Shen Dequan, Zhang Qinzhun, Tang Jiayu, Wu Jiahui, Huang Hui, Xu Yuchang, He Yinan, He Jialu, Ye Chengyin
Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China.
Department of Clinical Medicine, School of Medicine, Hangzhou City University, Hangzhou, China.
J Med Internet Res. 2025 May 13;27:e72925. doi: 10.2196/72925.
The increasing prevalence of pediatric atopic diseases in China poses substantial risks to children's physical health, mental well-being, and quality of life. Cognitive behavioral interventions for caregivers are effective in managing pediatric atopic diseases. Existing interventions are typically siloed and lack integration across the comorbidities of the atopic march. The protection motivation theory (PMT) could provide an integrated cognitive behavioral intervention framework for addressing shared pathophysiological mechanisms and unifying management strategies across atopic diseases, while online interventions offer advantages in accessibility, cost-effectiveness, and scalability, particularly for caregiver-mediated pediatric care.
This study aimed to develop and evaluate a PMT-based cognitive behavioral online (PMT-CBO) intervention for caregivers of children with atopic diseases, assessing its effects on caregivers' protective motivation, behavioral intentions, preventive practices, and children's atopic disease outcomes.
A quasi-experimental design was conducted in 3 health care institutions in Hangzhou, China, where 2 health care institutions were assigned to the PMT-CBO group (127/243, 52.3%) and 1 health care institution was assigned to the control group (116/243, 47.7%). Caregivers in the PMT-CBO group received a 4-week structured course comprising 16 online modules delivered via a WeChat mini-program, whereas controls received routine care with verbal education. Primary outcomes included caregivers' PMT dimensions (threat appraisal and coping appraisal), behavioral intentions, and preventive behaviors, and secondary outcomes involved children's symptom severity and medication adherence. The primary outcome scales or questionnaires were designed by the research team, while the secondary outcome scales were derived from established studies. All scales demonstrated good reliability and validity. Intention-to-treat analysis was used.
Compared to the control group, the PMT-CBO group demonstrated significant improvements in overall PMT scores (Z=-6.289; P<.001) and most subdimensions (response efficacy, self-efficacy, threat severity, and response cost, with P<.05), except susceptibility (Z=-1.321; P=.19) and reward appraisals (Z=-0.989; P=.32). In the intervention group, caregivers exhibited stronger intentions and partial behavioral optimization (eg, environmental allergen control, with Z=-3.025; P=.002) and children showed improved medication adherence (Z=-4.457; P<.001) and alleviated eczema (Z=-3.112; P=.002) and allergic rhinitis symptoms (Z=-3.277; P<.001), although no significant differences emerged in asthma control (Z=-.830; P=.41) or food allergy-related caregiver burden (Z=-1.693; P=.09).
The PMT-CBO intervention enhanced caregivers' motivation and intentions and children's medication adherence and eczema and rhinitis outcomes, with a 91.3% (116/127) completion rate via WeChat's scalable platform. Limited improvements in asthma control and food allergy management implied the future need for additional condition-specific plug-ins, beyond the core PMT-CBO modules. Moreover, merging this PMT-CBO intervention with implementation techniques or ecological frameworks could help address intention-behavior gaps and external barriers, thereby promoting equitable and precision-based allergy care.
中国儿童过敏性疾病患病率不断上升，对儿童的身体健康、心理健康和生活质量构成了重大风险。针对照料者的认知行为干预对管理儿童过敏性疾病有效。现有的干预措施通常是孤立的，缺乏对过敏性进程合并症的整合。保护动机理论（PMT）可以提供一个综合的认知行为干预框架，以解决过敏性疾病共同的病理生理机制并统一管理策略，而在线干预在可及性、成本效益和可扩展性方面具有优势，特别是对于照料者介导的儿童护理。
本研究旨在为过敏性疾病儿童的照料者开发并评估一种基于保护动机理论的认知行为在线（PMT-CBO）干预措施，评估其对照料者的保护动机、行为意图、预防行为以及儿童过敏性疾病结局的影响。
在中国杭州的3家医疗机构进行了一项准实验设计，其中2家医疗机构被分配到PMT-CBO组（127/243，52.3%），1家医疗机构被分配到对照组（116/243，47.7%）。PMT-CBO组的照料者接受了一个为期4周的结构化课程，包括通过微信小程序提供的16个在线模块，而对照组接受常规护理和口头教育。主要结局包括照料者的PMT维度（威胁评估和应对评估）、行为意图和预防行为，次要结局包括儿童的症状严重程度和药物依从性。主要结局量表或问卷由研究团队设计，次要结局量表来自已有的研究。所有量表均显示出良好的信度和效度。采用意向性分析。
与对照组相比，PMT-CBO组在总体PMT评分（Z=-6.289；P<.001）和大多数子维度（反应效能、自我效能、威胁严重性和反应成本，P<.05）上有显著改善，但易感性（Z=-1.321；P=.19）和奖励评估（Z=-0.989；P=.32）除外。在干预组中，照料者表现出更强的意图和部分行为优化（如环境过敏原控制，Z=-3.025；P=.002），儿童的药物依从性得到改善（Z=-4.457；P<.001），湿疹（Z=-3.112；P=.002）和过敏性鼻炎症状减轻（Z=-3.277；P<.001），尽管哮喘控制（Z=-.830；P=.41）或食物过敏相关的照料者负担（Z=-1.693；P=.09）没有显著差异。
PMT-CBO干预增强了照料者的动机和意图以及儿童的药物依从性和湿疹及鼻炎结局，通过微信可扩展平台的完成率为91.3%（116/127）。哮喘控制和食物过敏管理方面的改善有限，这意味着除了核心的PMT-CBO模块外，未来还需要额外的针对特定疾病的插件。此外，将这种PMT-CBO干预与实施技术或生态框架相结合，可能有助于解决意图-行为差距和外部障碍，从而促进公平和基于精准的过敏护理。
