Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
J Asthma. 2021 Mar;58(3):370-377. doi: 10.1080/02770903.2019.1690661. Epub 2019 Nov 22.
The recruitment setting plays a key role in the evaluation of behavioral interventions. We evaluated a behavioral intervention for urban adolescents with asthma in three randomized trials conducted separately in three different settings over the course of 8 years. We hypothesized that characteristics of trial participants recruited from the ED and clinic settings would be significantly different from that of youth participating in the school-based trials. The intervention evaluated was Puff City, a web-based program that uses tailoring to improve asthma management behaviors.
The present analysis includes youth aged 13-19 years who reported a physician diagnosis of asthma and symptoms at trial baseline. In the three trials, all participants were randomized post-baseline to a web-based, tailored intervention (treatment) or generic web-based asthma education (control).
Compared to school-based trial participants, ED participants had significantly more acute-care visits for asthma ( < 0.001) and more caregiver depression ( < 0.001). Clinic-based participants were more likely to have computer/ internet access than participants from the school-based trial ( < 0.001). Both ED and clinic participants were more likely to report controller medication ('s < 0.001) and higher teen emotional support ('s < 0.01) when compared to the schools, but were less likely to report Medicaid ('s < 0.014) and exposure to environmental tobacco smoke ( < 0.001).
Compared to participants in the school-based trials, participants recruited from ED and clinic settings differed significantly in terms of healthcare use, as well as psychosocial and sociodemographic factors. These factors can inform intervention content, and may impact external validity of behavioral interventions for asthma.
招募设置在行为干预措施的评估中起着关键作用。我们在 8 年内分三个不同的设置，通过三项随机试验评估了针对城市青少年哮喘的行为干预措施。我们假设从急诊室和诊所招募的试验参与者的特征与参与基于学校的试验的年轻人有显著不同。评估的干预措施是 Puff City，这是一个基于网络的程序，它使用定制来改善哮喘管理行为。
本分析包括在试验基线时报告医生诊断为哮喘和症状的 13-19 岁青少年。在三项试验中，所有参与者均在基线后随机分配到基于网络的定制干预措施（治疗）或通用基于网络的哮喘教育（对照）。
与基于学校的试验参与者相比，急诊室参与者因哮喘而进行的急性护理就诊次数明显更多（<0.001），照顾者的抑郁程度也明显更高（<0.001）。与来自基于学校的试验的参与者相比，诊所参与者更有可能具有计算机/互联网访问权限（<0.001）。与学校相比，急诊室和诊所的参与者更有可能报告使用控制器药物（<0.001）和更高的青少年情感支持（<0.01），但报告使用医疗补助的可能性较低（<0.014）和暴露于环境烟草烟雾的可能性较低（<0.001）。
与基于学校的试验参与者相比，从急诊室和诊所招募的参与者在医疗保健使用方面以及心理社会和社会人口统计学因素方面存在显著差异。这些因素可以为干预内容提供信息，并可能影响哮喘行为干预措施的外部有效性。
