Evaluation of a web-based asthma management intervention program for urban teenagers: reaching the hard to reach
Christine L M Joseph, Dennis R Ownby, Suzanne L Havstad, Jacqueline Saltzgaber, Shannon Considine, Dayna Johnson, Ed Peterson, Gwen Alexander, Mei Lu, Wanda Gibson-Scipio, Christine Cole Johnson, Research team members, Christine L M Joseph, Dennis R Ownby, Suzanne L Havstad, Jacqueline Saltzgaber, Shannon Considine, Dayna Johnson, Ed Peterson, Gwen Alexander, Mei Lu, Wanda Gibson-Scipio, Christine Cole Johnson, Research team members
Abstract
Purpose: Asthma interventions targeting urban adolescents are rare, despite a great need. Motivating adolescents to achieve better self-management of asthma is challenging, and the literature suggests that certain subgroups are more resistant than others. We conducted a school-based, randomized controlled trial (RCT) to evaluate Puff City, a Web-based, tailored asthma intervention, which included a referral coordinator, and incorporated theory-based strategies to target urban teens with characteristics previously found to be associated with lack of behavior change.
Methods: To identify eligible teens, we administered questionnaires on asthma diagnoses and symptoms to ninth through 12th graders of participating schools during a scheduled English class. We randomized eligible, consenting students to Puff City (treatment) or generic asthma education (control).
Results: We randomized 422 students (98% African-American, mean age = 15.6 years). At 12-month follow-up, adjusted odds ratios (aORs) (95% confidence intervals) indicated intervention benefit for treatment teens for symptom-days and restricted activity days (analyzed as categorical variables) as aOR = .49 (.24-.79), p = .006 and .53 (.32-.86), p = .010, respectively. Among teens meeting baseline criteria for rebelliousness, treatment teens reported fewer symptom-days, symptom-nights, school absences, and restricted activity days: aOR = .30 (.11-.80), .29 (.14-.64), .40 (.20-.78), and .23 (.10-.55); all p < .05. Among teens reporting low perceived emotional support, treatment students reported only fewer symptom-days than controls: aOR = .23 (.06-.88), p = .031. We did not observe statistically significant differences in medical care use.
Conclusions: Results suggest that a theory-based, tailored approach, with a referral coordinator, can improve asthma management in urban teens. Puff City represents a viable strategy for disseminating an effective intervention to high-risk and hard-to-reach populations.
Trial registration: ClinicalTrials.gov NCT00201058.
Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
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Source: PubMed