PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Asthma. 2020 Dec;57(12):1372-1378. doi: 10.1080/02770903.2019.1648503. Epub 2019 Aug 7.
While reminder-based electronic monitoring systems have shown promise in enhancing inhaled corticosteroid (ICS) adherence in select populations, more engaging strategies may be needed in families of children with high-risk asthma. This study assesses the acceptability and feasibility of gain-framed ICS adherence incentives in families of urban, minority children with frequent asthma hospitalization. We enrolled children aged 5-11 years with multiple yearly asthma hospitalizations in a 2-month, mixed methods, ICS adherence incentive pilot study. All participants received inhaler sensors and a smartphone app to track ICS use. During month 1, families received daily adherence reminders and weekly feedback, and children earned up to $1/day for complete adherence. No reminders, feedback, or incentives were provided in month 2. We assessed feasibility and acceptability using caregiver surveys and semi-structured interviews and ICS adherence using electronic monitoring data. Of the 29 families approached, 20 enrolled (69%). Participants were primarily Black (95%), publicly insured (75%), and averaged 2.9 asthma hospitalizations in the prior year. Fifteen of the 16 caregivers (94%) surveyed at month 2 liked the idea of receiving adherence incentives. Mean adherence was significantly higher in month 1 compared with month 2 (80% vs. 33%, mean difference = 47%; 95% CI [33, 61], < 0.001). Caregivers reported that their competing priorities often limited adherence, while incentives helped motivate child adherence. ICS adherence incentives were acceptable and feasible in a high-risk cohort of children with asthma. Future studies should assess the efficacy of adherence incentives in enhancing ICS adherence in high-risk children.
虽然基于提醒的电子监测系统在提高特定人群吸入皮质类固醇（ICS）的依从性方面显示出了一定的前景，但在高危哮喘儿童的家庭中，可能需要更有吸引力的策略。本研究评估了以收益为导向的 ICS 依从性激励措施在城市少数民族儿童高危哮喘家庭中的可接受性和可行性。我们招募了年龄在 5-11 岁之间、有多次哮喘住院经历的儿童，进行了为期 2 个月的、混合方法的 ICS 依从性激励试点研究。所有参与者都配备了吸入器传感器和智能手机应用程序，以跟踪 ICS 的使用情况。在第 1 个月，家庭每天收到依从性提醒和每周反馈，孩子在完全依从时每天最多可获得 1 美元的奖励。第 2 个月不提供提醒、反馈或激励。我们通过护理人员调查和半结构化访谈评估了可行性和可接受性，并通过电子监测数据评估了 ICS 依从性。在接触的 29 个家庭中，有 20 个家庭（69%）参与了研究。参与者主要是黑人（95%），有公共保险（75%），在前一年平均有 2.9 次哮喘住院。在第 2 个月接受调查的 16 名护理人员中的 15 名（94%）表示喜欢接受依从性激励的想法。与第 2 个月相比，第 1 个月的平均依从性显著更高（80%比 33%，平均差异=47%；95%CI[33, 61]， < 0.001）。护理人员报告说，他们的优先事项往往会限制依从性，而激励措施有助于激励孩子的依从性。ICS 依从性激励在高危哮喘儿童中是可接受和可行的。未来的研究应评估依从性激励在提高高危儿童 ICS 依从性方面的疗效。
