ABSTRACT
OBJECTIVE: To determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma. METHODS: We used a randomized clinical trial with 48 youth (aged 9-15 years) assigned to 1 of 3 groups: Teamwork Intervention (TI), Asthma Education (AE), or Standard Care (SC). Treatment occurred across 2 months, with a 3-month follow-up assessment. Adherence to inhaled corticosteroids was assessed via the MDILog-II. Parent-adolescent conflict, asthma functional severity, and spirometry assessments were obtained pre-treatment, post-treatment, and on follow-up. Mixed linear model analysis was used to evaluate group and time effects for outcome measures. RESULTS: TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions, and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group. CONCLUSIONS: Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Medication Adherence , Parent-Child Relations , Administration, Inhalation , Adolescent , Adrenal Cortex Hormones/administration & dosage , Anti-Asthmatic Agents/administration & dosage , Child , Female , Humans , Male , Parents , Treatment OutcomeABSTRACT
A behavior therapy approach for obtaining cooperation during needle sticks was provided to 8 pediatric patients with intellectual and developmental disabilities. Therapy was provided during mock needle sticks. Hand lotion was applied to simulate topical anesthetic. Distracting activities established relaxation while needle stick materials were gradually introduced. Positive reinforcement was provided for cooperation. Behavioral distress was ignored, blocked, or redirected. After cooperating with mock needle sticks, needle sites were prepared with topical anesthetic (EMLA), then therapists and medical staff implemented the behavioral protocol while completing the actual needle stick(s). Observational measures of cooperation and interfering were obtained. Results were replicated across 8 children and evaluated using paired samples t tests. Initially, all children were uncooperative with needle sticks. With treatment, behavioral distress decreased, and patients cooperated with mock and actual needle sticks. Results support the effectiveness of behavior therapy for promoting cooperation in children with intellectual and developmental disabilities during needle sticks.
Subject(s)
Behavior Therapy/methods , Cooperative Behavior , Phlebotomy , Adolescent , Caregivers , Child , Child, Preschool , Developmental Disabilities , Female , Humans , Male , Stress, Psychological , Task Performance and AnalysisABSTRACT
BACKGROUND: Adherence to CF treatments is poor, which can lead to negative health outcomes. The objective of our study was to qualitatively investigate the barriers and facilitators of self-management among older adolescents and adults with CF. METHODS: Individual semi-structured interviews were conducted, audio-taped, transcribed verbatim and coded to identify common themes. RESULTS: Twenty-five patients were interviewed. Four broad themes were identified: Barriers to Self-Management (e.g., treatment burden (identified by 64% of patients), accidental or purposeful forgetting (60%), no perceived benefit (56%)), Facilitators of Self-Management (e.g., CF clinic visits (76%), social support (68%), perceived benefit (68%)), Substitution of Alternative Approaches to Conventional Management (36%) and Planned Non-adherence (32%). CONCLUSIONS: Older adolescents and adults with CF identified many barriers and facilitators of adherence that may be amenable to self-management counseling strategies, particularly the use of health feedback.
