Yin Hsiang Shonna, Gupta Ruchi S, Mendelsohn Alan L, Dreyer Benard, van Schaick Linda, Brown Christina R, Encalada Karen, Sanchez Dayana C, Warren Christopher M, Tomopoulos Suzy
a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.
c Department of Population Health , NYU School of Medicine , New York , NY , USA.
J Asthma. 2017 Nov;54(9):919-929. doi: 10.1080/02770903.2016.1277542. Epub 2017 Jan 3.
The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan.
A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site.
217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2-0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06-0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5).
Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.
本研究的目的是确定与使用标准哮喘行动计划的家长相比，使用基于象形图和照片、识字要求低的书面哮喘行动计划（WAAP）的家长对儿童哮喘管理的理解是否更好。
在两家城市儿科门诊进行了一项随机对照研究。纳入标准为2至12岁哮喘儿童的英语和西班牙语家长。家长被随机分为接受针对假设患者的低识字要求或标准哮喘行动计划（美国过敏、哮喘与免疫学会），该计划涉及控制药物和急救药物。使用结构化问卷评估在以下方面的知识错误：（1）日常及生病时用药，（2）使用储雾罐的必要性，（3）使用沙丁胺醇并寻求医疗帮助的适当应急反应。进行了多项逻辑回归分析，并对家长年龄、健康素养（最新生命体征）、儿童哮喘严重程度、用药情况和地点进行了调整。
217名家长被随机分组（109名干预组和108名对照组）。与接受标准计划的家长相比，接受低识字要求计划的家长：（1）在日常及生病时用药知识方面出错的可能性较小（63.0%对77.3%，p = 0.03；调整后的优势比[AOR] = 0.5[95%置信区间：0.2 - 0.9]），（2）在储雾罐使用方面出错的可能性较小（14.0%对51.1%，p < 0.001；AOR = 0.1[0.06 - 0.3]）。在适当应急反应方面的错误没有差异（43.1%对48.1%，p = 0.5）。
使用低识字要求的WAAP与家长对哮喘管理有更好的理解相关。需要进一步研究来评估使用该行动计划是否能改善儿童哮喘结局。
