depressive symptoms . METHODS Thirty patients with JPFM were r and omly assigned to 8 weeks of either CST or self-monitoring . Adolescents in the CST condition received training in active pain-coping techniques , while those in the self-monitoring condition monitored daily pain intensity and sleep quality with no instructions about behavior change . After posttreatment assessment , subjects were crossed over into the opposite treatment arm for 8 weeks ( so that all adolescents eventually received both CST and self-monitoring ) and were reassessed at Week 16 . RESULTS At Week 8 , adolescents in both conditions showed significant decrease in depressive symptoms and functional disability . Those who received CST showed significantly greater ability to cope with pain than those in the self-monitoring condition and a trend toward decreased pain intensity . At Week 16 , adolescents had significantly lower levels of disability and depressive symptoms compared to baseline , but those who received self-monitoring followed by CST seemed to receive the most benefit . CONCLUSION CST can lead to improved functioning among JPFM patients . Although some of the improvement may be due to increased monitoring and attention , CST provides the specific benefit of improving  adolescents ' ability to cope with pain STUDY OBJECTIVES To examine the effectiveness of an interdisciplinary intervention for pediatric asthma . DESIGN R and omized , controlled study . SETTING Urban tertiary-referral pediatric hospital . PARTICIPANTS One hundred seventy-five patients with asthma lacking written treatment plans and presenting with asthma-related emergency department visits ( two or more ) and /or hospitalizations ( one or more ) in the past year were r and omized to a comparison group receiving medical care alone  ( n = 86 ) or to an interdisciplinary intervention group receiving medical care , asthma education , and problem-solving therapy  ( n = 89 ) INTERVENTION All participants received written asthma management plans , peak flow meters , and spacer devices . The intervention group also received asthma education , an asthma risk profile assessment , brief problem-solving therapy , and access to a 24-h nurse advice line . The primary outcome measure was change in asthma symptoms , and secondary outcomes included health-care utilization and asthma-related quality of life . RESULTS Both groups demonstrated significant reductions in asthma symptoms and improvements in quality of life without any between-group differences identified over the course of follow-up . In contrast , the intervention group demonstrated less frequent health-care utilization than the comparison group , with 28 % of the intervention group requiring emergency department or inpatient services for asthma compared to 41 % of the comparison group ( adjusted odds ratio , 1.92 ; 95 % confidence interval , 1.00 to 3.69 ) over the 12-month follow-up period . CONCLUSIONS This study examined the effectiveness of an interdisciplinary intervention for undertreated asthma . The intervention did not result in improvements in asthma symptoms , but accomplished modest reductions in the utilization of acute medical care INTRODUCTION Asthma is the most prevalent chronic illness , affecting more than 7 million children younger than 17 years . Asthma has become a leading public health concern because of the dramatic rise in the incidence of this disease during the past 15 years , particularly in minority population s. This study tested a two-part intervention on selected psychosocial and health outcomes of 8- to 13-year-old inner city minority students with asthma . METHOD The intervention consisted of participation in an asthma education program ( Open Airways ) followed by 5 monthly visits with a nurse practitioner . The total sample of 52 children was composed of 28 children in the treatment group who received the intervention and 24 children who served as a control group .  RESULTS Students in the treatment group scored significantly higher than the control group over time on measures of asthma knowledge , asthma self-efficacy , general self-care practice s , and asthma self-care practice s. No significant differences were found between the two groups on health outcomes . DISCUSSION A school-based intervention program can improve psychosocial outcomes for inner-city minority children with asthma . Recommendations for future research and clinical practice are discussed The goal of this study was to determine the effectiveness of an asthma educational intervention in improving asthma knowledge , self-efficacy , and quality of life in rural families . Children 6 to 12 years of age ( 62 % male , 56 % white , and 22 % Medicaid ) with persistent asthma ( 61 % ) were recruited from rural elementary schools and r and omized into the  control st and ard asthma education ( CON ) group or an interactive educational intervention (  INT )  group geared toward rural families .  Parent/caregiver and child asthma knowledge , self-efficacy , and quality of life were assessed at baseline and at 10 months post enrollment . Despite high frequency of symptom reports , only 18 % children reported an emergency department visit in the prior 6 months . Significant improvement in asthma knowledge was noted for INT parents and young INT children at follow-up ( Parent : CON = 16.3 ; INT = 17.5 , p < 0.001 ; Young children : CON = 10.8 , INT = 12.45 , p < 0.001 ) . Child self-efficacy significantly increased in the INT group at follow-up ; however , there was no significant difference in parent self-efficacy or parent and child quality of life at follow-up . Asthma symptom reports were significantly lower for the INT group at follow-up . For young rural children , an interactive asthma education intervention was associated with increased asthma knowledge and self-efficacy , decreased symptom reports , but not increased quality of life OBJECTIVE To evaluate an ambulatory , family-focused intervention aim ed at optimizing STUDY DESIGN Study design We r and omly assigned 105 children and adolescents , 8 to 17 years of age , with T1DM for < or = 6 years , to a family-focused teamwork ( TW ) intervention or to st and ard multidisciplinary diabetes care ( SC ) . Patients in both study groups were seen at 3- to 4-month intervals and were followed prospect ively for 1 year . Measures of family involvement in diabetes tasks , DFC , and quality of life were performed at baseline and after 1 year . Hemoglobin A1c was measured at each visit . RESULTS Patients ( n = 100 ) completed follow-up , ( 50 in TW and 50 in SC ) . At entry ,  A1c was 8.4 % + /- 1.3 % in TW and 8.3 % + /- 1.0 % in SC . After 1 year , A1c was 8.2 % + /- 1.1 % in TW compared with 8.7 % + /- 1.5 % in SC ( P < .05 ) . Both groups had similar frequencies of blood glucose monitoring ( BGM ) and insulin dosing . Families exposed to the TW intervention maintained or increased family involvement significantly more than families exposed to SC ( P = .05 ) . In multivariate analysis , the TW intervention and the daily frequency of BGM significantly predicted A1c ( R ( 2 ) = 0.17 , P = .05 ) . Despite increased family involvement , the TW group reported no increase in DFC or decrease in quality of life . CONCLUSIONS The ambulatory TW intervention prevented the expected deterioration in glycemic control seen with SC in youths with T1DM of < or = 6 years ' duration . Successful family involvement may assist in the preservation of health and the prevention of long-term diabetes complications for youth with diabetes BACKGROUND Improving asthma knowledge and self-management is a common focus of asthma educational programs , but most programs have had little influence on morbidity outcomes . We developed a novel multiple-component intervention that included the use of an asthma education video game intended to promote adoption of asthma self-management behaviors and appropriate asthma care . OBJECTIVE To determine the effectiveness of an asthma education video game in reducing morbidity among high-risk , school-aged children with asthma . METHODS We enrolled 119 children aged 5 to 12 years from low-income , urban areas in and around San Francisco , CA , and San Jose , CA . Children with moderate-to-severe asthma and parental reports of significant asthma health care utilization were r and omized to participate in the disease management intervention or to receive their usual care ( control group ) . Patients were evaluated for clinical and quality -of-life outcomes at weeks 8 , 32 , and 52 of the study . RESULTS Compared with controls , the intervention group had significant improvements in the physical domain ( P = .04 and P = .01 at 32 and 52 weeks , respectively ) and social activity domain ( P = .02 and P = .05 at 32 and 52 weeks , respectively ) of asthma quality of life on the Child Health Survey for Asthma and child ( P = .02 at 8 weeks ) and parent ( P = .04 and .004 at 32 and 52 weeks , respectively ) asthma self-management knowledge . There were no significant differences between groups on clinical outcome variables . CONCLUSIONS A multicomponent educational , behavioral , and medical intervention targeted at high-risk , inner-city children with asthma can improve asthma knowledge and quality of life OBJECTIVE To compare the marginal benefit of in-home asthma self-management support provided by community health workers ( CHWs ) with st and ard asthma education from clinic-based nurses . DESIGN R and omized controlled trial . SETTING Community and public health clinics and homes . PARTICIPANTS Three hundred nine children aged 3 to 13 years with asthma living in low-income households . INTERVENTIONS All participants received nurse-provided asthma education and referrals to community re sources . Some participants also received CHW-provided home environmental assessment s , asthma education , social support , and asthma-control re sources . OUTCOME MEASURES Asthma symptom-free days , Pediatric Asthma Caretaker Quality of Life Scale score , and use of urgent health services . RESULTS Both groups showed significant increases in caretaker quality of life ( nurse-only group : 0.4 points ; 95 % confidence interval [ CI ] , 0.3 - 0.6 ; nurse + CHW group : 0.6 points ; 95 % CI , 0.4 - 0.8 ) and number of symptom-free days ( nurse only : 1.3 days ; 95 % CI , 0.5 - 2.1 ; nurse + CHW : 1.9 days ; 95 % CI , 1.1 - 2.8 ) , and absolute decreases in the proportion of children who used urgent health services in the prior 3 months ( nurse only : 17.6 % ; 95 % CI , 8.1%-27.2 % ; nurse + CHW : 23.1 % ; 95 % CI , 13.6%-32.6 % ) . Quality of life improved by 0.22 more points in the nurse + CHW group ( 95 % CI , 0.00 - 0.44 ; P = .049 ) . The number of symptom-free days increased by 0.94 days per 2 weeks ( 95 % CI , 0.02 - 1.86 ; P = .046 ) , or 24.4 days per year , in the nurse + CHW group . While use of urgent health services decreased more in the nurse + CHW group , the difference between groups was not significant . CONCLUSION The addition of CHW home visits to clinic-based asthma education yielded a clinical ly important increase in symptom-free days and a modest improvement in caretaker quality of life Adherence to recommended aerosol medicines and airway clearance techniques ( ACT ) for children with cystic fibrosis ( CF ) requires self-management skills . A multi-centre , r and omized , controlled trial was conducted to investigate the effectiveness of a self-management education programme called ‘ Airways ’ for six-to 11-year old children with CF and their caregivers . Assessment s were conducted immediately before and after the intervention period , and six and 12 months after the post-intervention assessment . The pen and paper education programme was completed by the child and caregiver together at home . Participants in the intervention and control groups had similar baseline characteristics . A per- protocol analysis was conducted and for variables that changed significantly , an additional intention-to-treat analysis was performed that included data from participants in the intervention group who withdrew from the study during the intervention period . The intervention group increased the percentage of prescribed aerosols taken ( P < 0.001 ) and this was maintained at 12-month follow-up ( P < 0.001 ) . There was no change in the percentage of prescribed ACT performed , although when the child was unwell , caregivers in the intervention group increased the frequency and /or duration of ACT ( P = 0.028 ) in the per protocol analysis but not in the intention-to-treat analysis . Children in the intervention group increased their knowledge of ACT ( P < 0.001 ) which was maintained at 12-month follow-up ( P < 0.001 ) and felt more positively about their chest treatment regimens immediately following the intervention ( P = 0.017 ) but not at 12-month follow-up . There were no significant changes in the control group for these variables over time . No significant changes occurred in the caregivers ' reports of self-management behaviours and self-efficacy in either group . The positive results suggest that ‘ Airways ’ is a valuable educational tool for primary school-aged children with CF and their caregiver RATIONALE Urban African-American youth , aged 15 - 19 years , have  asthma fatality rates that are higher than in whites and younger children , yet few programs target this population . Traditionally , urban youth are believed to be difficult to engage in health-related programs , both in terms of connecting and convincing . OBJECTIVES Develop and evaluate a multimedia , web-based asthma management program to specifically target urban high school students . The program uses " tailoring , " in conjunction with theory-based models , to alter behavior through individualized health messages based on the user 's beliefs , attitudes , and personal barriers to change . METHODS High school students reporting asthma symptoms were r and omized to receive the tailored program ( treatment ) or to access generic asthma websites ( control ) . The program was made available on school computers . MEASUREMENTS AND MAIN RESULTS Functional status and medical care use were measured at study initiation and 12 months postbaseline , as were selected management behaviors . The intervention period was 180 days ( calculated from baseline ) . A total of 314 students were r and omized ( 98 % African American , 49 % Medicaid enrollees ; mean age , 15.2 yr ) . At 12 months , treatment students reported fewer symptom-days , symptom-nights , school days missed , restricted-activity days , and hospitalizations for asthma when compared with control students ; adjusted relative risk and 95 % confidence intervals were as follows : 0.5 ( 0.4 - 0.8 ) , p = 0.003 ; 0.4 ( 0.2 - 0.8 ) , p = 0.009 ; 0.3 ( 0.1 - 0.7 ) , p = 0.006 ; 0.5 ( 0.3 - 0.8 ) , p = 0.02 ; and 0.2 ( 0.2 - 0.9 ) , p = 0.01 , respectively . Positive behaviors were more frequently noted among treatment students compared with control students . Cost estimates for program delivery were $ 6.66 per participating treatment group student . CONCLUSIONS A web-based , tailored approach to changing negative asthma management behaviors is economical , feasible , and effective in improving asthma outcomes in a traditionally hard-to-reach population OBJECTIVE To determine whether health outcomes of children who have asthma can be improved through the use of an Internet-enabled interactive multimedia asthma education program . METHODS Two hundred twenty-eight children with asthma visiting a pediatric pulmonary clinic were r and omly assigned to control and intervention groups . Children and caregivers in both groups received traditional patient education based on the National Asthma Education and Prevention Program . Intervention group participants received additional self-management education through the Interactive Multimedia Program for Asthma Control and Tracking .  Pediatric Asthma Care Knowledge Survey , Pediatric Asthma Caregiver 's Quality of Life Question naire , asthma symptom history , spirometry , and health services utilization data were collected at the initial visit and at 3 and 12 months . RESULTS Interactive Multimedia Program for Asthma Control and Tracking significantly increased asthma knowledge of children and caregivers , decreased asthma symptom days ( 81 vs 51 per year ) , and decreased number of emergency department visits ( 1.93 vs 0.62 per year ) among the intervention group participants . The intervention group children were also using a significantly lower average daily dose of inhaled corticosteroids ( 434 vs 754 micro g [ beclomethasone equivalents ] ) at visit 3 . Asthma knowledge of all 7- to 17-year-old children correlated with fewer urgent physician visits ( r = 0.37 ) and less frequent use of quick-relief medicines ( r = 0.30 ) . CONCLUSIONS Supplementing conventional asthma care with interactive multimedia education can significantly improve asthma knowledge and reduce the burden of childhood asthma OBJECTIVE To determine if scheduled telephone calls from a pediatric diabetes educator to children who have type 1 diabetes improve hemoglobin A1c ( HbA1c ) level , hospital admissions , diabetes knowledge , compliance , and psychological well-being . RESEARCH DESIGN AND METHODS A r and omized controlled trial of 123 young subjects ( mean age 11.9 yr , 69 male ) with type 1 diabetes ( mean duration 3.65 yr ) . For 7 months , the intervention group held bimonthly 15 - 30 min scheduled supportive telephone discussion s. The primary outcome was change in the HbA1c level . Admission rates and changes in diabetes knowledge , psychological parameters , compliance , and patient perception were measured . RESULTS There was no significant difference between the treatment and control groups either before or after the intervention . The mean HbA1c level in the control group increased from 8.32 to 8.82 % and in the intervention group from 8.15 to 8.85 % ( p = 0.24 ) . Both groups showed an increase in admissions of 0.2 per yr ( p = 0.57 ) . There was no improvement in diabetes knowledge ( p = 0.34 ) , compliance , or psychological function . The intervention group viewed their contact with the clinic as more helpful ( p = 0.003 ) . Analysis of family function did not reveal subgroups with statistically significant differences . A mean of 13 calls was made to each subject at a cost of 36 Australian dollars per child per month . CONCLUSIONS Scheduled bimonthly phone support does not improve the HbA1c level , admission rates , diabetes knowledge , psychological function , or self-management but is perceived by patients as helpful . Further study into the effects of more frequent but shorter periods of support for patients experiencing specific difficulties is needed OBJECTIVE To evaluate the effectiveness of a peer-led asthma self-management program for adolescents . DESIGN R and omized controlled trial comparing a peer-led asthma program ( intervention group ) and a conventional adult-led asthma program ( control group ) . Each program was implemented at a full-day camp . SETTING A city and adjacent suburbs in upstate New York . PARTICIPANTS A total of 112 adolescents aged 13 to 17 years with persistent asthma . INTERVENTION A peer-led asthma self-management program implemented at a day camp . MAIN OUTCOME MEASURES The Child Attitude Toward Illness Scale and the Paediatric Asthma Quality of Life Question naire were administered at baseline and immediately and 3 , 6 , and 9 months after the intervention . Spirometry was conducted twice : before and 9 months after the intervention . RESULTS The intervention group reported more positive attitudes at 6 months ( mean difference , 4.11 ; 95 % confidence interval [ CI ] , 0.65 - 7.56 ) and higher quality of life at 6 months ( difference , 11.38 ; 95 % CI , 0.96 - 21.79 ) and 9 months ( difference , 12.97 ; 95 % CI , 3.46 - 22.48 ) than the control group . The intervention was found to be more beneficial to adolescents of male gender or low family income , as shown by greater improvement in positive attitudes toward asthma and quality of life than their counterparts . CONCLUSION An asthma self-management program led by peer leaders is a developmentally appropriate approach that can be effective in assisting adolescents with asthma in improving their attitudes and quality of life , particularly for males and those of low socioeconomic status . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01161225 Background : Pediatric summer camps are emerging as a means to increase social support and improve children 's attitudes about their chronic illness . Because of the high rate of camp attendance , it may be feasible to implement interventions within that setting ; however , it has yet to be determined what components of camp are beneficial . Objective : The objective of this pilot study was to determine the efficacy of a problem-solving intervention targeting disease management in improving psychosocial functioning of children with persistent asthma , over and above the benefits of participation in a pediatric summer camp . Methods : Fifty campers were r and omly assigned to receive camp plus a nightly problem-solving intervention activity or camp as usual . Changes in self-reported asthma knowledge and problem-solving skills and self- and parent-reported child self- and social competence health-related quality of life were assessed thrice : before camp , on the last day of camp , and 3-months post-camp . Results : There were no significant differences between the problem-solving intervention group and the camp as usual group in change across psychosocial variables from before camp to last day of camp or before camp to 3-months post-camp . Increases in asthma knowledge and problem-solving were found 3-months post-camp when groups were combined . Conclusions : Although support was found for improvements in disease knowledge and problem-solving skills after camp participation , there were no identified benefits to the problem-solving intervention . Children with asthma who participated in camp were functioning at a high level in terms of knowledge , problem-solving , and social and self-competence , suggesting that interventions may be more effective if targeted to patients with identified problems with disease management M eeting the complex needs of patients with chronic illness or impairment is the single greatest challenge facing organized medical practice . Usual care is not doing the job ; dozens of surveys and audits have revealed that sizable proportions of chronically ill patients are not receiving effective therapy , have poor disease con- trol , and are unhappy with their care ( 1 ) . Results of r and omized trials also show that effective disease management programs can achieve substantially better outcomes than usual care , the control intervention . These trials , along with the ideas and efforts for improvement discussed in this issue , show that we can improve care and outcomes . As the articles suggest , these improvements will not come easily . If we are to improve care for most patients with chronic illness , the evidence strongly suggests that we reshape our ambulatory care systems for this purpose . Pri- mary care practice was largely design ed to provide ready access and care to patients with acute , varied problems , with an emphasis on triage and patient flow ; short appointments ; diagnosis and treatment of symptoms and signs ; reliance on laborato- ry investigations and prescriptions ; brief , didactic patient education ; and patient- initiated follow-up . Patients and families struggling with chronic illness have differ- ent needs , and these needs are unlikely to be met by an acute care organization and culture . They require planned , regular interactions with their caregivers , with a focus on function and prevention of exacerbations and complications . This interac- tion includes systematic assessment s , attention to treatment guidelines , and behav- iorally sophisticated support for the patient 's role as self-manager . These interactions must be linked through time by clinical ly relevant information systems and continu- ing follow-up initiated by the medical practice . Comprehensive System The effectiveness of a cognitive-behavioral program , Transition Preparation Training ( TPT ) , in combination with spina bifida ( SB ) management was compared to adolescents with SB who received only SB management .  Design , setting and participants : Prospect i ve controlled trial with an ethnically diverse sample ( 94 % ) of 65 adolescents with SB ( 31 in treatment group [ mean age : 16.19 ] ; 34 in control group [ mean age : 15.71 ] ) conducted at Childrens Hospital Los Angeles between September 2006 and September 2008 . INTERVENTIONS : TPT was a three-module , eight sessions program offered in a 2 day workshop format to facilitate development of health care transition plan . MAIN OUTCOME MEASURES : Subjective well being as measured by the Personal Adjustment and Role Skills Scale ( PARS III ) , Role mastery measured using Community Life Skills Scale ( CLSS ) , and Self Care Practice with the Denyes Self-Care Practice Instrument ( DSCPI-90 © ) . RESULTS : No significant differences were found between groups of any treatment effect or treatment follow-up interaction . No substantial changes in the scores either between treatments of post treatments were found BACKGROUND Cancer is the number one disease killer of children and adolescents in North America . For adolescents , this diagnosis comes at a particularly vulnerable stage . Educating adolescents with cancer from diagnosis through treatment teaches and empowers them . Increasing evidence shows that these adolescents want more information . Few educational tools exist for young cancer patients ; none are interactive ; therefore , a CD-ROM was developed to meet this need . PROCEDURE Animation , voiceover , music , videos , and games were combined to develop a comprehensive multimedia CD-ROM to teach 12- to 18-year-olds with solid tumors about their disease , treatment , coping skills , and late effects in an interactive and non-threatening way . The CD-ROM was evaluated in a pre-post design with 65 subjects recruited from four pediatric oncology centers r and omized to the CD-ROM or a " H and book " containing analogous information .  Pre-post question naires measured coping strategies , health locus of control , quality of life , cancer knowledge , and self-efficacy ; post-test variables also included acceptability and use by teens , their families , and healthcare professionals . RESULTS Teens receiving the CD-ROM were significantly more likely to increase their internal locus of control scores ; however , no significant differences were observed on other measures , attributable in part to the study sample size . Among teens , acceptability was higher in the CD-ROM versus the H and book group , but not different between the two parent groups . Pediatric oncology healthcare providers gave positive feedback on the CD-ROM . CONCLUSIONS This CD-ROM is an innovative and engaging educational tool -- the first portable interactive product with access on dem and for adolescents with solid tumors INTRODUCTION The purpose of this r and omized control trial was to evaluate the effects of a computer-assisted instructional ( CAI ) game on asthma symptoms ( eg , coughing , wheezing , shortness of breath , and nighttime awakenings ) in 7- to 12-year-old inner-city children over 12 weeks . METHOD A CAI that focused on reducing environmental irritants/allergens and the correct use of prescribed medications to prevent asthma symptoms was used with 101 children ( 56 in the intervention group and 45 in the control group ) . The primary outcome evaluated a change in children 's asthma symptoms as measured by responses to nine symptom questions in Juniper 's Pediatric Asthma Quality of Life Question naire ( PAQOL ) and measurements of lung function . RESULTS No significant changes in asthma symptoms occurred between the two groups before and after the intervention . No significant changes were noted in PAQOL scores for activities , emotions , and total PAQOL score , lung function measurements , and asthma severity between the two groups . Asthma knowledge of both groups was high before intervention , but there were no significant changes between groups after the intervention . DISCUSSION Findings indicate that this CAI game was not effective in improving asthma symptoms in this group of children Adherence to combination antiretroviral therapy ( ART ) has been shown to be a determining factor in controlling viral replication , maintaining immunologic function and long-term survival in HIV-positive individuals . Little information is available on strategies to improve adherence in pediatric HIV-infected patients . We conducted a r and omized , nonblinded , pilot study to determine if a home-based nursing intervention would improve medication adherence . The study was offered to all eligible HIV-positive patients receiving care at Connecticut Children 's Medical Center 's ( CCMC ) Pediatric and Youth HIV Program . Sixty-seven percent ( 37/55 ) of the patients and their caretakers participated . We r and omized participants to either st and ard of care or the intervention trial . The intervention was design ed to improve knowledge and underst and ing of HIV infection and HIV medications and to resolve or modify barriers to adherence . Both groups completed pre- and post-intervention question naires , assessing their knowledge and underst and ing of HIV , ART , and adherence . Adherence was estimated objective ly from medication refill history and subjectively from a self-report score . We also inferred adherence from pre- to post-test plasma viral load and CD4 + T-cell percentages . The knowledge score ( p = 0.02 ) and medication refill history ( p = 0.002 ) improved significantly in the intervention group . The adherence self-report score improved , although not significantly ( p = 0.07 ) . We did not observe statistical differences in CD4 + T-cell counts or viral load between groups . We conclude that our home-based nursing intervention helped HIV-positive children and their families in better adhering to prescribed medication regimens Adolescents with haemophilia must assume responsibility for their health and management of their disease . An online self-management program was developed to support adolescents during this transition . To determine the feasibility of the program using a r and omized control trial ( RCT ) design in terms of accrual/attrition rates , willingness to be r and omized , compliance with the program/ outcome measures and satisfaction . Adolescents , ages 13 - 18 , were enrolled in a pilot RCT ( NCT01477437 ) and r and omized to either the intervention ( 8-week program with telephone coaching ) or the control arm ( no access to the website , weekly telephone call as attention- strategy ) . All participants completed pre/post- outcome measures . Twenty-nine teens participated ( intervention n = 16 , control n = 13 ) . Participants in the intervention arm spent an average of 50 min on the website per week and completed the modules in an average of 14 weeks ( SD = 4.9 ) . Attrition was higher in the control group compared to the intervention group ( 54 % vs. 25 % ) . 17/18 ( 94 % ) who completed the program also completed the post study measures . Teens on the intervention arm showed significant improvement in disease-specific knowledge ( P = 0.004 ) , self-efficacy ( P = 0.007 ) and transition preparedness ( P = 0.046 ) . There was a statistically significant improvement in knowledge in the intervention group when compared to the control group ( P = 0.01 ) . Overall , the teens found the website to be informative , comprehensive and easy to use and were satisfied with the program . This pilot RCT study suggests benefit to the program and indicates an RCT design to be feasible with minor adjustments to the protocol OBJECTIVE To pilot test a two-session computer-delivered motivational intervention to facilitate adherence among youth with HIV newly prescribed antiretroviral treatment ( ART ) . METHODS Youth ( N = 76 ) newly prescribed ART were recruited from 8 sites , and were r and omized to the intervention or an active nutrition and physical activity control . Primary outcomes were HIV-1 viral load at baseline , 3 months , and 6 months , and self-reported adherence at 3 and 6 months . RESULTS Satisfaction ratings were high . Effect sizes suggested that the intervention group showed a greater drop than controls in viral load from baseline to 6 months ( Cohen 's d = 0.39 at 3 months ; d = 0.19 at 6 months ) , and had greater percent undetectable by 6 months ( d = 0.28 ) . Effects sizes were medium to large for 7-day and weekend adherence . CONCLUSIONS A brief computer-delivered motivational intervention showed promise for youth starting ART and is ready to be tested in a full-scale clinical trial
OBJECTIVE To systematic ally explore the effectiveness and effective components of self-management interventions .