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Evid Based Nurs 5:107 doi:10.1136/ebn.5.4.107
  • Treatment

An interactive monitoring device reduced asthma symptoms and functional limitations in inner city children with asthma


 
 QUESTION: Does an interactive, home based device that monitors asthma symptoms, aspects of quality of life, and self care (Health Buddy) reduce asthma symptoms and increase self care behaviours in inner city children with persistent asthma?

Design

Randomised {allocation concealed}*, controlled trial with follow up at 6 and 12 weeks.

Setting

An inner city primary care clinic in Oakland, California, USA.

Patients

134 children who were 8–16 years of age (mean age 12 y, 57% boys, 76% African-American), had a diagnosis of persistent asthma, had an English speaking caregiver, and had a telephone at home. Exclusion criteria were involvement in other asthma or drug efficacy studies or behaviour modification research, mental or physical challenges that made it difficult to use the Health Buddy, or comorbid conditions affecting quality of life. Follow up was 96% at 6 weeks and 91% at 12 weeks.

Intervention

66 children were allocated to the Health Buddy (Health Hero Network, Mountain View, California), an interactive device connected to a home telephone. Each day, a nurse coordinator sent a set of queries (dialogues) using a standard internet browser. Children answered the queries by pressing 1 of 4 buttons. The dialogues were aimed at a third grade reading level and consisted of 10 questions about asthma symptoms, peak flow readings, use of medication and health services, and functional status. Each answer by the child received immediate feedback from the device (ie, praise for a correct answer or encouragement to try again). Children were to access the device on their own at a regular time once each day. 68 children were allocated to the control group and used a standard asthma diary to log their symptoms, peak flow, medication use, and restricted activity.

Main outcome measures

Main outcome was limitation in activity because of asthma. Secondary outcomes included peak flow readings in the red zone (<50% of personal best, signalling severe asthma exacerbation) or yellow zone (50% to 80% of personal best, signalling asthma that is not sufficiently controlled and requires additional medication), and perceived asthma symptoms in the previous 14 days; missed school days and use of health services because of asthma in the previous 6 weeks; and self care behaviours.

Main results

Analyses adjusted for different visits, asthma severity, and baseline symptoms showed that children allocated to the Health Buddy were less likely than children allocated to the asthma diary to report limitations in activities (odds ratio [OR] 0.52, 95% CI 0.29 to 0.94), made fewer urgent calls to health services (OR 0.43, CI 0.18 to 0.99), and were more likely to take their asthma medication without additional reminders (p=0.04). They were also less likely to have peak flow readings in the yellow or red zones (OR 0.43, CI 0.23 to 0.82). The groups did not differ for coughing or wheezing (p=0.23), trouble sleeping (p=0.83), emergency department visits (p=0.21), or hospital admissions (p=0.96).

Conclusion

In inner city children with asthma, an interactive communication device for monitoring asthma symptoms and functional status reduced limitations in activity and urgent calls to health services when compared with a standard asthma diary.

COMMENTARY

  1. David Pontin, RN, RHV, RSCN, PhD
  1. Senior Lecturer
 University of West of England
 Bristol, UK

      The study by Guendelman et al used a child centred approach to asthma self management. Children communicated directly with nurses through the Health Buddy. Differences in the reporting of symptoms between parents and children1,2 and different perceptions of quality of life3 suggest that it is important to obtain information directly from children who have asthma rather than relying on adult carers to describe symptoms and quality of life. New communication technologies such as the Health Buddy could help to empower children to take a larger role in their own care.

      Study participants were children attending an ambulatory clinic serving an inner city Medicaid insured population, and thus generalisability to other populations may be limited. The follow up period was too short to assess lasting changes in health behaviour, and the authors note that in both groups, child recording of health maintenance data diminished towards the end of the study, which might be attributed to saturation with the health messages.

      The results of this study are relevant to community and hospital based nurses, particularly those planning self management programmes for children with asthma. Because of the eventual drop off rate in using the Health Buddy system and asthma diary, Guendelman et al suggest that this intervention might be better targeted to children during critical care management times, such as at the start of asthma care or after an acute exacerbation or hospital admission. Further research is needed to evaluate the effectiveness of a more targeted use of the Health Buddy system, and whether the system is more effective and cost effective than close follow up by a nurse case manager alone.

      References

      Footnotes

      • Source of funding: Merck and Company, Inc.

      • For correspondence: Dr S Guendelman, School of Public Health, University of California, Berkeley, CA, USA.sylviag{at}uclink4.berkeley.edu

      • * Information provided by author.

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