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Technology-Assisted Stepped Care Study (TASC Phase 3)

2022年3月9日 更新者：Children's Hospital Medical Center, Cincinnati

Technology Assisted Stepped Care (TASC): Phase 3

The overall goal of this project is to demonstrate the feasibility, implementation, and preliminary efficacy of a technology-assisted stepped care (TASC) adherence-promotion intervention in adolescents with asthma. This is the third phase (Phase 3) of a three-phase project to test the preliminary efficacy of a technology-assisted stepped care (TASC) intervention. In Phase 1, we developed the intervention using patient and provider feedback from focus groups. In Phase 2 we refined the developed intervention by having five adolescents from the focus groups test the intervention for feasibility. In this third phase, we will enroll up to 50 adolescents to pilot-test the refined intervention for preliminary efficacy.

調査の概要

状態

完了

条件

介入・治療

詳細な説明

Up to fifty adolescents with asthma will be enrolled in an open label pilot trial of the TASC adherence-promotion intervention for a duration of twelve months. First, participants will complete baseline questionnaires related to demographic, and clinical predictors of adherence and asthma and a 4 week run-in phase to assess baseline adherence using electronic inhaler monitoring with a cellphone that is provided to them. Following the run-in period, all participants will receive Step 1 of the TASC intervention for a minimum of 4 weeks. Step 1 (Information) will include electronic educational information related to asthma symptoms and triggers, attacks, self-monitoring, treatments, action plans, and automated text message medication reminders. Following the initial four weeks of Step 1, adherence will be evaluated and a rate of less than 68% will serve as the cause for "stepping up" to the next level of the intervention. Adherence checks will continue to occur every four weeks for the duration of the study and adherence <68% will prompt movement from one level of treatment to the next. Participants may remain at a treatment level for more than four weeks and may complete 1, 2, or 3 interventions steps during the 5 month study depending on the adolescent's adherence. Step 2 (Motivation) will include electronic monitoring of adherence and personally tailored feedback via text messages. Adolescents will be given access to the adherence tracking cellphone app and graphs of their inhaler adherence. Adolescents will also receive brief, personalized text messages that provide supportive motivation and directive, tangible actions. Step 3 (Behavioral) will include problem-solving telehealth intervention with a trained clinician. Four telehealth sessions individually tailored to the unique needs and barriers of the adolescent will be provided. The primary outcome measure will be electronically-monitored adherence assessed at post-treatment. Secondary outcomes include asthma severity as well as process evaluation questions and quantitative measures of feasibility, acceptability, and satisfaction to demonstrate implementation. Participants will remain in the study for an additional 7 months after they complete month 5 of the study. For the remaining 7 months, participants will be randomized to one of two booster session patterns with the goal to improve inhaler adherence. The statistician will make the randomization schedule and the principle investigator will maintain the randomization schedule. Two different booster patterns are being used to test which pattern will be most effective. The first booster session pattern will include booster sessions at the end of month 6, 8, and 12. The second booster session pattern will include booster sessions at the end of month 6, 7, 8, 10, and 12. Booster sessions will review content provided during the intervention and the intervention delivery method will be consistent with the participants final intervention step. Participants will also continue to complete monthly check-ins with the study coordinator to complete the Composite Asthma Severity Index, the Asthma Control Test, and a spirometry test.

研究の種類

介入

入学 (実際)

40

段階

  • 適用できない

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究場所

  • アメリカ
    • Ohio
      • Cincinnati、Ohio、アメリカ、45229
        • Cincinnati Children's Medical Hospital

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

12年～18年 (子、大人)

健康ボランティアの受け入れ

いいえ

受講資格のある性別

全て

説明

Inclusion Criteria:

  • Patient age between 12-18 years
  • Patient is diagnosed with severe-persistent or moderate-persistent asthma per NAEPP asthma guidelines
  • Patient is prescribed at least one daily inhaled controller medication or a daily combination inhaled corticosteroid and long-acting beta-agonist and a beta-agonist bronchodilator
  • English fluency for patient, caregiver, and clinician

Exclusion Criteria:

  • Significant cognitive deficits that may interfere with comprehension per medical team or chart review.
  • Diagnosis of serious mental illness (e.g., schizophrenia)
  • Diagnosis of pervasive developmental disorder
  • Active chronic disease apart from asthma or allergic disease (e.g. Bronchiectasis)
  • Patient receives school administered daily controller medication at the time of the enrollment visit

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：ヘルスサービス研究
  • 割り当て：なし
  • 介入モデル：単一グループの割り当て
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
実験的：TASC介入
すべての参加者は、介入のステップ 1 を受け取ります。 アドヒアランスが 68% 以下または 68% の参加者は、研究の 3 か月目または 4 か月後にステップ 2 またはステップ 3 に進みます。
行動：テクノロジーを利用した段階的ケア
介入のステップ 1 には、喘息に関連する教材が含まれています。 ステップ 2 には、アドヒアランスの電子モニタリングと、参加者に個人的に合わせたテキスト メッセージによる介入が含まれます。 ステップ 3 には、訓練を受けた臨床医による問題解決の遠隔医療セッションが含まれます。

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Electronic Monitoring
時間枠：12 months
The Propeller Health monitoring system includes a Bluetooth enabled sensor that attaches to the patient's inhaler. This sensor records every dose, or "puff", the patient takes and sends it to a corresponding online database that is accessible to study staff. Participants will be given this sensor at baseline.
12 months

二次結果の測定

結果測定
メジャーの説明
時間枠
実現可能性/受容性アンケート
時間枠：5ヶ月
形式、内容、長さ、スキル、および介入の受容性に関する 5 ～ 31 項目の尺度が、各ステップの終了時および研究の終了時にアンケートの形式で参加者に提供されます。 実現可能性セクションは 0 から 4 のスケールであり、0 が最悪で 4 が最良です。 受容性アンケートは、「まったくない」から「非常に」までの尺度であり、「まったくない」が最悪で「非常に」が最良です。
5ヶ月
システム ユーザビリティ スケール
時間枠：5ヶ月
ユーザビリティの全体像を示す 10 項目のリッカート尺度が、各ステップの終了時および研究の終了時にアンケートの形で参加者に提供されます。 尺度は「まったくそう思わない」から「非常にそう思う」までの範囲で、項目の半分が逆のスコアになっています。
5ヶ月
Lung Function Assessment
時間枠：Baseline assessment and then once a month for 12 months
The mobile spirometer records multiple parameters of the patient's lung function including forced expiratory volume, peak expiratory flow, forced vital capacity, and forced expiratory flow. The spirometer sends the values to the corresponding mobile phone application, Propeller Health, which is directly accessible to the patient.
Baseline assessment and then once a month for 12 months
Composite Asthma Severity Index (CASI)
時間枠：Baseline assessment and then once a month for 12 months
The participants' composite asthma severity index score will be calculated through the TreatSmart program. TreatSmart will be used to determine the participant's symptom burden, health care utilization, systemic corticosteroid use, and current medication use to determine the level of asthma severity/control the participant has. The program also makes an initial treatment recommendation based on the National Asthma Education and Prevention Program (NAEPP asthma guidelines). Individuals are placed in Step 1 through Step 6 depending on the strength and frequency of their inhaled corticosteroid (1 being low dose and 6 being a high dose). In addition, individuals are categorized as very poorly controlled, not well controlled, or well controlled based on how frequently they have had asthma symptoms or used their rescue inhaler, gone to the hospital or urgent care, or received steroids for asthma symptoms.
Baseline assessment and then once a month for 12 months
Asthma Control Test (ACT)
時間枠：Baseline assessment and then once a month for 12 months
The ACT will be used as a measure of disease severity in this study. The ACT is a 5-question scoring tool designed for patients with asthma who are 12 years and older. The questions ask the patient to rate their asthma severity, symptom frequency, control, and inhaler use on a scale of 1-5. The total score is calculated by the sum of each response, which determines how well-controlled the patient's asthma is on a scale from 5-25.
Baseline assessment and then once a month for 12 months
Attendance/Participation rates
時間枠：12 months
Participation rates will be measured 3 different ways. The first measure will be how often participants accessed the electronic material (educational materials and/or Propeller Health app), the second measure will be how many responses to directive text messaging were received, and the third measure will be attendance to the telehealth sessions.
12 months
Acceptability of Intervention Measure (AIM)
時間枠：At 5 months
A 4 item measure of participants' belief that the intervention is acceptable will be given at the end of the study. Participants respond to each statement on a 5 point Likert scale (1= Completely Disagree, 5= Completely Agree).
At 5 months
Intervention Appropriateness Measure (IAM)
時間枠：At 5 months
A 4 item measure of participants' perception that the intervention is appropriate will be given at the end of the study. Participants respond to each statement on a 5 point Likert scale (1= Completely Disagree, 5= Completely Agree).
At 5 months
Feasibility of Intervention Measure (FIM)
時間枠：At 5 months
A 4 item measure of participants' belief that the intervention is feasible will be given at the end of the study. Participants respond to each statement on a 5 point Likert scale (1= Completely Disagree, 5= Completely Agree).
At 5 months
Treatment Fidelity
時間枠：12 months
Treatment fidelity needed for the intervention will be assessed. Treatment fidelity will be assessed through fidelity checklists created specifically for each intervention session.
12 months
Time Needed for Intervention
時間枠：12 months
Sessions will be timed and the number of weeks to complete the session will be tracked to determine the average length of time needed for the intervention.
12 months
Perceived Characteristics of Intervention Scale
時間枠：At 12 months
19 item measure of interventionist views toward the study intervention.
At 12 months

その他の成果指標

結果測定
メジャーの説明
時間枠
Behavior Assessment System for Children-Third Edition, Self-report of Personality (BASC-3-SRP-A
時間枠：Baseline assessment and at 5 months
The BASC-3 is a widely used, reliable (α= 0.94 - 0.96 , test-retest r= 0.81 -0.82), and valid inventory to assess emotional and behavioral symptoms in adolescents and young adults (ages 13-21).
Baseline assessment and at 5 months
Adolescent Barriers to Medication Scales (AMBS)
時間枠：Baseline Assessment
The AMBS is an 18-item validated measure of perceived barriers to medication adherence in adolescents.
Baseline Assessment
Technology-based Experience of Need Satisfaction- Interface questionnaire (TENS-Interface)
時間枠：Baseline assessment and then at 2 months
A 15- item measure of participant's competence, autonomy, and relatedness in using technology. Participants rate their level of agreement to each statement on a 5- point Likert scale (1= Do Not Agree, 5= Strongly Agree).
Baseline assessment and then at 2 months
Autonomy and Competence in Technology Adoption Questionnaire (ACTA)
時間枠：Baseline Assessment
A 10-item measure of why people adopt use of a technology (i.e. download an app, register with a website, purchase a wearable device, etc.).Participants respond to self-regulation statements on a scale of 1 to 5, 1 being 'not at all true' and 5 being 'very true.'
Baseline Assessment
Technology-based Experience of Need Satisfaction- Task questionnaire (TENS- Task)
時間枠：Baseline assessment and then at 2 months
An 8-item measure of participant's competence, autonomy, and relatedness in managing their asthma using technology. Participants rate their level of agreement to each statement on a 5- point Likert scale (1= Do Not Agree, 5= Strongly Agree).
Baseline assessment and then at 2 months
Technology Effects on Need Satisfaction in Life (TENS- Life)
時間枠：Baseline assessment and then at 2 months
The TENS-Life is a 10- item measure of the extent to which a user perceives that the use of a particular technology has had an influence on the satisfaction of basic psychological needs in their life. Participants rate their level of agreement to each statement on a 5- point Likert scale (1= Do Not Agree, 5= Strongly Agree).
Baseline assessment and then at 2 months
知識アンケート
時間枠：ベースライン評価
喘息の症状、誘因、投薬に関する個人の知識を評価する 13 項目のアンケート。 参加者は各発言に対する同意のレベルを「非常に同意する」から「非常に同意しない」までのスケールで評価します。 このアンケートはベースライン訪問時に記入されます。
ベースライン評価
困難に関するアンケート
時間枠：ベースライン評価
世帯内の個人の経済的負担を評価する 19 項目の検証済みアンケート。
ベースライン評価

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Children's Hospital Medical Center, Cincinnati

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (実際)

2018年12月7日

一次修了 (実際)

2021年4月20日

研究の完了 (実際)

2021年4月20日

試験登録日

最初に提出

2019年2月8日

QC基準を満たした最初の提出物

2019年3月19日

最初の投稿 (実際)

2019年3月21日

学習記録の更新

投稿された最後の更新 (実際)

2022年3月10日

QC基準を満たした最後の更新が送信されました

2022年3月9日

最終確認日

2022年3月1日

詳しくは

本研究に関する用語

その他の研究ID番号

  • CIN001- {"TASC Phase 3"}

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

未定

医薬品およびデバイス情報、研究文書

米国FDA規制医薬品の研究

いいえ

米国FDA規制機器製品の研究

いいえ

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