Mosler Gioia, Harris Katherine, Grigg Jonathan, Steed Liz
Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK.
Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, 58 Turner St, London, E1 2AB UK.
Pilot Feasibility Stud. 2020 Sep 2;6:122. doi: 10.1186/s40814-020-00670-6. eCollection 2020.
Asthma control in adolescents is low with half of the young people in a London study identified as having suboptimal control when measured using the Asthma Control Test. Control of asthma symptoms can be improved by addressing barriers to good self-management, such as poor understanding of asthma and adherence to medication. The aim of this study was therefore to develop the My Asthma in School (MAIS) intervention for the improvement of asthma control and self-management in adolescents and to test its initial feasibility. The intervention intended to combine a strong focus on theory with a design specifically aimed to engage adolescents.
The intervention development was based on previous qualitative and quantitative findings, and on guidelines from the Medical Research Council for the development of complex interventions. The COM-B (Capability, Opportunity, Motivation-Behaviour) model was applied to inform the design of intervention elements. Behavioural targets were identified from existing barriers to good asthma self-management and were then used to guide the development of engaging intervention elements, which were described using the Behavioural Change Technique (BCT) Taxonomy version 1. Adolescents were involved throughout this process. The MAIS intervention was tested in a feasibility phase in London secondary schools with adolescents aged between 11 and 13.
The complex school-based MAIS intervention comprised a first school visit from a theatre group, who conducted a workshop with all year 7-8 students and addressed peer understanding and attitudes to asthma. The second visit included four self-management workshops for adolescents with asthma, including games, short-films and role play activities. Forty different types of techniques to change behaviour were applied, totalling 163 instances of BCT use across intervention elements, addressing all areas of capability, opportunity and motivation. In this initial feasibility study, 1814 adolescents with and without asthma from nine schools received the theatre intervention visit; 23 adolescents with asthma from one of the schools attended the workshop visit. The intervention was found acceptable and engaging, and 91.4% of participants agreed that the workshops changed how they think or feel about asthma.
This study demonstrates development and initial feasibility of a complex theory-based intervention, and how it can combine engaging media and interactive elements, to achieve a multi-directional approach to behavioural change. However more work is needed to assess the feasibility of trial processes, including recruitment and delivery format of the workshops.
青少年哮喘控制水平较低，在伦敦的一项研究中，使用哮喘控制测试进行测量时，有一半的年轻人被认定为控制不佳。通过消除良好自我管理的障碍，如对哮喘的理解不足和药物依从性差等，可以改善哮喘症状的控制。因此，本研究的目的是开发“学校中的我的哮喘”（MAIS）干预措施，以改善青少年的哮喘控制和自我管理，并测试其初步可行性。该干预措施旨在将对理论的高度关注与专门针对青少年的设计相结合。
干预措施的开发基于先前的定性和定量研究结果，以及医学研究理事会关于复杂干预措施开发的指南。应用COM-B（能力、机会、动机-行为）模型为干预要素的设计提供信息。从良好哮喘自我管理的现有障碍中确定行为目标，然后用于指导引人入胜的干预要素的开发，这些要素使用行为改变技术（BCT）分类法第1版进行描述。青少年全程参与了这一过程。MAIS干预措施在伦敦的中学进行了可行性阶段测试，参与的青少年年龄在11至13岁之间。
基于学校的复杂MAIS干预措施包括剧院团体的首次学校访问，他们与所有7-8年级的学生举办了一个工作坊，并探讨了同龄人对哮喘的理解和态度。第二次访问包括为患有哮喘的青少年举办的四个自我管理工作坊，包括游戏、短片和角色扮演活动。应用了40种不同类型的行为改变技术，干预要素中总共使用了163次BCT，涉及能力、机会和动机的所有领域。在这项初步可行性研究中，来自九所学校的1814名有和没有哮喘的青少年接受了剧院干预访问；来自其中一所学校的23名患有哮喘的青少年参加了工作坊访问。该干预措施被认为是可接受且引人入胜的，91.4%的参与者同意这些工作坊改变了他们对哮喘的看法或感受。
本研究展示了一种基于理论的复杂干预措施的开发及其初步可行性，以及它如何能够结合引人入胜的媒体和互动元素，实现行为改变的多方向方法。然而，需要更多工作来评估试验过程的可行性，包括工作坊的招募和实施形式。
