Breathe With Ease: A Unique Approach to Managing Stress (BEAMS)
Improving Asthma Outcomes Through Stress Management
Uncontrolled asthma in at-risk youth responds well to guideline-based therapy when patients remain adherent to their management plans. Adherence to inhaled corticosteroids (ICS), when indicated for persistent or uncontrolled asthma, is a critical component of most asthma management plans, and other self-management practices such as trigger avoidance are similarly related to improved asthma outcomes. Adherence to self-management practices is mediated by multiple factors, including psychosocial stress of parents and their children.
A targeted, culturally appropriate intervention to manage psychosocial stress among the parents of young, African American, and socioeconomically disadvantaged urban children with asthma who are receiving guideline-based care may improve asthma self-management, and therefore asthma outcomes.
Our overall aim is to implement and evaluate a highly collaborative, multi-dimensional, culturally appropriate and community-based asthma intervention to augment existing guideline-based best practice. The intervention will target the parents of at-risk, urban, African American youth, and will employ individualized psychosocial stress management and peer support.
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Descripción detallada
Uncontrolled asthma in at-risk youth responds well to guideline-based therapy when patients remain adherent to their management plans. Adherence to inhaled corticosteroids (ICS), when indicated for persistent or uncontrolled asthma, is a critical component of most asthma management plans, and other self-management practices such as trigger avoidance are similarly related to improved asthma outcomes. Adherence to self-management practices is mediated by multiple factors, including psychosocial stress of parents and their children.
A targeted, culturally appropriate intervention to manage psychosocial stress among the parents of young, African American, and socioeconomically disadvantaged urban children with asthma who are receiving guideline-based care may improve asthma self-management, and therefore asthma outcomes.
Our overall aim is to implement and evaluate a highly collaborative, multi-dimensional, culturally appropriate and community-based asthma intervention to augment existing guideline-based best practice. The intervention will target the parents of at-risk, urban, African American youth, and will employ individualized psychosocial stress management and peer support.
We will conduct a single blind, prospective randomized controlled trial comparing the IMPACT DC Asthma Clinic's existing intervention of guideline-based clinical care, education, and short-term care coordination (usual care) to usual care plus parental stress management in a cohort of up to 200 parent-child dyads of AA youth aged 4-12 years.
Tipo de estudio
Inscripción (Actual)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
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District of Columbia
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Washington, District of Columbia, Estados Unidos, 20010
- Children's National Medical Center
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
We plan to enroll parent-child dyads that meet the following criteria:
Inclusion criteria (Parent):
- self-identify as African-American
- both the legal guardian and primary asthma caregiver of an eligible child.
Exclusion criteria (Parent):
- unable or unwilling to sign informed consent document
- exclusionary psychiatric condition, including but not limited to psychosis, based on the screening form at recruitment
- enrolled in another asthma research study.
Inclusion criteria (Child):
- parent-identified as African-American
- age 4-12 years inclusive at recruitment
- physician diagnosis of persistent asthma
- publicly financed insurance
Exclusion criteria (Child):
- chronic medical condition (other than asthma) including but not limited to diabetes, sickle cell disease, heart disease, lung disease or neurological disorder.
In addition, the PI may choose to not include a participant if he does not believe it is in the family's best interest to participate.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Único
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
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Comparador activo: Usual Care
IMPACT DC Asthma Clinic intervention of guideline-based clinical care, education, and short-term care coordination
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IMPACT DC Asthma Clinic intervention of guideline-based clinical care, education, and short-term care coordination
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Experimental: Intervention
Parental stress management in addition to IMPACT DC intervention of guideline-based clinical care, education, and short-term care coordination.
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The intervention for this study is a multi-dimensional stress management program designed to be responsive to parent and other stakeholder preferences.
The intervention will have two separate yet coordinated components: one-on-one stress management sessions and peer group sessions led by "community wellness coaches."
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Symptom-free Days in the Last 14 Days
Periodo de tiempo: Repeated Measures at 6 months (3 month data collected to allow for repeated measures)
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Symptom-free days are defined as a 24-hour period with no coughing, wheezing, chest tightness, or shortness of breath and no need for rescue medications
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Repeated Measures at 6 months (3 month data collected to allow for repeated measures)
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Asthma Morbidity - Nighttime Asthma Symptoms
Periodo de tiempo: Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Nights of asthma symptoms in prior 14d
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Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Asthma Severity and Control
Periodo de tiempo: Repeated Measures at 3, 6, and 12 months
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Repeated Measures at 3, 6, and 12 months
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Asthma Medication Adherence
Periodo de tiempo: Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Reported use of inhaled corticosteroids and LTRA in past two days
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Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Health Care Utilization - Emergency Department Visits for Asthma
Periodo de tiempo: 12 months after enrollment
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Health care utilization - emergency department visits for asthma over six month and twelve month follow up periods.
Reported as those documented in the electronic medical record of Children's National Health System plus parent report of visits elsewhere
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12 months after enrollment
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Asthma Exacerbations - Courses of Systemic Steroids
Periodo de tiempo: Assessed at 6m and 12m following enrollment
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Courses of systemic steroids over 12m follow up period
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Assessed at 6m and 12m following enrollment
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Parental Stress
Periodo de tiempo: Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Score on Perceived Stress Scale (PSS).
The Perceived Stress Scale consists of 10 questions and is a measure of the degree to which situations in one's life are appraised as stressful.
Scores range from 0 - 40, with higher scores indicating a higher level of perceived stress.
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Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Parental Depression
Periodo de tiempo: Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Score on Center for Epidemiologic Studies Depression Scale (CES-D - 10).
The CESD-10 scale screens for depressive symptoms.
Scores range from 0-30, with higher scores indicating a higher degree of depressive symptoms.
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Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Child Anxiety
Periodo de tiempo: Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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PROMIS Parent Proxy Anxiety.
For PROMIS instruments, T-scores rescale the raw score into a standardized score with a mean of 50 and a standard deviation of 10.
A higher T-score represents higher anxiety and/or depression.
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Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Child Depression
Periodo de tiempo: Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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PROMIS Parent Proxy Depressive Symptoms is a parent-report assessment of child depression.
For PROMIS instruments, T-scores rescale the raw score into a standardized score with a mean of 50 and a standard deviation of 10.
A higher T-score represents higher anxiety and/or depression.
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Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Caregiver Quality of Life
Periodo de tiempo: Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Caregiver quality of life score, assessed by modified Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ).
The measure had five response options, with scores ranging from 13-65 and higher scores meaning better quality of life.
No subscales were analyzed.
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Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Number of Participants With AEs and SAEs
Periodo de tiempo: 12m follow up period
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Safety data: Number of Participants with AEs and SAEs
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12m follow up period
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Economic Outcomes
Periodo de tiempo: 12m follow-up period
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Analysis of costs of care in both groups
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12m follow-up period
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Caregiver Smoking Behavior
Periodo de tiempo: Repeated Measures at 6 and 12 months
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parent report of cigarettes smoked per day
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Repeated Measures at 6 and 12 months
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Coping Strategies
Periodo de tiempo: Repeated measures at 12m FU (6m data used for repeated measures)
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Brief COPE
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Repeated measures at 12m FU (6m data used for repeated measures)
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Mindfulness
Periodo de tiempo: Repeated Measures at 6 and 12 months
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Interpersonal Mindfulness in Parenting
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Repeated Measures at 6 and 12 months
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Parental Resilience
Periodo de tiempo: Repeated Measures at 6 and 12 months
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Parental resilience assessed by score on Revised Life Orientation Test (LOT-R) measure.
The LOT-R assesses optimism/resilience, and is comprised of 10 questions.
Scores range from 0-40, with a higher score indicating a higher level of optimism.
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Repeated Measures at 6 and 12 months
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Exacerbations - Hospital Admissions
Periodo de tiempo: Assessed at 6m and 12m after enrollment
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Number of participants with hospital admissions due to exacerbations
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Assessed at 6m and 12m after enrollment
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Symptom-free Days in the Last 14 Days
Periodo de tiempo: Repeated Measures at 12 months (with data also assessed at 3m and 6m)
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Symptom-free days are defined as a 24-hour period with no coughing, wheezing, chest tightness, or shortness of breath and no need for rescue medications
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Repeated Measures at 12 months (with data also assessed at 3m and 6m)
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Asthma Morbidity - Daytime Asthma Symptoms, Days of Activity Limitations, and Days of Quick Relief Medicine Use
Periodo de tiempo: Repeated measures at 6 and 12 months (3m data collected for repeated measures)
|
Days of asthma symptoms, activity limitation, and quick relief medicine use in prior 14d
|
Repeated measures at 6 and 12 months (3m data collected for repeated measures)
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Otras medidas de resultado
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Sociodemographics
Periodo de tiempo: Baseline
|
Age, gender, race, ethnicity, insurance type, parental education, household income, family medical history
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Baseline
|
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Number of Participants With Positive Smoke Exposure
Periodo de tiempo: Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Participants with environmental smoke exposure.
Responses were regrouped as negative (none) or positive (daily, often, or rarely) based on two questions: "How often did anyone smoke inside the home where child usually lives?" or "How often did anyone smoke in the room where child usually sleeps?"
A positive response on either or both questions was considered positive exposure.
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Repeated Measures at 6 and 12 months (3m data collected for repeated measures)
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Parental Health Literacy
Periodo de tiempo: Baseline
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Single Item Literacy Screener (SILS)
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Baseline
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Use of Existing Ancillary Services
Periodo de tiempo: Assessed at 6m and 12m following enrollment
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Assessed at 6m and 12m following enrollment
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|
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Parental Resilience
Periodo de tiempo: Baseline
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Parental resilience assessed by score on Revised Life Orientation Test (LOT-R) measure.
The LOT-R assesses optimism/resilience, and is comprised of 10 questions.
Scores range from 0-40, with a higher score indicating a higher level of optimism.
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Baseline
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Intervention Component Uptake
Periodo de tiempo: 6 month intervention period
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Completion of intervention sessions
|
6 month intervention period
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Intervention Satisfaction
Periodo de tiempo: 6 month intervention period
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Brief survey of satisfaction with intervention components.
|
6 month intervention period
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Intervention Fidelity
Periodo de tiempo: 6 month intervention period
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Checklist of staff's fidelity to individual components of intervention protocol
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6 month intervention period
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Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Stephen Teach, MD, MPH, Children's National Health System
Publicaciones y enlaces útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- 5819
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